Club drugs, popular for years at all night clubs and dance parties in the city, are becoming more mainstream. Classified as club drugs are ecstasy (methylenedioxymeth-amphetamine), ketamine, LSD (lysergic acid diethylamide), GHB (gamma hydroxy butyrate), Rohypnol and methamphetamine. The availability of these club drugs is increasing in nearly every city across the nation, including Atlanta. According to the Office of National Drug Control Policy, all of the club drugs are prevalent in Atlanta, with methamphetamine the second most widely used drug in the community behind cocaine. Ecstasy, GHB and ketamine are also widely popular in Atlanta and have been identified as growing in popularity over the past year.

Research has shown that the use of club drugs can cause serious health problems, especially when used in combination with other drugs. A drug interaction can occur when two or more drugs are taken during the same period of time, altering the effects of the drugs, potentially causing serious harm. The following is a list of the club drugs most popular in the Atlanta area, with information about these drugs' effects on the body and potential drug interaction side effects with HIV medications.

Methamphetamine ("Speed," "Meth")

Methamphetamine is an addictive stimulant that strongly activates certain systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects are greater because it is synthetic. Many individuals begin using methamphetamine because of the initial heightened physical and mental performance. The drug alters mood in different ways, depending on how it is taken. Immediately after smoking or intravenous injection, the user experiences an intense "rush" or "flash" that lasts only a few minutes and is described as extremely pleasurable. Snorting or ingesting orally produces euphoria -- a high, but not an intense rush. In all forms, the drug stimulates the central nervous system, with effects lasting anywhere from four to 24 hours. Methamphetamine has a high potential for abuse and dependency because of the effects after the drug begins to wear off. Individuals often feel tired, lethargic and depressed after a methamphetamine "high" and desire more to obtain the pleasurable euphoria.

When methamphetamine is taken with protease inhibitors, there is an expected increase in the potency of the recreational drug of two to three times. With this increase in potency comes the increased likelihood of an overdose. According to Project Inform, research shows that Norvir is predicted to have the greatest increase of potency on this recreational drug. However, any increase in potency of a recreational drug, because of a drug interaction, has potential for causing serious harm and even death.

Ecstasy ("X," "E," "MDMA")

3,4-Methylenedioxymethamphetamine, or MDMA, is a synthetic psychoactive drug with both stimulant (amphetamine-like) and hallucinogenic (LSD-like) properties. The pleasurable effects sought by individuals include a relaxed upbeat mood, reduced anxiety, increased sensitivity to others and a high energy level that can be sustained for many hours. Ecstasy is not physically addictive; however, the drug often takes on great importance in people's lives, and some people become rather compulsive in the use of ecstasy, which borders on addiction. One problem that occurs when MDMA is taken too frequently is the loss of its ability to elevate one's mood by permanently damaging serotonin neurons, causing individuals to feel more depressed than usual. To gain relief from these feelings of depression, these individuals attempt to attain the euphoria of MDMA with increased doses, which could potentially lead to a drug overdose.

When taken while on a drug regimen for HIV, MDMA can have potentially harmful interactions with protease inhibitors. Some HIV medications slow down the liver enzyme that metabolizes MDMA. This causes the dose of MDMA to increase in potency because of the length of time the body needs to process the drug due to the decrease in liver enzymes available for metabolism. This increase in recreational drug potency increases the potential for drug overdose.

Gamma Hydroxy Butyrate ("GHB," "Liquid X," "Grievous Bodily Harm")

Gamma hydroxy butyrate is a depressant which quickly affects the central nervous system. It is usually seen as a colorless, odorless liquid with a salty taste, but can also be found in powder and capsule forms. GHB is used to obtain a euphoric, sedated state of being. The feeling of relaxation and calmness are felt with a low to moderate dose and is experienced 10 minutes to an hour after ingestion. However, negative effects can occur with too large a dose. People experience nausea, drowsiness, respiratory distress, dizziness, seizures and amnesia. Poisonings and deaths resulting from ingestion of the drug have been well documented. Overdoses often occur because the withdrawal effects, including sweating, insomnia, muscular cramping, tremors and anxiety, cause individuals to take more GHB in a shorter period of time, not waiting for the previous dose to metabolize out of the body.

GHB has very serious effects on the body. There is an important distinction between the effects of a low to moderate dose of this drug and a high dosage, which could lead to serious, negative side effects. Because everyone's body metabolizes drugs differently, there is a fine line between the "right" dosage and too high a dose. This uncertainty creates a very dangerous drug, even without the additional effects due to drug interactions. GHB is even more dangerous in combination with protease inhibitors. The combination of these two drugs can lead to a five to tenfold increase in GHB potency within the body.

Ketamine ("K," "Special K," "Vitamin K," "Super Acid")

Ketamine, or ketamine hydrochloride, is a non-barbiturate, rapid-acting dissociative anesthetic which separates perception from sensation. Ketamine is a liquid, and the most potent ways of using it are by injecting it intramuscularly or intravenously. It can also be made into a tablet or a powder by evaporating the liquid and reducing it to a fine white powder that can be smoked or snorted. Since ketamine is specifically an anesthetic, its greatest effect is the ability to stop the user from feeling pain, which could lead the user to inadvertently cause injury to him or herself. Ketamine can cause psychological dependence because the dissociation from one's consciousness experienced with this drug is a way to self-medicate and escape from the problems experienced during one's everyday conscious life.

Ketamine directly effects one's liver through the metabolizing process. When combined with protease inhibitors, this recreational drug can lead to a "chemical hepatitis," which is an inflammation of the liver, causing jaundice. Although further studies are needed to determine the long-term effects this drug combination has on the liver, it is important to recognize that damage is being done to the liver which could potentially lead to liver failure.

Drug interactions are serious and it is the intent of this article to educate about the possible side effects of club drugs and the effects of the interactions between club drugs and HIV medication. This information is meant for educational purposes only. It neither endorses nor encourages the use of recreational drugs. Nothing contained here should be regarded in any way as a substitute for medical advice from a qualified physician or other health care provider who is familiar with all of the details of your situation. There are several resources available to provide more information about club drugs and their effects on your body and your HIV medication. Please visit AIDS Survival Project's Treatment Resource Center during regular business hours or call us at (404) 874-7926.