This is an archive page. The links are no longer being updated.
Statement for the Record
Senate Caucus on International Narcotics
Other Way: Rave Promoters and Club Drugs"
Glen R. Hanson,
Acting Director, National Institute on
Drug Abuse, NIH
Tuesday, December 4, 2001
Mr. Chairman and distinguished members of the Caucus, thank you for inviting the
National Institute on Drug Abuse (NIDA) to participate in this important and timely hearing that
focuses on a category of drugs commonly referred to as "club or rave drugs." I am Dr. Glen
Hanson, the newly designated Acting Director of NIDA, and am pleased to be able to represent
NIDA this afternoon.
As the world's largest supporter of research on the health aspects of drug abuse and
addiction, I will share with you today what NIDA-supported research is telling us about club
drugs particularly 3,4-methylenedioxymethamphetamine (MDMA). I will also discuss briefly
what we know about other drugs, including methamphetamine, ketamine, rohypnol, and gamma
hydroxybutyrate (GHB) that are also reportedly being used in rave, dance party, night club
settings, and other social settings frequented by adolescents and young adults.
There is now substantial scientific evidence demonstrating that these drugs are not
benign. In fact, studies conducted to date in both animals and more recently in humans
overwhelmingly confirm that club drugs are not harmless "fun party drugs" as they are often
portrayed. While users of "club drugs" often take some of these drugs for energy to keep on
dancing or partying, research reveals these drugs can cause long-lasting negative effects on the
brain altering memory and other behaviors. "Club drugs" include a group of diverse compounds
that are capable of producing a range of unwanted effects, including hallucinations,
hyperthermia, paranoia, amnesia, unconsciousness, and, in some cases, even death. When used
with alcohol, these drugs can be even more harmful.
We have also learned like most other drugs of abuse, the "club drugs" are rarely used
alone. "Polydrug use" appears to be the norm, especially among young "club drug" or "rave
drug" users. It is not uncommon for users to mix substances such as MDMA for example, with
both alcohol and GHB or to "bump" and take sequential doses of a drug or drugs when the initial
dose begins to fade. This is confirmed by both treatment admission reports and medical examiner
reports. Also, drugs that are sold to individuals as "Ecstasy" tablets frequently contain not only
MDMA, but other drugs or drug combinations that can be harmful. Because of these drug
combinations, it is extremely challenging to anticipate with certainty all the potential medical
consequences that can result from the use of these popular party drugs. However, despite, the
challenges that confront us in studying such a diverse pharmacological group of drugs, we have
learned a great deal about each one of the compounds.
Because of MDMA's increasing fascination both to young people and the popular media,
and the fact that our research on the long-term effects of this drug is progressing at a rapid pace, I
will discuss it first.
3,4-methylenedioxymethamphetamine, which is frequently referred to by the acronym,
MDMA, and also known on the street as "Ecstasy," has both stimulant and hallucinogenic
properties. While MDMA does not cause overt hallucinations, many people report distorted time
and exaggerated sensory perception while under the influence of the drug. It also causes an
amphetamine-like hyperactivity in people and laboratory animals and like other stimulants, it
appears to have the ability to cause addiction. Use of MDMA increases heart rate, blood
pressure and can disable the body's ability to regulate its own temperature. Because of its
stimulant properties, when it is used in club or dance settings, it enables users to dance
vigorously for extended periods, but can also lead to severe rises in body temperature, referred to
as hyperthermia, as well as dehydration, hypertension, and even heart or kidney failure in
particularly susceptible people.
MDMA is typically available in capsule or tablet form and is usually taken orally,
although there are documented cases suggesting that more and more it is being administered by
other routes, including injection and snorting. MDMA's acute effects typically last from three
to six hours depending on the dosage, with the reported average dose of MDMA being consumed
by a user being between one and two tablets, with each containing approximately 60-120 mg of
MDMA. However, much higher doses of five tablets and greater are not unusual. MDMA
appears to be well absorbed from the gastrointestinal tract, and peak levels are reached in about
MDMA works in the brain by increasing the activity levels of at least three
neurotransmitters: serotonin, dopamine, and norepinephrine. Much like the way amphetamines
work, MDMA causes these neurotransmitters to be released from their storage sites in neurons
resulting in increased brain activity. Compared to the very potent stimulant, methamphetamine,
MDMA causes greater serotonin release and somewhat lesser dopamine release. Serotonin is the
neurotransmitter that plays an important role in regulation of mood, sleep, pain, emotion,
appetite, and other behaviors. By releasing large amounts of serotonin and also interfering with
its synthesis, MDMA causes the brain to become significantly depleted of this important
neurotransmitter. As a result, it takes the human brain time to rebuild its serotonin levels. For
people who take MDMA at moderate to high doses, depletion of serotonin may be long-term.
These persistent deficits in serotonin are likely responsible for many of the long-lasting
behavioral effects that the user experiences and what concerns us most about this drug.
There is also ample evidence to show that MDMA damages brain cells. We know that
even one dose of MDMA (10 mg/kg in rats) has the ability to decrease serotonin levels for up to
2 weeks. Through the use of brain imaging technology, we can also see that human MDMA
abusers may have fewer serotonin-producing neuronal processes in the brain than non-users.
Despite what we have come to know about the detrimental consequences of this drug, there are
increasing numbers of students and young adults who continue to use MDMA and other "club,
rave or designer drugs" at increasingly higher doses. Several of our Nation's top monitoring
mechanisms, including NIDA's long-standing national survey of drug use among 8th, 10th and
12th graders, Monitoring the Future (MTF), and our Community Epidemiology Work Group
(CEWG), as well as findings from the Substance Abuse Mental Health Service Administration's
(SAMHSA) National Household Survey on Drug Abuse, and the Drug Abuse Warning Network
(DAWN) Survey, are reporting that the use of club drugs, particularly MDMA, is increasing in
popularity among high school and college students. The most recent findings from SAMHSA's
2000 National Household Survey on Drug Abuse, which was released in October 2001, also
shows an increase in MDMA use, with about 6.5 million people aged 12 or older reporting that
they tried ecstasy at least once in their lifetime; up from 5.1 million lifetime users in 1999.
NIDA's new MTF findings will be released later this month and will provide us with a better
percentage of drug use trends among our Nation's youth, which in turn will help assist in
developing better prevention approaches.
What the research is revealing about another drug used by
some of our Nation's youth, gamma hydroxybutyrate (GHB),
is equally disturbing. GHB is a central nervous system depressant
(CNS) that is manufactured in clandestine labs and is typically
sold in clear liquid in small bottles at night clubs or
raves and is often added by the capful to beverages, particularly
alcohol, and consumed orally. It is also available in capsule
form. The onset of action is within 15 to 60 minutes and
the effects typically last from 1-3 hours.
Although the predominant effects of GHB are sedative, GHB can produce a wide range of
pharmacological effects depending on the dose. At lower doses GHB relieves anxiety and
produces relaxation. However, as the dose increases, the sedative effects result in sleep and
eventual coma or if the individual is left unattended, even death.
Overdoses tend to be more frequent with GHB than with other "club drugs," especially
when used in combination with alcohol. Reported GHB-related emergency episodes in the U.S.
have increased dramatically in recent years, from 56 in 1994 to 4,969 in 2000, according to
SAMHSA's DAWN Survey. Some emergency room physicians are reporting a withdrawal
syndrome that appears in patients who have self-administered the drug in a consistent dosing
schedule (i.e. every 2 to 3 hours) for several months. The symptoms, which may include anxiety,
restlessness, insomnia, rapid heartbeat, nausea, vomiting, may be alleviated under the proper
As our knowledge about the GHB and its use patterns evolve, so do the number of
questions that need to be further explored. For example, we need to know more about the basic
pharmacology of GHB; what the long-term consequences (e.g., tolerance, dependence,
withdrawal) of using it are; who is using it; and most importantly, how to develop effective
prevention and treatment strategies for it.
Another drug that I'll briefly focus on today is methamphetamine. Although
methamphetamine is not often considered under the umbrella term of "club drugs," there
continues to be populations that regularly abuse this powerfully addictive stimulant in the "club"
Methamphetamine is a stimulant that has pronounced effects on the central nervous
system. It can enter the bloodstream very quickly and can increase activity, decrease appetite,
and cause a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours.
After the initial "rush," there is typically a state of high agitation that in some individuals can
lead to violent and dangerous behavior. The long-term effects of this drug on the brain may be
particularly damaging when taken at the high doses typically used by drug abusers.
Methamphetamine has been shown in both laboratory animals and more recently humans, to be
toxic to dopamine cells, meaning it can literally damage the nerve endings of human brain cells,
resulting in cognitive impairments.
Methamphetamine is an inexpensive and highly addictive drug. Its heaviest use is in the
Western states and in some rural areas elsewhere. While it remains the most common primary
drug problem in Honolulu and San Diego, the drug does not appear to be generally increasing in
popularity among young Americans throughout the country, although some indicators suggest
pockets of increasing use in some cities.
We are attempting to develop more effective treatments for some of these addictions. For
example, we will be starting a clinical trial of ondansetron (used to treat nausea and vomiting) in
methamphetamine-dependent patients. This drug has some amphetamine-blocking properties in
clinical pharmacology studies. Additionally, medications that have demonstrated some success in
treating other ailments, such as bupropion, which is often used to treat depression, and selegiline,
typically prescribed to treat Parkinson's disease, are currently being tested in Phase 1 clinical
trials. Behavioral therapies also have shown promising results in treating patients who suffer
from addiction to stimulants.
Ketamine is another drug that is used in rave or club settings. Ketamine is a rapid-acting
general anaesthetic. It has sedative-hypnotic, analgesic, and hallucinogenic properties and is
marketed in the United States and a number of foreign countries for use as a general anesthetic in
both human and veterinary medical practice. Ketamine is similar to phencyclidine (PCP),
although ketamine is more rapid in onset and less potent. Its effects typically last approximately
an hour or less, with the overt hallucinatory effects also being short-acting. However, the user's
senses, judgment and coordination can be affected for up to two days after initial use of the drug
and reports show that even three days after ingestion ketamine users continue to show persistent
memory impairment and elevated psychotic symptoms. There have been significant increases in
ketamine-related emergency department visits reported in this country between 1994 and 2000,
increasing from 19 to 263, according to SAMHSA's DAWN Survey.
Rohypnol is currently licensed overseas, but not in this country, as an anti-seizure drug.
It is an extremely potent benzodiazepine and is typically sold as individually wrapped tablets that
are colorless, odorless and tasteless when mixed in beverages and taken orally. Because of its
ability to sedate and to cause amnesia, it has been used to diminish women's resistance to sexual
assault, giving it the reputation of being associated with "date rape."
These are a few of the illicit drugs that are reportedly
being used by some of our youth in social settings such
as all night dance parties, raves or night clubs. NIDA will
continue to monitor the constantly evolving patterns and
trends of drug abuse. By supporting a comprehensive research
portfolio, that includes basic research to prevention and
treatment, NIDA is poised to utilize the power of science
and its application to inform the public and policy makers
about the harmful consequences of these drugs, making informed
public health decisions possible. NIDA is already actively
sharing the scientific findings about these drugs. For example,
we teamed with "In the Mix," this past Spring to
develop a television show on Ecstasy for their award-winning
PBS series for teens. We also brought together the world's
leading researchers this past summer to candidly discuss
with over 500 participants the latest scientific findings
on MDMA at the conference, "MDMA/Ecstasy Research: The
Advances, Challenges, And Future Directions." We have
and will continue to develop publications on all drugs of
abuse, particularly those used in the rave culture to inform
the public about these substances. We will also continue
to make all of these materials available on a specially-designed
website - www.clubdrugs.org.
As new findings become available, we will be able to alert
the public immediately through this and other venues.
Thank you for the opportunity to testify before this Caucus.
I will be happy to respond to any questions you may have.
Dr. Glen Hanson, Acting Director, NIDA
On November 30, 2001, Glen R. Hanson, D.D.S., Ph.D., was named the Acting Director
off the National Institute on Drug Abuse by Ruth Kirschstein, M.D., Acting Director of the
National Institutes of Health. Dr. Hanson assumed his duties on December 1, 2001. His
appointment follows the resignation of Dr. Alan I. Leshner, who served as NIDA's director since
1994 and left the Institute to become the Chief Executive Officer of the American Association
for the Advancement of Science.
Dr. Hanson is recognized as an expert on psychostimulants. He is particularly known for
his work on the neurotoxic properties of Ecstasy (MDMA) and amphetamines, as well as the role
of brain peptides in psychiatric and neurological functions. As a researcher, he has been
supported by grants from NIDA and the National Institute of Mental Health since the early 1980s
and in 1998 received a Senior Scientist Award from NIDA. Dr. Hanson has served on several
grant review committees for NIH and on the editorial board of the Journal of Pharmacology and
Experimental Therapeutics. He is a frequent reviewer for most of the major pharmacology and
Dr. Hanson joined NIDA in September 2000 as the director of NIDA's Division of
Neuroscience and Behavioral Research. He is a professor in the University of Utah's
Department of Pharmacology and Toxicology and holds a D.D.S. from the University of
California, Los Angeles, and a Ph.D. from the University of Utah. From 1978 to 1980, Dr.
Hanson was a Fellow in the National Institutes of Health Pharmacology Research Associates
The National Institute on Drug Abuse is a component of the National Institutes of Health,
U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the
world's research on the health aspects of drug abuse and addiction. The Institute carries out a
large variety of programs to ensure the rapid dissemination of research information and its
implementation in policy and practice.
HHS Home (www.hhs.gov) |
Topics (www.hhs.gov/SiteMap.html) |
What's New (www.hhs.gov/about/index.html#topiclist) |
For Kids (www.hhs.gov/kids/) |
FAQs (answers.hhs.gov) |
Site Info (www.hhs.gov/SiteMap.html) |
Disclaimers (www.hhs.gov/Disclaimer.html) |
Privacy Notice (www.hhs.gov/Privacy.html) |
FOIA (www.hhs.gov/foia/) |
Accessibility (www.hhs.gov/Accessibility.html) |
Contact Us (www.hhs.gov/ContactUs.html)
revised: December 14, 2001