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Club drugs is a term that encompasses those drugs commonly abused within the context of the club and rave scenes which have developed over the past decade in the United States and Europe. Club drugs are a diverse group in terms of pharmacology, psychological effect, and toxicity. They form a unified grouping because of the context in which they are used, the clubs and raves that define turn-of-the-century youth culture. Because of the diversity and pleasure seeking inherent to the club world, no list of club drugs can pretend to be comprehensive but most lists include drugs like MDMA, GHB, KETAMINE, ROHYPNOL, METHAMPHETAMINE and LSD. Most of these drugs are perceived by users as relatively benign compared to "older" drugs like COCAINE. As might be expected, this perception is often not borne out in reality.

Many observers of the history of drug use in the United States have noted the cyclical nature of patterns of drug use. Few today recall that the cocaine epidemic of the 1980s was in fact the second cocaine epidemic in this century, the previous one having ended in the 1930s. Indeed, the lack of a cultural memory of the lessons of the previous epidemic no doubt played a role in the reemergence of the belief that cocaine was a "safe drug" in the 1960s and 70s, a belief that had been popular in the early 1900's until certain less palatable realities began to sink in. Club drugs seem to fit this pattern insofar as the lack of direct experience with the negative consequences of their use (MDMA for instance was not recreationally used before the 1980s) imparts the belief that they are a safe means of entertainment. History suggests that such a view is unlikely to stand the test of time.

MDMA is new as psychoactive drugs go; it only emerged as a recreational drug in the mid-1980s. It is an AMPHETAMINE derived HALLUCINOGEN, sometimes described as an empathogen or entactogen due to the enhanced feelings of emotional and physical closeness to others it generates in many users. Although it has a reputation as a benign "love drug," MDMA has contributed to hundreds of deaths in its short time as an abused drug. It has been linked to seizures as well as kidney and cardiovascular failure. MDMA has produced long-term neurotoxicity in animals and a number of frequent human users have exhibited cognitive and emotional deficits.

Both rohypnol and GHB have gained notoriety as "date-rape" drugs due to their criminally abused propensity for impairing memory and inducing unconsciousness. Again, both are fairly new to the world of recreational drug use, although rohypnol belongs to the same class of drugs, the BENZODIAZEPINES, as VALIUM, a drug with a well known history of abuse. These drugs are especially dangerous when used with ALCOHOL, which exacerbates their depressant effects often leading to stupor, respiratory depression, and in some cases coma and death. Like alcohol, GHB and rohypnol seem to cause an increase in violent behavior in some users. These drugs have been linked to such a disproportionate number of negative events that many countries have opted to increase restrictions on their use.

Methamphetamine is an exception to the rule that club drugs are new; it has a long and well-documented history of abuse and toxic effects. Its appearance on the club scene seems to be linked to its low cost and the present negative perception of cocaine as an alternative PSYCHOSTIMULANT. Methamphetamine is substantially more toxic to the brain and liver than cocaine, while sharing some of cocaine's potentially lethal effects on the cardiovascular system. Amphetamine use has also been linked to toxic psychosis.

Ketamine is a dissociative anesthetic formerly used in humans but now largely restricted to veterinary use. Ketamine shares its major site of action with PHENCYCLIDINE (PCP) and, like the latter drug, can produce many of the symptoms of psychosis in humans including hallucinations and indifference to pain or death. Given that chronic PCP use has been associated with the development of long-term psychosis, it seems likely that this may prove to be a risk with ketamine as well. Ketamine is thought to have few other toxic effects.

LSD is another drug with a well-known history of misuse and abuse. Its major dangers lie in its hallucinogenic properties, which may cause users to physically harm themselves or others. LSD also seems to aggravate depression and psychosis. Outside of its intense psychological effects LSD has few, if any, physiological side effects even when taken at doses well in excess of those used recreationally.

Club drugs are hardly risk-free, and the next decade or so will probably provide the public with more evidence of their dangers. A particularly risky and difficult-to-analyze aspect of the club drug phenomena is that most club drug users use several of these drugs as well as TOBACCO and alcohol. With such a variety of drugs being abused by individual users, toxic and other dangerous results are far more likely to occur and less predictable in terms of long-term consequences.