Club Drugs & Ecstasy "Though some researchers have indicated club drug users are more likely to be poly-drug users, there remains little known about the prevalence and specific combinations of the substances they use…" (Grov, et al., 2009, p. 848).

The use of club drugs in the United States has been a problem for healthcare agencies and law enforcement for many years. The focus of research on the use of club drugs (notably ecstasy) in most articles is on "rave" events, where loud music and drug use is typical. This paper reviews and critiques the literature related to the use and abuse of club drugs.

The Literature on Club Drugs and the Issues Associated with Club Drug Usage

How extreme is club drug use in Chicago? A profile of adult club drug use was measured by Michael Fendrich and colleagues and published in the peer-reviewed journal Addiction (Fendrich, et al., 2003, p. 1693). What this team found, by surveying 627 "randomly selected adult participants," is that use of Methylenedioxymethamphetamine (MDMA) -- also known as ecstasy -- was combined with "…multiple illicit substances" (Fendrich, 1693). About twice as many of the 627 participants had used ecstasy combined with other drugs as those that were just taking ecstasy.

This survey was conducted because the use of club drugs has not been fully explored, and moreover, there have not been studies of "local trends," the authors explain (1694). Also the study was important because most research done on club drugs tend to focus only on "MDMA and LSD, virtually ignoring other drugs" that are part of the club scene (such as ketamine and GHB) (Fendrich, 1694). A third reason for this article is that big national surveys on the topic have not delved into "…the details and context of club drug use," offering little information about the "frequency of ingestion of these substances" (Fendrich, 1694).

The area that should receive more research attention is the relationship between the uses of club drugs and "high-risk sexual behavior," Fendrich continues. The results of this survey show that the most often used club drug among the Chicago participants was LSD (16.7% said they used LSD); next in line was MDMA / ecstasy (9.6%); and methamphetamine was the third most used club drug in Chicago (6.7%) (Fendrich, 1696). About 36% of the 627 respondents reported using ecstasy at least ten times, Fendrich continues (1697), and about half of the 627 individuals reported having used a club drug at a rave.

How dangerous is the use of ecstasy in a concert-related event called a rave? A rave is an all-night dance party with electronic music, an elaborate laser light show, and when thousands of people are expected the promoters position ambulances nearby because it is known that people use club drugs in unsafe ways. The Centers for Disease Control and Prevention (CDC) publish a "Morbidity and Mortality Weekly Report," and on June 11, 2010, the report showed that as a result of a New Year's Eve rave in Los Angeles, 18 individuals were taken to emergency departments in Los Angeles hospitals. Of those 18 (ages between 16 and 34 years) nine were female and all were treated for "MDMA-related illness within 12 hours of the rave" (CDC). Five of the 18 individuals had used ecstasy along with other drugs; 10 of the 18 had used alcohol and club drugs; and one of the participants at the rave (24 years of age) died at home on January 1 (CDC). The cause of death was "multiple drug intoxication"; friends said the individual was using cocaine and ecstasy at the rave and once home, he apparently injected heroin as well.

A second report from the CDC on the Los Angeles incident points to the fact that 45,000 people had attended the rave and there were three stages playing electronic music from 6 p.m. On the 31st of January until 4 a.m. On the 1st of January. In addition to the 18 individuals mentioned in the first CDC report, a further investigation found that 30 attendees were taken to area hospitals, one for "trauma" and 29 for "various drug and/or alcohol intoxications" (CDC). Many of those who were hospitalized showed symptoms consistent with the over-use of MDMA: "agitation, hypertension, mydriasis, and tachycardia" (CDC, p. 2). One patient (among the 30) actually was admitted to the ICU with "seizure, rhabdomyolysis, renal failure requiring hemodialysis, and hepatic failure"; he was in the hospital for 28 days.

A research article in the Journal of Psychoactive Drugs reports on the results of a survey using 96 club rave attendees who attended a rave in the Baltimore-Washington area between August and October, 2000. In that research -- which involved...

Yacoubian, determined that "…almost all of the respondents were telling the truth about their recent ecstasy use patterns" (Yacoubian, et al., 2006, p. 33).
Meantime, one of the principal reasons for this particular research is that few if any studies have "…explored the validity of self-reported ecstasy use in the United States" (Yacoubian, 31). When a researcher is asking club drug users to volunteer honest answers about their use of drugs, he or she cannot be sure that the answers provided are fully truthful. But when urine or "oral fluid" (OF) are used in conjunction with verbal acknowledgements, the researchers can have a better idea of what really happened and how many drugs the tested individuals actually used. And in this case, there was an 88% "concordance…between the self-reports and the OF testing that was done at the same time, Yacoubian explains.

The only "discordance between the OF results and…self-reports" were either over-reporting or under reporting, Yacoubian explains (33). In fact about 7% of the 96 participants in the survey self-reported no use of ecstasy albeit their oral fluid tests showed they had indeed taken ecstasy (under-reporting), and 5% said they had taken ecstasy but their OF results showed that they had not taken the drug (Yacoubian, 33). What needs to be researched next, Yacoubian concludes, is the underground rave scene and the drug usage in that environment, which the author believes will reveal "…more illicit drug use" and "less reporting of ecstasy use" (34).

Another peer-reviewed article with Yacoubian was published in Contemporary Drug Problems, and the authors explain that very few research projects have delved into the use of ecstasy in terms of their dependence on this drug. He took oral fluid samples and enlisted self-reporting using 192 rave attendees along the corridor between Washington, D.C. And Baltimore in 2002 (in his previous article, presented just ahead of this review, Yacoubian surveyed drug users / rave attendees from the year 2000). The oral fluid samples were taken between midnight and five in the morning in September and November, 2002. Eighty percent of the 192 rave attendees filled out the interview and 82% provided an OF specimen.

Twenty-four percent of those participating had used ecstasy "…within two days preceding the interview" and 30% gave positive tests for MDMA, Yacoubian explained (Yacoubian, 2004, p. 163). Sixteen percent of the respondents indicated they had at least one of the three dependency symptoms, and those who reported frequent use of ecstasy were also willing to admit they used "…most other drugs of abuse during the 12 months preceding the interview" (Yacoubian, 163).

Another peer-reviewed ecstasy research article was published in 2010 in the journal Substance Use & Misuse (Miller, et al., 2010, p. 437). In this article the authors point to the use of the Internet as a potentially reliable tool in asking club drug users to report their experiences. The advantages of the Internet include "…speed, convenience, anonymity, and low cost" (Miller, 438). Since this is an Australian-based research article, the authors note that the general population of Australia have "high rates of Internet use"; and since Internet surveys can be used "successfully to access specific populations" (Internet surveys may be "more honest and accurate than those given in traditional face-to-face interviews"), it is logical that scholars consider using the Internet in this kind of research (Miller, 439).

That having been said, the author compared research strategies using the "National Drug Strategy Household Survey -- Probability Sample" (NDSHS) (face-to-face); the EDRS ("ecstasy and related drug survey); and the Internet "Non-Probability Sample" (Miller, 440). What the authors discovered was the samples were "broadly comparable," but the Internet sample was "significantly more likely than the NDSHS sample to report..." The ease with which ecstasy can be obtained, where the drug can be obtained (the dealer), and whether or not ecstasy is the favorite drug of the participant. The Internet sample was more likely to be utilized by younger males, and the Internet sample shows that as a tool for research "…it may be an effective way to recruit more dedicated, less poly-drug-using ERD users than other methods" (Miller, 444).

Meanwhile, Seattle is a city that like other American cities has seen an upsurge in the use of club drugs. An article in the journal Substance Use & Misuse researched the use of MDMA through seven data…