Epidemiology ofCommon Club Drugs

Dr. Char-Nie CHEN

What are Club Drugs?

Rave Culture (1)(Dr. Erica Weir, 2000, p. 1844)

A subculture of youth who, in reactionto the materialism of the "me"generation, have embraced a partyetiquette of peace, love, unity andrespect - "PLUR”Began in UK & US in mid-1980s & thento Australia, India, Belgium, Egypt andCanada

Rave Culture (2)(Dr. Erica Weir, 2000, p. 1844)

Up to 20,000 youths dance vigorouslyand continuously all night to repetitiveelectronic music by celebrated DJsRavers seek sensory amplification andeuphoric transcendence through acombination of marathon trancedancing, liberal drug use and hypnoticmusic

Common Club Drugsin Hong Kong

3,4-methylene-dioxy-meth-amphetamine (MDMA)

Meth-amphetamine (Desoxyn; speed; ice)

Ketamine (Ketajet)

Other Club Drugs

Lysergic acid diethyl-amide(LSD) Gamma-hydroxy-butyrate(GHB) Flunitrazepam (Rohypnol)

Meth-amphetamines

Amphetamines (1)1887 - Amphetamine was synthesized1910 - Patented as anorectics in Germany1932 - S.K.F. produced Benzedrine inhaler1937 - Narcolepsy (and many others)1940s - German, Japanese, & British

soldiers in WW II1950s - American soldiers in Korean War

Amphetamines (2)1958 - P.H. Connell: Amphetamine psychosis1960s - Japanese Bohryokudan Triad and

amphetamine sales1968 - BMA Working Party: No place for

depression1970 - FDA: Narcolepsy, ADHD, short-term weight

reduction1971 - Withdrawn from market1980s - Ice developed in Hawaii for smoking

4 kinds of amphetamines?(Kovar, K-A et al., 1996)

Psycho-stimulants: central stimulationAmphetamine & methamphetamine Entactogens: insight enhancementMDMA, MDA, MDE, MMDA, MBDB Methoxy-phenethylamine hallucinogens:Mescaline, etc. Methoxy-amphetamine hallucinogens:TMA, DMA, PMA, DOET, DOB, DOM / STP

Amphetamines Dextro-amphetamine Amphetamine sulfate Biphetamine Meth-amphetamine HCl Meth-amphetamine

Methamphetamines(Speed, ice)

Methamphetamine HCl (Speed)for oral, snorting & injection -‘Flash house’ Methamphetamine (free base)- ‘ice’ - for smoking & injection Listed as Schedule II in USA

Annual Proportion of Methamphetamine UseHong Kong 1993-2000 (CRDA, 2000)

0

5

10

15

20

25

93 94 95 96 97 98 99 00

NA <21y NA >21y

PA <21y PA >21y

% NA=Newly-reported abusers; PA=Previously-reported abusers

Weighted EDs & Unweighted MEsMethamphetamines USA (DAWN, 2000)

0

20004000

60008000

10000

1200014000

1600018000

20000

1994 1995 1996 1997 1998 1999

0

100

200

300

400

500

600

700EDsMEs

Calendar Years

EDs (No.) MEs (No.)

3,4-methylene-dioxy-meth-amphetamine

(MDMA)

MDMA (Ecstasy, Fing頭丸頭丸頭丸頭丸)1912 - Synthesized by Merck1950s - Intensive study by American CIA1960s - Used in the Haight-Ashbury district of San

Francisco (the Hippie Movement)1978-85 - Alexander Shulgin introduced to

psychotherapists as adjunct to psychotherapy:Entactogen

1983 - Used in rave parties, night clubs & discos1985 - American DEA: Public hearing1986 - Listed as Schedule I Controlled Substance

in USA

Annual Proportion of MDMA UseHong Kong 1993-2000 (CRDA, 2000)

-20-10

010203040506070

93 94 95 96 97 98 99 00

NA <21y NA >21y

PA <21y PA >21y

% NA=Newly-reported abusers; PA=Previously-reported abusers

Weighted EDs & Unweighted MEsMDMA USA (DAWN, 2000)

0

500

1000

1500

2000

2500

3000

1994 1995 1996 1997 1998 1999

0

12

34

5

67

89

10

EDsMEs

Calendar Years

EDs (No.) MEs (No.)

Ketamine 氯胺酮 (K仔)

1962 - Synthesized (an analog ofPhencyclidine)1965 - Replaced phencyclidine as asurgical anaesthetic both in humansand in animals1970 - Listed in Schedule III in USA1980s - Abuse began

Phencyclidine ㆝使塵

1957 - Synthesized in Parke-Davis Lab(Sernyl)1957/65 - Used as I.V. surgicalanaesthetic, but 10-20% had CNCdepression (Sernylan)1967 - Widespread abuse as ‘peaCe’ pillsin San Francisco, but many bad trips1970 - Listed as a Schedule II in USA1979 - All legal manufacture ceased

Ketamine Abuse in HK (CRDA Report, 46th)

1.11.11.11.1 0.20.20.20.2 0.30.30.30.3 0000

44.344.344.344.3

22.722.722.722.7

12.212.212.212.21111

0000

10101010

20202020

30303030

40404040

50505050

1999 2000

N <21yN <21yN <21yN <21y P <21yP <21yP <21yP <21y

N >21yN >21yN >21yN >21y P >21yP >21yP >21yP >21y

%

Annual Proportion of Ketamine UseHong Kong 1993-2000 (CRDA, 2000)

-20

-10

0

10

20

30

40

50

93 94 95 96 97 98 99 00

NA <21y NA >21y

PA <21y PA >21y

% NA=Newly-reported abusers; PA=Previously-reported abusers

Weighted EDs & Unweighted MEsKetamine USA (DAWN, 2000)

0

50

100

150

200

250

300

350

400

450

1994 1995 1996 1997 1998 1999

0

2

4

6

8

10

12

14

16

18

EDsMEs

Calendar Years

EDs (No.) MEs (No.)

Annual Proportion of Heroin UseHong Kong 1993-2000 (CRDA, 2000)

0

20

40

60

80

100

93 94 95 96 97 98 99 00

NA <21y NA >21y

PA <21y PA >21y

% NA=Newly-reported abusers; PA=Previously-reported abusers

0

20

40

60

80

100

93 94 95 96 97 98 99 000

20

40

60

80

100

93 94 95 96 97 98 99 00

0

20

40

60

80

100

93 94 95 96 97 98 99 000

20

40

60

80

100

93 94 95 96 97 98 99 00

MDMA Ketamine

Methamphetamine

Heroin

NA <21y NA >21y NA >21y (CRDA, 2000)NA <21y

DeathExamined by

Medical Examiners

1

6

8

3

9

0

2

4

6

8

10

12

14

16

1994 1995 1996 1997 1998

4

7

9

16

10

0

2

4

6

8

10

12

14

16

1994 1995 1996 1997 1998

KetamineMDMA

507 487 484

622

501

0

100

200

300

400

500

600

700

1994 1995 1996 1997 1998

Methamphetamine

Ratio of EDs/MEs(DAWN, 2000)

1994

1995

1996

1997

1998

Total No. of Deaths in 1994-98

Ketamine 5:1 21:1 9:1 20:1 21:1 46

MDMA 250:1 70:1 40:1 212:1 127:1 27

Math-amphet-amine

35:1

33:1

23:1

28:1

23:1

2,601

Note: ME = Medical Examiners' cases, which are voluntary reports;ED = Emergency Department mentions, which are weighted data.

Poly-Drug Abuse

Proportion of Poly-drug UseHong Kong 1991-2000 (CRDA, 2001)

05

1015202530354045

91 92 93 94 95 96 97 98 99 00

NA <21y NA >21y

PA <21y PA >21y

%

Proportion of Poly-drug EpisodesUSA 1999 (DAWN, 2000)

51

78 81

0

20

40

60

80

100

M etham p M DM A Ketam ine

%