Effects of ghb and rohypnol

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A more recent article on primary care management of stimulant and deer drug is available. PAUL M. Patient Information Handout. Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymetham-phetamine MDMAalso known as ecstasy; gamma-hydroxybutyrate GHB ; flunitrazepam Rohypnol ; and ketamine Ketalar.

These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown.

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Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome.

Severe drug reactions can occur even with a small dose and may require critical care. Club drug overdose usually resolves with full recovery within seven hours. Education of the patient and family is essential. Table 1 1 lists the various street names for these agents. Club drugs are favored over other recreational drugs, such as marijuana, lysergic acid diethylamide LSDmethamphetamine, and opiates, because they are believed to enhance social interaction.

MDMA is structurally similar to amphetamine and mescaline, which is a hallucinogen. However, it is not as stimulating or addictive as amphetamine, and is considered much less likely to cause psychosis than LSD and other potent hallucinogens. Ketamine is a Effects of ghb and rohypnol anesthetic that produces a dreamy tranquility and disinhibition in small doses. Unlike opiates, these sedatives encourage sociability and seldom cause nausea. Mexican valium, circles, roofies, la rocha, roche, rophies, R2, rope, forget-me pill. Information from Gahlinger PM. Illegal drugs: a complete guide to their history, chemistry, use and abuse.

New York: Plume, — The popularity of these club drugs is due to their low cost and convenient distribution as small pills, powders, or liquids that can be taken orally. Consequently, these drugs are popular among young persons who have been educated about the hazards of drug injection and the dangers of heroin, cocaine, and methamphetamine. However, most users are unaware that MDMA is a type of methamphetamine, and incorrectly assume that substances that appear as pharmaceuticals are safe to use.

Club drugs often are taken together, with alcohol, or with other drugs to enhance their effect. Often, they are misrepresented, adulterated, or entirely substituted for another substance without the users' Effects of ghb and rohypnol. These actions result in an extraordinarily high risk of unanticipated effects and overdose. One Australian study 7 showed that only 8 percent of club-goers had not consumed any psychoactive substance. MDMA was developed in as an appetite suppressant, but animal tests were unimpressive, and it was never tested in humans. MDMA has become the most common stimulant found in dance clubs and is available at 70 percent of raves.

MDMA ingestion increases the release of serotonin, dopamine, and norepinephrine from presynaptic neurons and prevents their metabolism by inhibiting monoamine oxidase. Effects of an oral dose appear within 30 to 60 minutes and last up to eight hours. Users of MDMA describe initial feelings of agitation, a distorted sense of time, and diminished hunger and thirst, followed by euphoria with a sense of profound insight, intimacy, and well-being. Unpleasant side effects of MDMA include trismus and bruxism, which can be reduced by sucking on a pacifier or lollipop.

Adverse effects of MDMA ingestion result from sympathetic overload and include tachycardia, mydriasis, diaphoresis, tremor, hypertension, 15 arrhythmias, 16 parkinsonism, 17 esophoria tendency for eyes to turn inwardand urinary retention. MDMA ingestion directly causes a rise in antidiuretic hormone. Two days after ingestion of MDMA, users typically experience depression consistent with serotonin depletion, 24 which may be severe. Repeated use of MDMA has been associated with cognitive deficits in animals and humans, with potentially permanent memory impairment. GHB was first synthesized in France in as an anesthetic.

It later achieved popularity as a recreational drug and a nutritional supplement marketed to bodybuilders. Recently, sodium oxybate has been studied as a treatment for alcohol withdrawal. GHB is easily manufactured from industrial chemicals. Internet Web sites offer instructions for home production and sell kits with the requisite materials.

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GHB is chemically related to gamma butyrolactone and 1,4-butanediol, which are metabolized in the body to GHB. Overdose is common because the strength of the solution is often unknown. The unpleasant salty or soapy taste may be masked in flavored or alcoholic beverages. Toxicity is increased if taken with alcohol or other CNS depressants. GHB produces euphoria, progressing with higher doses to dizziness, hypersalivation, hypotonia, and amnesia.

Coma may be interrupted by agitation, with flailing activity described similar to a drowning swimmer fighting for air. Flunitrazepam, marketed as Rohypnol, is a potent benzodiazepine with a rapid onset. Manufactured by Roche Laboratories, it is available in more than 60 countries in Europe and Latin America for preoperative anesthesia, sedation, and treatment of insomnia. In a single 1- or 2-mg dose, Rohypnol reduces anxiety, inhibition, and muscular tension with a potency that is approximately 10 times that of diazepam Valium.

Higher doses produce anterograde amnesia, lack of muscular control, and loss of consciousness. Effects occur about 30 minutes after ingestion, peak at two hours, and may last up to eight to 12 hours. The effects are much greater with the concurrent ingestion of alcohol or other sedating drugs.

Some users experience hypotension, dizziness, confusion, visual disturbances, urinary retention, or aggressive behavior. Like other benzodiazepines, chronic use of Rohypnol can produce dependence.

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The withdrawal syndrome includes headache, tension, anxiety, restlessness, muscle pain, photosensitivity, numbness and tingling of the extremities, and increased seizure potential. Ketamine was derived from phencyclidine PCP in the s for use as a dissociative anesthetic. Ketamine is difficult to manufacture; therefore, most of the illicit supply is diverted from human and veterinary anesthesia products. As a pharmaceutical, ketamine is distributed in a liquid form that can be ingested or injected.

In clubs, it usually has been dried to a powder and is smoked in a mixture of marijuana or tobacco, or is taken intranasally. Effects of ketamine ingestion appear rapidly and last about 30 to 45 minutes, with sensations of floating outside the body, visual hallucinations, and a dream-like state.

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They also may experience tachycardia, palpitations, hypertension, and respiratory depression with apnea. Because club drugs are illicitly obtained and often are adulterated or substituted, they must be considered as unknown substances. In the ever-changing world of illegal drug distribution, Internet Web sites can be helpful in identifying the rapidly changing appearances of these substances Table 2. The immediate concern with the use of club drugs is cardiorespiratory maintenance.

Users often present with multiple drug ingestions, which may include stimulant and depressant drugs e. When the predominant symptoms are controlled, the symptoms of a second underlying drug may surface. Most hallucinogens are CNS stimulants; in overdose, patients may exhibit hyperthermia, hypertension, tachycardia, anxiety, and agitation. The risk of escape or self-injury also should be considered. No standard treatment regimen has been identified for club drug overdose. Basic management should include cardiac monitoring, pulse oximetry, urinalysis, and performance of a comprehensive chemistry panel to check for electrolyte imbalance, renal toxicity, and possible underlying disorders Figure 1.

Precautions should be taken to prevent seizures. Gastrointestinal decontamination with activated charcoal and a cathartic may be useful in acute exposures if the drug was taken orally within the 60 minutes. Otherwise, unless a massive dose was taken, inducing emesis is seldom effective and may increase psychologic distress.

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Hypertension and tachycardia generally will resolve with the management of anxiety or agitation. Severe hypertension can be treated with labetalol Normodynephentolamine Regitinenitroprusside Niprideor similar agents. For agitation, benzodiazepines such as diazepam, lorazepam Ativanor midazolam Versed may be used. Hyperthermia should be treated immediately with tepid water bathing and fanning. One study 53 reported that a single tablet of MDMA resulted in fatal hyperthermia. The use of dantrolene Dantrium is questionable and no longer recommended.

The serotonin antagonists chlorpromazine Thorazine and cyproheptadine Periactin appear to be effective in mild to moderate cases of serotonin syndrome. There are no specific antidotes for ingestion of club drugs, except for Rohypnol, which has the antidote flumazenil. With supportive care, patients usually will recover completely within seven hours. GHB has a rapid elimination, and the drug is cleared within four to six hours after ingestion, regardless of the dose. Intubation should be avoided unless it is absolutely necessary, because patients may become unexpectedly combative or have protracted periods of emesis.

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A benzodiazepine may be given for withdrawal symptoms. For assistance with assay in cases of suspected rape, contact Roche Laboratories —— for a free screening for Rohypnol. Tests for ingestion of ketamine are seldom available, but ketamine may be suspected if a toxicologic test is positive for PCP. Providing the patient and family with educational materials about specific substances may be helpful. These materials are available on many Web sites. Already a member or subscriber?

Log in. Address correspondence to Paul M. Gahlinger, M. Reprints are not available from the author. The author indicates that he does not have any conflicrs of interest.

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Club Drugs (GHB, Ketamine, and Rohypnol)