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      Club drugs: review of the ‘rave’ with a note of concern for the Indian scenario

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          Abstract

          ‘Club drugs’ which include Ecstasy, gamma-hydroxybutyrate (GHB), ketamine, and Rohypnol (flunitrazepam) have become popular with participants in ‘raves’, because they are perceived to enhance energy, endurance, sociability and sexual arousal. These drugs vary in their pharmacologic properties, physiological and psychological effects, and potential consequences. The use of club drugs by young people has increased in the last decade, and continue to get modified and evolve, making them very difficult to monitor. Further, these drugs are not picked up by routine drugs screening procedures, thereby making these popular with the criminals. India, which is in a phase of social transition, also faces this rising menace. Despite the nature and extent of this problem, this area has been under-researched. Data from India are sparse barring a few newspaper and police reports. Keeping abreast of current trends in club drug use prepares the clinician to recognize the clinical effects of club drug use, to manage club drug related emergencies, and to generate social awareness.

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          Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") are attenuated by the serotonin uptake inhibitor citalopram.

          F Vollenweider, Reto Gamma, Kenneth Liechti … (2000)
          3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy") is a recreational drug that has been shown to release serotonin (5-HT) and dopamine (DA) in animals. The effect of MDMA on 5-HT release can be blocked by 5-HT uptake inhibitors such as citalopram, suggesting that MDMA interacts with the 5-HT uptake site. It is unknown whether this mechanism is also responsible for the psychological effects of MDMA in humans. We investigated the effect of citalopram pretreatment (40 mg iv) on the psychological effects of MDMA (1.5 mg/kg po) in a double-blind placebo-controlled psychometric study in 16 healthy human volunteers. MDMA produced an emotional state with heightened mood, increased self-confidence and extroversion, moderate derealization, and an intensification of sensory perception. Most of these effects were markedly reduced by citalopram. This finding suggests that the psychological effects of MDMA are mediated via action at the 5-HT uptake site to increase 5-HT release through the carrier, as expected from animal studies.
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            A review of the nonmedical use of ketamine: use, users and consequences.

            K Jansen (2015)
            Ketamine is a dissociative anesthetic with an accepted place in human medicine. Ketamine also has psychedelic properties, and there has been a recent increase in nonmedical use linked with the growth of the "dance culture." This has attracted little comment in the formal literature but has been the subject of many reports in the media. Myths and misunderstandings are common. The psychedelic properties of ketamine have also led to its use as an adjunct to psychotherapy. This review is intended as a resource for the wide range of persons now requesting accurate information about the nonmedical use of ketamine. It accepts the current necessity of sometimes referring to anecdotal reports while seeking to encourage an increase in formal research. The review includes the history of ketamine, its growing role as a "dance drug," the sought-after effects (including the near-death experience) for which it is taken in a nonmedical context, how these are produced, common mental and physical adverse effects, and the ketamine model of schizophrenia.
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              A method of conducting therapeutic sessions with MDMA.

              George R Greer, Requa Tolbert (1998)
              A method for preparing clients and conducting therapeutic sessions with 3,4-methylenedioxymethamphetamine (MDMA) is described, with emphasis on the need for careful attention to the mental set of therapists and clients and the setting of the session. The therapists' belief was that MDMA inhibited the fear response to a perceived emotional threat, allowing the client to place the emotional sequelae of past experiences into a more realistic perspective in their current emotional lives and relationships. Clients were carefully screened and prepared until they had a clear purpose for the session, including a willingness to experience and to learn from anything that might happen. Sympathomimetic effects of MDMA determined the medical contraindications, and clients with histories of serious functional psychiatric impairments were excluded. Total doses of 75-150 mg, plus 50 mg if requested later, were administered, followed by clients lying down and listening to music with eyeshades and headphones during the peak MDMA effect. Screening and follow-up questionnaires were utilized. Two case histories are presented: a man achieving relief of pain from multiple myeloma, and a woman finding relief from problems as the daughter of Holocaust survivors. Use of consciousness-altering drugs in other contexts is discussed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Med Res
                Journal ID (publisher-id): IJMR
                Title: The Indian Journal of Medical Research
                Publisher: Medknow Publications (India )
                ISSN (Print): 0971-5916
                Publication date (Print): June 2011
                Volume: 133
                Issue: 6
                Pages: 594-604
                Affiliations
                [1] Drug De-addiction & Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
                Author notes
                Reprint requests: Dr Debasish Basu, Professor of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India e-mail: db_sm2002@ 123456yahoo.com
                Article
                Publisher ID: IJMR-133-594
                PMC ID: 3135986
                PubMed ID: 21727657
                SO-VID: 4413924b-6e5b-4630-b3a3-fcb6a1b23a42
                Copyright © Copyright: © The Indian Journal of Medical Research
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 February 2010
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Medicine
                Keywords: rohypnol,club drugs,rave drugs,gamma-hydroxybutyrate,ketamine,ecstasy
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: rohypnol, club drugs, rave drugs, gamma-hydroxybutyrate, ketamine, ecstasy

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