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`NIDA Community Drug Alert Bulletin - Club Drugs
`
`Dear Colleague;
`
`In recent years, a number of our Nation's best monitoring mechanisms have
`detected alarming increases in the popularity of some dangerous substances
`known collectively as "club drugs." These drugs are often used by young adults at
`all-night dance parties, such as "raves" or "trances," dance clubs, and bars. But in
`the past few years, these drugs have been found increasingly in more mainstream
`settings.
`
`"Club drug" is a vague term that refers to a wide variety of drugs including MDMA
`(Ecstasy), GHB, Rohypnol, ketamine, methamphetamine, and LSD. Uncertainties
`about the drug sources, pharmacological agents, chemicals used to manufacture
`them, and possible contaminants make it difficult to determine toxicity,
`consequences, and symptoms. However, the information in this bulletin is based
`on scientifically sound data regarding the use of these drugs.
`
`Data on students reported through the NIDA-sponsored 2003 Monitoring the
`Future (MTF) study showed declines in use of MDMA and LSD. The use of
`methamphetamine, Rohypnol, ketamine, and GHB remained unchanged and these
`drugs continue to present a threat to our communities. NIDA-supported research
`has shown that use of club drugs can cause serious health problems and, in some
`cases, even death. Used in combination with alcohol, these drugs can be even
`more dangerous. In recent years, there has been an increase in reports of club
`drugs used to commit sexual assaults - yet another reason NIDA is alerting you to
`these trends. Thus, we are issuing this updated alert to aid communities in their
`information gathering activities.
`
`What follows is an overview of the scientific data on several of the most prevalent
`club drugs. Because many of the drug use trends are still emerging, some of the
`data presented here are preliminary. However, we feel obliged to share what we
`know now to help you and your community as you anticipate or respond to club
`drug-related problems. We also will increase our research efforts on the effects of
`club drugs and will facilitate the development of treatment and prevention
`strategies targeted to the populations that abuse club drugs.
`
`As new research emerges, NIDA will continue to disseminate findings to you
`quickly. To this end, we have established a Web site to provide scientific
`information about club drugs - www.clubdrugs.gov. We hope this information will
`be helpful as you combat drug use in your own community.
`
`Sincerely,
`
`Nora D. Volkow, M.D.
`Director
`
`Some Facts About Club Drugs
`
`Methylenedioxymethamphetamine (MDMA)
`
`Slang or Street Names: Ecstasy, XTC, X, Adam, Clarity, Lover's Speed
`
`http://archives.drugabuse.gov/ClubAlert/clubdrugalert.html
`
`CDAB Home
`
`Facts About Club Drugs
`
`(cid:1) MDMA (Ecstasy)
`
`(cid:1) GHB
`
`(cid:1) Ketamine
`
`(cid:1) Rohypnol
`
`(cid:1) Methamphetamine
`
`(cid:1) LSD
`
`More information on Club
`Drugs
`
`clubdrugs.gov Web Site
`
`Uncertainties about
`the sources,
`chemicals, and
`possible contaminants
`used to manufacture
`many club drugs,
`make it extremely
`difficult to determine
`toxicity and resulting
`medical consequences.
`
`JAZZ EXHIBIT 2004
`Amneal Pharms. et al. (Petitioners) v. Jazz Pharms., Inc. (Patent Owner)
`Case IPR2015-00554
`
`Page 1 of 5
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`Chemically, MDMA is similar to the stimulant amphetamine and the hallucinogen
`mescaline. MDMA can produce both stimulant and mild sensory-altering effects.
`
`(cid:1) Methylenedioxyamphetamine (MDA), methylenedioxyethylamphetamine
`(MDEA), and paramethoxyamphetamine (PMA) are chemically similar to MDMA,
`are sometimes found in ecstasy tablets, and can produce deleterious health
`effects.
`
`(cid:1) MDMA is usually taken orally, via a tablet or capsule. Its effects last
`approximately 3 to 6 hours, though depression, sleep problems, and anxiety
`have been reported for days to weeks afterwards.
`
`(cid:1) MDMA can produce a significant increase in heart rate and blood pressure and a
`sense of alertness similar to that associated with amphetamine use.
`
`(cid:1) MDMA can cause a marked increase in body temperature (hyperthermia),
`which may further be exacerbated by hot and crowded conditions characteristic
`of the rave environment. Hyperthermia can lead to liver, kidney, and
`cardiovascular system failure. MDMA can interfere with its own metabolism
`(breakdown), so repeated use over a short interval of time can lead to
`especially harmful levels in the body.
`
`(cid:1) MDMA users can become dehydrated, prompting increased water consumption.
`In some cases, this has led to the problem of "water intoxication" or
`hyponatremia, a potentially fatal condition in which excessive water
`consumption causes a dramatic decrease in electrolytes. MDMA can affect the
`hormone that regulates the amount of sodium in the blood, which can also
`cause hyponatremia.
`
`(cid:1) In animal studies, repeated administration of MDMA was found to produce
`long-lasting, perhaps permanent, damage to the neurons that release
`serotonin. In humans, chronic use of MDMA has been associated with memory
`impairment, which may indicate damage to the parts of the brain involved in
`memory processing.
`
`(cid:1) Recent animal studies have shown that binge use of MDMA is toxic to the
`heart. Health effects observed included arrhythmia, heart muscle damage, and
`reductions in heart rate and blood pressure. (Initially, MDMA increases heart
`rate and blood pressure, but following repeated use, this effect is reversed.)
`
`(cid:1) Newborn rats exposed to MDMA develop impairments of spatial learning and
`memory that are seen when the rats become young adults. The newborn stage
`of rodent brain development is analogous to late third trimester in humans.
`
`(cid:1) NIDA's 2003 Monitoring the Future (MTF) study reported that 2.1 percent of
`8th-graders, 3.0 percent of 10th-graders, and 4.5 percent of 12th-graders had
`used MDMA in the 12 months prior to the survey. This is a decrease from 2001
`peak rates of 3.5, 6.2, and 9.2 percent, respectively.
`
`*MDMA abuse has been reported across the country, including most of the 21 areas
`that are monitored by NIDA's Community Epidemiology Work Group (CEWG), a
`network of researchers that provide ongoing community-level surveillance of drug
`abuse. CEWG cities in which MDMA use has been reported include: Chicago, Denver,
`Miami, Atlanta, New Orleans, San Francisco, Austin, Seattle, Boston, Detroit, New
`York, St. Louis, Dallas, Baltimore, Los Angeles, Minneapolis/St. Paul, Newark,
`Philadelphia, and Washington, DC.
`
`Gamma-hydroxybutyrate (GHB)
`
`Slang or Street Names: Grievous Bodily Harm, G, Liquid Ecstasy, Georgia Home
`Boy
`
`GHB can be produced in clear liquid, white powder, tablet, and capsule forms, and it
`is often used in combination with alcohol, making it even more hazardous. GHB has
`been increasingly involved in poisonings, overdoses, drug-facilitated sexual assaults
`(such as "date rapes"), and fatalities. The drug is used predominantly by adolescents
`and young adults - often when they attend nightclubs and raves - and is prominent in
`many gay male communities.
`
`(cid:1) GHB is usually abused either for its intoxicating/sedating/euphoria-inducing
`properties or for its growth hormone-releasing effects.
`
`(cid:1) Chemicals that can be converted by the body into GHB include gamma-
`butyrolactone (GBL) and 1,4- butanediol (BD), which are found in a number of
`products that are labeled as cleaning agents and are often sold over the
`Internet and in retail stores.
`
`http://archives.drugabuse.gov/ClubAlert/clubdrugalert.html
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`(cid:1) GHB is a central nervous system depressant and its intoxicating effects begin
`10 to 20 minutes after the drug is taken. The effects typically last up to 4
`hours, depending on the dosage. At higher doses, GHB's sedative effects may
`result in sleep, coma, or death.
`
`(cid:1) GHB is cleared from the body relatively quickly (in approximately 2 hours).
`There are no GHB detection tests for use in emergency rooms and many
`clinicians are unfamiliar with it, so many GHB incidents go undetected.
`
`(cid:1) In July 2002, the Food and Drug Administration approved the medically
`supervised use of GHB for the treatment of cataplexy (episodes in which
`muscles suddenly go limp) associated with narcolepsy.
`
`*CEWG cities in which GHB abuse has been reported include: Detroit, Phoenix,
`Honolulu, Miami, New York, Atlanta, Minneapolis/St. Paul, Dallas, Seattle, San
`Francisco, San Diego, New Orleans, Newark, Los Angeles, Baltimore, Boston, and
`Denver.
`
`Ketamine
`
`Slang or Street Names: Special K, K, Vitamin K, Cat Valium
`
`Ketamine is an anesthetic that can be injected, snorted, or smoked. It has been
`approved for both human and animal use in medical settings since 1970. About 90
`percent of the ketamine sold legally today is intended for veterinary use.
`
`(cid:1) Large doses cause reactions similar to those associated with use of
`phencyclidine (PCP), such as dream-like states and altered perceptions or
`hallucinations.
`
`(cid:1) Ketamine is produced in liquid form or as a white powder that is often snorted
`or smoked with marijuana or tobacco products. In some cities (Boston, New
`Orleans, and Minneapolis/St. Paul, for example), ketamine has been reported
`to be injected intramuscularly.
`
`(cid:1) Low-dose intoxication from ketamine results in impaired attention, learning
`ability, and memory.
`
`(cid:1) At higher doses, ketamine can cause delirium, amnesia, impaired motor
`function, high blood pressure, depression, and potentially fatal respiratory
`problems.
`
`*CEWG cities in which ketamine abuse has been reported include: Seattle, Miami,
`New York, Chicago, Minneapolis/St. Paul, Newark, Boston, Detroit, New Orleans, and
`San Diego.
`
`Rohypnol
`
`Slang or Street Names: Roofies, Rophies, Roche, Forget-me Pill
`
`Rohypnol (flunitrazepam) belongs to the class of drugs known as benzodiazepines
`(which include Valium, Halcion, Xanax, and Versed). It is not approved for
`prescription use in the United States, although it is used in many countries as a
`treatment for insomnia, as a sedative, and as a presurgery anesthetic.
`
`(cid:1) Rohypnol is tasteless and odorless, and it dissolves easily in carbonated
`beverages. The sedative and toxic effects of Rohypnol are aggravated by
`concurrent use of alcohol. Even without alcohol, a dose of Rohypnol as small as
`1 mg can impair a user for 8 to 12 hours.
`
`(cid:1) Rohypnol is usually taken orally, although there are reports that it can be
`ground up and snorted.
`
`(cid:1) The drug can cause profound "anterograde amnesia;" that is, individuals may
`not remember events they experienced while under the effects of the drug.
`Reportedly, it has been used in sexual assaults.
`
`(cid:1) Other adverse effects associated with Rohypnol include decreased blood
`pressure, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal
`disturbances, and urinary retention.
`
`*CEWG areas in which Rohypnol abuse has been reported include: Miami, Houston,
`and sites along the Texas-Mexico border.
`
`http://archives.drugabuse.gov/ClubAlert/clubdrugalert.html
`
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`Methamphetamine
`
`Slang or Street Names: Speed, Ice, Chalk, Meth, Crystal, Crank, Fire, Glass
`
`Methamphetamine is a toxic, addictive stimulant that affects many areas of the
`central nervous system. The drug is often made in clandestine laboratories from
`relatively inexpensive over-the-counter ingredients. It is used by diverse groups,
`including clubgoers, in some areas of the country. Methamphetamine has been
`available in western and southwestern regions of the country for several years, but
`appears to be increasingly available in other regions.
`
`(cid:1) Methamphetamine can be smoked, snorted, injected, or ingested orally. It is a
`white, odorless, bitter-tasting crystalline powder that dissolves easily in
`beverages.
`
`(cid:1) Methamphetamine is typically sold through networks; not on the street like
`many other illicit drugs.
`
`(cid:1) Methamphetamine abuse is associated with serious health consequences,
`including memory loss, aggression, violence, psychotic behavior, and cardiac
`and neurological damage.
`
`(cid:1) Methamphetamine abusers typically display signs of agitation, excited speech,
`decreased appetite, and increased physical activity levels.
`
`(cid:1) Methamphetamine is neurotoxic. Abusers may suffer significant reductions in
`dopamine transporters and receptors.
`
`(cid:1) Methamphetamine abuse can contribute to higher rates of infectious disease
`transmission, especially hepatitis and HIV/AIDS.
`
`(cid:1) NIDA's 2003 MTF study found that 3.2 percent of 12th-graders, 3.3 percent of
`10th-graders, and 2.5 percent of 8th-graders had used methamphetamine
`within the past year.
`
`*CEWG cities in which methamphetamine abuse has been reported include: San
`Diego, San Francisco, Phoenix, Atlanta, St. Louis, Denver, Honolulu, Los Angeles,
`Minneapolis/St. Paul, Philadelphia, Boston, Seattle, and Dallas. Methamphetamine
`abuse has also been reported in many rural areas of the country.
`
`Lysergic Acid Diethylamide (LSD)
`
`Slang or Street Names: Acid, Boomers, Yellow Sunshines
`
`LSD is a hallucinogen, inducing abnormalities in sensory perceptions. The effects of
`LSD are unpredictable depending on the amount taken, on the surroundings in which
`the drug is used, and on the user's personality, mood, and expectations.
`
`(cid:1) LSD is typically taken by mouth. It is sold in tablet, capsule, and liquid forms,
`as well as on pieces of blotter paper that have absorbed the drug.
`
`(cid:1) Typically, an LSD user feels the effects of the drug 30 to 90 minutes after
`taking it. The physical effects include dilated pupils, elevated body
`temperature, increased heart rate and blood pressure, sweating, loss of
`appetite, sleeplessness, dry mouth, and tremors.
`
`(cid:1) LSD users frequently report numbness, weakness, trembling, and nausea.
`
`(cid:1) There are two long-term disorders associated with LSD?persistent psychosis
`and hallucinogen persisting perception disorder (which used to be called
`"flashbacks").
`
`(cid:1) NIDA's MTF survey data found that LSD use has decreased significantly among
`10th- and 12thgraders over the past few years. In 2003, past year use reached
`the lowest levels in the history of the survey: 1.3 percent of 8th-graders, 1.7
`percent of 10th-graders, and 1.9 percent of 12th-graders reported past year
`use of LSD.
`
`*CEWG cities in which LSD abuse has been reported include: Boston, Detroit, Seattle,
`Chicago, Denver, New Orleans, San Francisco, Atlanta, and Phoenix.
`
`* Information from NIDA's Community Epidemiology Work Group (CEWG), a network
`of epidemiologists and researchers from 21 U.S. metropolitan areas who monitor drug
`
`http://archives.drugabuse.gov/ClubAlert/clubdrugalert.html
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`use trends.
`
`These publications may be reprinted without permission.
`
`NIDA Community Alert Bulletin on Club Drugs was published in December, 1999, and
`updated May, 2004
`
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`_
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`http://archives.drugabuse.gov/ClubAlert/clubdrugalert.html
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