X, Liquid E, and Special K - The Abuse of Drugs at Clubs and Raves

PROLOGUE Clinical toxicology is a topic instructed at some level in most colleges of pharmacy. Traditionally, instruction involves an array of commonly encountered toxic ingestions that might include: acetaminophen, tricyclic antidepressants, and benzodiazepines. Recently, an emerging group of chemicals known as “club drugs” have become increasingly popular substances of abuse. Commonly cited in the lay press, club drugs have become especially popular across college campuses in the United States(1). Methylenedioxymethamphetamine (e.g., MDMA, ecstasy) has been reported to be the fastest growing abused drug in the US(1). In 2000, 1.3 million high school seniors consumed MDMA, while approximately 450,000 admitted to being current users(2). The Community Epidemiology Working Group (CEWG) reported the spread of MDMA use to 17 of 21 metropolitan areas assessed, with use expanding to a variety of settings including house parties(3). Of patients aged 14 to 24 enrolled in a recovery program in Seattle, 44 percent had used ecstasy, while 43 percent of those older than 25 years had also done so. Based on trends identified by CEWG, the National Institute on Drug Abuse (NIDA) launched a multimedia campaign to address emerging club drug use trends in 2000. To assess club drug knowledge, we conducted a survey of baseline club drug knowledge amongst third year professional students at the University of Kentucky College of Pharmacy. Seventy-two of seventy-eight students completed the survey for a response rate of 92 percent. When asked to describe a club drug, only six percent of students were able to correctly identify these substances as agents used to enhance social interactions and reduce inhibitions within party and club settings. Only 50 percent of respondents could correctly identify the most common age group and socioeconomic status of club drug users. When questioned specifically about individual agents, 53 percent of respondents correctly identified at least two clinical effects of MDMA, 57 percent of respondents correctly identified two clinical effects of gammahydroxybutyrate (GHB), and 14 percent of respondents correctly identified two clinical effects of ketamine. In general even fewer students could accurately describe management strategies for club drug ingestions. Six percent of students could correctly identify one management strategy for MDMA ingestion, 68 percent for GHB ingestion, and 10 percent for ketamine. In response to statistics reflecting the increasing abuse of club drugs and considering the low level of knowledge amongst both pharmacy students and pharmacists regarding the clinical effects and management strategies for club drug ingestions, a “Club Drug Module” was designed for instruction to third year professional students. Information provided to students included drug sources, clinical presentation, pharmacology, and therapeutic management strategies. The module also incorporates a presentation regarding preventative efforts provided by a state law enforcement official.