Rave Drugs: Designer Drugs With aPrice Rave Drugs: Designer Drugs With a Price Travis R. Welch, NREMT, PA-S

The “Rave” scene began as a subculture in England circa 1980, and has since migrated into mainstream culture throughout the United States.

Rave Culture In The United States Is Characterized By:  2 Types of Raves  secretive: warehouses, deserts, woods, etc.  commercialized: typically held in established clubs  Extremely loud “techno” music/dancing  Lighting and visual stimuli: lasers, video screens, etc...  age group  Alcohol-free environment  Escapist culture  All-night events  Designer drugs: bought, sold, consumed

Rave Paraphernalia  Water bottles  Light sticks  Pacifiers  Bags of small candies/brearespiratione-drop bottles  Dust masks/Vicks Vapo-Rub  Caffeinated beverages/over the counter stimulants

Rave Paraphernalia Defined  Water bottles -- Ecstasy the most widely used drug associated with raves causes dehydration and increases body temperature.  Light sticks -- These are used to enhance the visual experience while on the drugs (individuals see “trails” of light)  Pacifiers -- Rave drugs tend to cause the user to grind their teeth, the pacifier prevents this.  Bags of small candies and breath mints -- The drugs intended for sale are often stored in these bags.  Eye drop bottles -- These are used to store the liquid form of the drugs.  Dust mask and Vicks Vapo-Rub -- These are combined to enhance the effects of the designer drugs. The Vicks is placed under the nose the the mask is used to keep the rub from dissipating.  Caffeinated beverages/stimulants -- These help with exhaustion caused by the dancing and stimulant effect of the drugs.

Some Designer Drugs Affiliated With Raves:  Ecstasy  LSD  Ketamine  GHB  Rohypnol  Nitrous Oxide

As with all drugs, the amount used combined with the mental/physical state of the user and the setting in which it is consumed, will determine the effect of the chemical. The higher the dose the more pronounced and more prolonged the effects.

ECSTASY (MDMA) (Methylenedioxymethamphetamine)  Street names: E, X, XTC, rolling, clarity, essence, Adam, go, disco biscuit, crystal, hug drug  Over-sensitivity to sensory stimuli  Overall feeling of euphoria  Dehydration/hyperthermic  Insomnia  Hallucinogenic  Stimulant  Appetite suppressant  Dilated pupils

Ecstasy (MDMA) §MDMA is marketed as a "feel good" drug. Devotees say it produces profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation--hence the name "hug drug." MDMA is also said to suppress the need to eat, drink, or sleep, enabling club scene users to endure all-night and sometimes two, or three-day parties. §MDMA is taken orally, usually in tablet or capsule form. Its effects last approximately four to six hours. Source: Strategic Domestic Unit DEA

Ecstasy (MDMA) Overdose §Hypertension, Tachycardia §Muscle Cramping §Faintness §Panic attacks §LOC §Seizures

Reported Ecstasy After-effects §Anxiety §Paranoia §Depression

Ecstasy (MDMA) §Ecstasy causes long-lasting damage to brain areas that are critical for thought and memory. Source: The Journal of Neuroscience (June 14, 1999) §The proportion of eighth graders reporting any use of Ecstasy in the prior 12 months rose from 1.7 percent in 1999 to 3.1 percent in Among 10th-graders, the use of Ecstasy rose from 4.4 percent to 5.4 percent, and among 12th graders from 5.6 percent to 8.2 percent. Ecstasy then, would be used by more American teen-agers today than is Cocaine. Source: University of Michigan (December 14, 2000)

LSD (Lysergic Acid Diethylamide)  Street names: sold under more than 80 names; acid, blotter, cid, doses, trips, hits, tabs, dope  Distorted and intensified sensory input  Powerful hallucinogenic  Delusions/paranoia  Strong effect on mood and emotion  Dilated pupils  Raised: body temp., heartbeat, blood pressure  Facial flushing/profuse perspiration  Blurred vision  Dizziness and nausea  Synesthesia- “hearing colors” or “seeing sounds”

KETAMINE (Ketamine Hydrochloride)  Street names: special K, K, kit kat, cat valium, jet, super acid, honey oil, green, super C  Powerful anesthetic (Used in widely in veterinary medicine)  Overtly hallucinatory complete muscle loss (including muscles of respiration)  Muscle relaxation to complete muscle loss (including muscles of respiration) loss of consciousness  Mild sedative effects to loss of consciousness  Hypnotic amnesia  Partial amnesia  Detached, distant, and estranged from surroundings  Described as similar to drunkenness only stronger

GHB (Gamma-Hydroxybutyrate)  Street names: liquid X, liquid E, G, Georgia home boy, goop, gamma-oh, grievous bodily harm  Powerful sedative  Produces euphoric and psychedelic hallucinatory states  Stimulates muscle growth  Adverse effects: drowsiness, nausea, vomiting, dizziness, severe respiratory depression, unconsciousness, seizures, coma, death  Induces a reduced level of consciousness  Memory loss

ROHYPNOL (Flunitrazepam)  Street names: roofies, R-2, Mexican valium, rophies, rope, roaches, forget me drug, circles  Powerful anesthetic  Sedation to loss of consciousness  Muscle relaxation to complete loss of muscle control  Reduction in anxiety  Prevention of convulsions  Partial amnesia  Adverse effects: drowsiness, dizziness, loss of motor control, lack of coordination, slurred speech, confusion, respiratory depression  Impairs cognitive and psychomotor functions  Alcohol and Rohypnol potentiate each other’s toxicity

Another concern… §GHB, ROHYPNOL, KETAMINE have sedative and amnesia-causing affects that lead them to being abused as “date-rape” drugs which has a plethora of consequences. DEATH §These substances can lead to LOC that can lead to aspiration, respiratory depression, or DEATH

NITROUS OXIDE (N2O)  Disorientation  Fixated vision  Throbbing or pulsating auditory hallucinations  Similarly pulsating visual hallucination  Increased pain threshold  Deeper mental connections  Weak anaesthetic  Bacteriostatic (stops bacteria growth)  Light use is not necessarily hazardous

Emergency Medical Treatment §Is the scene secured? §Be aware of possibility of sudden changes of mood or hallucinations! §Aggressive airway management as needed. §Monitor patient frequently and be prepared to treat for shock, or cardiopulmonary collapse. §Determine substance taken if possible, and transport substance with patient to ER if possible.

Emergency Medical Treatment (Summary) §Treat patient symptomatically. §A thorough history and patient assessment (and frequent reassessment) will be key to the management of these patients!!!

Other considerations §These drugs are often produced in clandestine labs, similar to those used to manufacture methampethamine, so the purity of the tablets are questionable at best. §The presence of other chemicals opens the door for a plethora of medical conditions and complications. §If lab is encountered, proceed as with a clandestine methampethamine lab and consider responder PPE and Pt decon procedures

Questions???