Although alcohol and marijuana are the most common drugs of abuse by adolescents, there is another class of drugs being used by this age group with increasing frequency, known as "club drugs." Named after the locations of their frequent use (night clubs and raves), club drugs range from stimulants to depressants to hallucinogens.
Commonly used club drug stimulants include 3, 4-methylenedioxymethamphetamine (MDMA), also known as ecstasy, XTC, and X; and methamphetamine, also known as speed, crank, and crystal. MDMA, a selective serotonergic neurotoxin taken orally, also has hallucinogenic properties. Its effects can be felt within 30 minutes of ingestion and last for up to 8hours.Anoverdosecouldresultinsympathetichyperactivity,abnormalbehavior, andfever, whichis the main sourceof themoreseriouscomplications, including acute renal failure, seizures, and coma. Management of MDMA overdose includes a cooling blanket for hyperthermia, adequate control of hypertension, and benzodiazepines for agitation and seizures.
Methamphetamine, the N-methyl homolog of amphetamine, acts by increasingthereleaseofandinhibitingthebreakdownofcatecholamines.Itcan be smoked, snorted, injected, or taken orally, and its rate of effect is directly related to its method of intake. The side effects of methamphetamine relate to its stimulant effect on peripheral alpha-and beta-receptors and include fever, tachypnea, hypertension, insomnia, anorexia, paranoia, and psychosis. Management of amphetamine overdose includes a cooling blanket for hyperthermia,adequatecontrolofhypertension,andhaloperidolforthepsychosis.
Ketamine, gamma-hydroxybutyrate (GHB), and flunitrazepam comprise the commonly used club drug depressants. Flunitrazepam—whose brand name is Rohypnol and whose street names include roofies, Mexican valium, and the forget-me-pill—has the same anxiolytic, sedative, and antiepileptic effects as other benzodiazepines. Because it is a depressant, its side effects include hypotension, drowsiness, confusion, and dizziness. Due to its disinhibitive and amnestic effects, flunitrazepam is also known as a "date rape" drug.
GHB, another central nervous system depressant, is also called liquid ecstasy,soap,andgoop.Availableinmultipleforms,includingliquid,powder, and tablet, it can be easily made at home with instructions from the Internet. With its effects of euphoria and intoxication, it has also gained the classification as a "date rape" drug. Adverse effects can range from drowsiness and nausea to respiratory depression, seizure, and coma. Fortunately, GHB has a short duration of effect, with an onset of action of 10 to 20 minutes and a total effect time of up to 4 hours.
With its induction of dreamlike states, ketamine also falls within the depressant and "date rape" drug category. Also known as special K, vitamin K,andcatvalium,ketaminecancauseamnesiaatlowerdosesanddepression, hypertension, and respiratory depression at higher doses.
Club drug hallucinogens, in addition to MDMA, include d-lysergic acid (or lysergic acid diethylamide, LSD) and phencyclidine (PCP). LSD, derivedfrommorninggloryseeds,mayalsobecalledacid,dotes,andsugar.In addition to the hallucinations for which it is known, LSD can also engender a feeling of euphoria. Management of a negative LSD reaction includes a calm interaction with the patient as well as haloperidol for extreme reactions and seizures.
Phencyclidine,alsoknownasangeldust,supergrass,andwack,produces itshallucinogeniceffectsbyinhibitingthereuptakeofcatecholamines.Severe adverse effects of PCP include hypertension, hypotension, hypothermia, seizures, and delirium. Management of a negative PCP reaction includes putting the patient in a calm, dark, padded room while the drug effects dissipate. Haloperidol and diazepam can be used to treat the seizures and the delirium.
Greydanus DE, Patel DR. Substance abuse in adolescents: a complex conundrum for the
clinician. Pediatr Clin North Am. 2003;50:1179–1223.
Rimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am.
2005;52:307–319.
Review other book chapters online related to Niacin overdose:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6 
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