Dawn Tdr Club Drugs 02.indd
JULY 2004
Club Drugs, 2002 Update
In Brief
Although relatively rare, club drug-related ED visits
more than doubled from 1994 to 1999. In contrast,
This issue of The DAWN Report focuses on emergency
drug abuse-related ED visits overall rose only 7 percent
department (ED) visits related to the abuse of a group of
during the same period. When The DAWN Report
drugs often referred to as “club drugs.”1 Four such drugs
examined club drugs initially in 2000, GHB-related ED
are included in this analysis—GHB (gamma hydroxy
visits had risen from less than 60 to around 3,000 and
butyrate), Ketamine, LSD (lysergic acid diethylamide),
Ecstasy-related ED visits had risen from 250 to 2,850 in
and MDMA (methylenedioxymethamphetamine,
just 6 years. Even Ketamine, the least frequent club drug
commonly known as Ecstasy).2
reported in ED visits, had grown from 19 to nearly 400
According to estimates from the Drug Abuse Warning
visits, according to DAWN.
Network (DAWN) for 2002:
These trends now appear quite different. From 2000 to
■ Collectively, GHB, Ketamine, LSD, and MDMA were
2002, ED visits associated with GHB, Ketamine, LSD,
involved in about 8,100 ED visits,3 slightly more than
and MDMA did not increase. Instead:
1 percent of total drug abuse-related ED visits, in the
■ From 2000 to 2002, ED visits associated with GHB
coterminous U.S. in 2002.
declined by one-third;
■ In 2002, MDMA was the most common club drug in
■ Ketamine-related ED visits have remained at very low
drug-related ED visits, followed by GHB and LSD. The
levels since 1998;
estimates of ED visits associated with Ketamine have
■ ED visits involving LSD were relatively stable between
remained low and statistically unchanged since 1998.
1994 and 1999, but then declined rapidly from over
■ Drug abuse-related ED visits involving GHB appear
5,100 visits in 1999 to fewer than 900 visits in 2002;
to have peaked in 2000 and then declined by a third
and
between 2000 and 2002. Similarly, ED visits involving
■ The last significant increase in ED visits associated with
MDMA appear to have peaked in 2001 and have been
MDMA occurred between 1999 and 2001. From 2001
stable since.
to 2002, MDMA visits remained stable5 (Figure 2).
■ Between 1994 and 2002, LSD-related ED visits
declined more than 80 percent nationally (from 5,158
FIGURE 1
Club drug-related ED visits as
to 891 visits).
a portion of total drug abuse-
■ More than three-quarters of club drug-related ED
related ED visits, 2002
visits involved multiple drugs. Alcohol, marijuana,
and cocaine were the most common drugs reported
in combination with club drugs.
Trends in Club Drug-related
ED Visits: 1994-2002
Drug Abuse-
Club Drug-
Related ED Visits
Related ED Visits
670,307
8,127
In 2002, about 670,000, or less than 1 percent, of the
more than 102 million ED visits in the coterminous U.S.
were related to drug abuse. Among these, club drugs
were implicated in about 1.2 percent or 8,100 ED visits
in 2002 (Figure 1).4
SOURCE: Office of Applied Studies, SAMHSA, Drug
Abuse Warning Network, 2002 (03/2003 update).
2
CLUB DRUGS, 2002 UPDATE • JULY 2004
Club Drugs in Multi-drug ED Visits, 26 (Figure 4). By contrast, less than one-third of all
2002
drug-related ED visits involved patients younger than
26 years old.
About half (54%) of all drug abuse-related ED visits
involve multiple drugs. Multi-drug visits were even
Discussion
more common among club drug visits. In 2002, at least
one other drug was present in the majority of ED visits
An increase or decrease in ED visits associated with
involving GHB (84%), Ketamine (80%), LSD (77%),
a particular drug may or may not be an accurate
and MDMA (72%). Some of these visits involved
reflection of the nature or extent of the drug’s prevalence
multiple club drugs, but club drugs were also frequently
in the population at large. For example, use of a less
used in combination with alcohol, marijuana, cocaine,
potent drug could lead to fewer ED visits even if the use
and heroin (Table 1).
itself had risen. New or different combinations of drugs
or drugs with alcohol could lead to greater or fewer
Characteristics of Patients, 2002
health effects requiring emergency care. Other factors
unrelated to drug use, such as insurance coverage, can
Gender. ED visits related to MDMA involved nearly
affect whether a person seeks care in an ED versus
equal numbers of males and females (50% male and
another health care setting or at all.
49% female). However, males were disproportionately
represented in ED visits involving GHB (66%), Ketamine
(77%), and LSD (87%)(Figure 3). By comparison,
ED visits related to drug abuse overall were relatively
The DAWN Report is published periodical y by the Office of
evenly divided between males and females (53% of visits
Applied Studies, Substance Abuse and Mental Health Services
Administration (SAMHSA). This issue was written by Dana Lehder
involved males while 46% involved females).
Roberts (OAS/SAMHSA) and Dr. Judy Bal (OAS/SAMHSA). Al
Age. Most of the patients in club drug-related ED visits
material appearing in this report is in the public domain and may
were under age 26: 56 percent of GHB visits, 68 percent
be reproduced or copied without permission from SAMHSA.
of Ketamine visits, 76 percent of LSD visits, and 75
Citation of the source is appreciated.
percent of MDMA visits involved patients younger than
TABLE 1
Presence of other drugs in ED visits involving club drugs: Estimates
for the coterminous U.S., 2002
Drug categories and visits characteristics
GHB
Ketamine
LSD
MDMA (Ecstasy)
Drug concomitance
Single-drug visits
531 (16%)
52 (20%)
204 (23%)
1,121 (28%)
Multi-drug visits
2,799 (84%)
208 (80%)
687 (77%)
2,905 (72%)
TOTAL CLUB DRUG VISITS
3,330
260
891
4,026
Selected drug combinations
GHB
9 (3%)
5 (1%)
198 (5%)
Ketamine
9 (<1%)
9 (1%)
31 (1%)
LSD
5 (<1%)
9 (3%)
122 (3%)
MDMA (Ecstasy)
198 (6%)
31 (12%)
122 (14%)
Alcohol-in-combination
2,131 (64%)
76 (29%)
402 (45%)
1,594 (40%)
Amphetamines
184 (6%)
10 (4%)
18 (2%)
75 (2%)
Cocaine
501 (15%)
34 (13%)
175 (20%)
815 (20%)
Heroin
7 (<1%)
63 (24%)
130 (15%)
184 (5%)
Marijuana
458 (14%)
50 (19%)
382 (43%)
1,555 (39%)
Methamphetamine
240 (7%)
18 (7%)
42 (5%)
173 (4%)
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (03/2003 update).
CLUB DRUGS, 2002 UPDATE • JULY 2004
3
FIGURE 2
Club drug abuse-related ED visits: 1994-2002
MDMA (Ecstasy)
GHB
6,000
6,000
5,542
4,969
5,000
5,000
4,511
4,026
4,000
4,000
3,178
3,340 3,330
3,000
2,850
3,000
V
isits
V
isits
2,000
2,000
1,282
1,143
1,000
1,000
637
638 762
253 421 319
56
145
0
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
1994 1995 1996 1997 1998 1999 2000 2001 2002
LSD
Ketamine
6,000
5,682
6,000
5,158
5,219 4,982 5,126
5,000
5,000
4,569
4,016
4,000
4,000
3,000
2,821
3,000
V
isits
V
isits
2,000
2,000
1,000
891
1,000
679
19
81
209 396 263
260
…
…
0
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
1994 1995 1996 1997 1998 1999 2000 2001 2002
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (03/2003 update).
Dots (…) indicate that an estimate with an RSE greater than 50% has been suppressed.
FIGURE 3
FIGURE 4
Drug abuse-related ED visits, by
Drug abuse-related ED visits, by
club drug and gender, 2002
club drug and age group, 2002
100
100
80
80
Female
≥ age 26
60
60
Male
V
i
s
i
t
s
< age 26
V
isits
40
50%
77%
87%
66%
40
75%
68%
76%
56%
20
20
0
0
MDMA Ketamine
LSD
GHB
MDMA Ketamine
LSD
GHB
(Ecstasy)
(Ecstasy)
SOURCE: Office of Applied Studies, SAMHSA, Drug
SOURCE: Office of Applied Studies, SAMHSA, Drug
Abuse Warning Network, 2002 (03/2003 update).
Abuse Warning Network, 2002 (03/2003 update).
4
CLUB DRUGS, 2002 UPDATE • JULY 2004
End Notes
About DAWN
1 Recent data suggest that the term “club drugs,” which
developed from the association of a group of drugs with
The Drug Abuse Warning Network (DAWN) is a national
“raves” and dance clubs, may be outdated, as the use of these
surveil ance system that col ects data on drug abuse-
drugs may have expanded beyond the club scene. We retain
the term here for consistency with prior reports. Source:
related visits to emergency departments (EDs) and drug
Community Epidemiology Work Group, National Institute
abuse-related deaths reviewed by medical examiners and
on Drug Abuse. (2003, June). Epidemiologic Trends in Drug
coroners. Data on ED visits are col ected from a national
Abuse: Advance Report. Retrieved [December 2, 2003], from
http://www.drugabuse.gov/PDF/CEWG/AdvReport603.pdf
probability sample of non-Federal, short-stay hospitals, with
2 Flunitrazepam (Rohypnol) estimates are not included in
oversampling in 21 major metropolitan areas. Data from the
this update because the estimates have proven to be too
sample are used to generate estimates for the coterminous
imprecise, with relative standard errors exceeding 50 percent
U.S. and the 21 metropolitan areas.
of the estimate in most years. Methamphetamine, which was
included in previous publications related to club drugs, will
be addressed in a separate issue of The DAWN Report. It will
ED visits are reportable to DAWN if a patient between the
be available from the DAWN web site at http://DAWNinfo.
ages of 6 and 97 was treated for a condition associated
samhsa.gov/.
with intentional drug abuse, including recreational use,
3 Up to 4 drugs plus alcohol can be reported for a single ED
dependence, or suicide attempt. Visits involving chronic
visit in DAWN. Among the 8,127 visits involving club drugs
in 2002, 374 visits involved multiple club drugs.
health conditions resulting from drug abuse are reportable.
4 Substance Abuse and Mental Health Services Administration,
Abuse of prescription and over-the-counter medications is
Office of Applied Studies. (2003). Emergency Department
reportable. Adverse reactions associated with appropriate
Trends From Drug Abuse Warning Network, Final Estimates
use of these drugs and accidental ingestion or inhalation of
1995-2002 (DHHS Publication No. SMA 03-3780, DAWN
Series D-24). Rockville, MD.
any drug are not reportable.
5 “Stable” means that the estimates for the 2 years were
within the margin of error. In a statistical sense, there is no
significant difference between the two estimates.
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
