"The term club drug refers to a wide variety of dangerous drugs. These drugs are often used by young adults at all-night dance parties, dance clubs, and bars. They include methylenedioxymethamphetamine (MDMA), also known as Ecstasy, XTC, X, Adam, Clarity, and Lover's Speed; gamma-hydroxybutyrate (GHB), also known as Grievous Bodily Harm, G, Liquid Ecstasy, and Georgia Home Boy; ketamine, also known as Special K, K, Vitamin K, and Cat Valium; Rohypnol, also known as Roofies, Rophies, Roche, and Forget-me Pill; methamphetamine, also known as Speed, Ice, Chalk, Meth, Crystal, Crank, Fire, and Glass; and lysergic acid diethylamide (LSD), also known as Acid, Boomers, and Yellow Sunshines. Club drugs have become more common in recent years. Sometimes people use them to commit sexual assaults. Club drugs can cause serious health problems and sometimes death. They are even more dangerous if used with alcohol.\n\nClub drugs are a pharmacologically heterogeneous group of psychoactive drugs that tend to be abused by teens and young adults at bars, nightclubs, concerts, and parties. GHB, Rohypnol, ketamine, MDMA, and methamphetamine are some of the drugs included in this group. GHB (Xyrem) is a central nervous system depressant that was approved by the Food and Drug Administration in 2002 for use in the treatment of narcolepsy, a sleep disorder. This approval came with severe restrictions, including its use only for the treatment of narcolepsy and the requirement for a patient registry monitored by the FDA. GHB is also a metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It exists naturally in the brain, but at much lower concentrations than those found when GHB is abused. Rohypnol (flunitrazepam) is a benzodiazepine, chemically similar to sedative-hypnotic drugs such as Valium or Xanax. It is not approved for medical use in the United States, and its importation is banned. Ketamine is a dissociative anesthetic, mostly used in veterinary practice.\n\nGHB and Rohypnol are available in odorless, colorless, and tasteless forms that are frequently combined with alcohol and other beverages. Both drugs have been used to commit sexual assaults, also known as date rape, drug rape, acquaintance rape, or drug-assisted assault, due to their ability to sedate and incapacitate unsuspecting victims, preventing them from resisting sexual assault. GHB is usually ingested orally, either in liquid or powder form, while Rohypnol is typically taken orally in pill form. Recent reports, however, have shown that Rohypnol is being ground up and snorted. Both GHB and Rohypnol are also abused for their intoxicating effects, similar to other central nervous system depressants. GHB also has anabolic effects and has been used by bodybuilders to aid in fat reduction and muscle building. Ketamine is usually snorted or injected intramuscularly.\n\nAt high doses, GHB's sedative effects may result in sleep, coma, or death. Rohypnol can produce anterograde amnesia, in which individuals may not remember events they experienced while under the influence of the drug. Ketamine is a dissociative anesthetic because it distorts perceptions of sight and sound and produces feelings of detachment from the environment and self. Low-dose intoxication results in impaired attention, learning ability, and memory. At higher doses, ketamine can cause dreamlike states and hallucinations; at higher doses still, ketamine can cause delirium and amnesia.\n\nRepeated use of GHB may lead to withdrawal effects, including insomnia, anxiety, tremors, and sweating. Severe withdrawal reactions have been reported among patients presenting from an overdose of GHB or related compounds, especially if other drugs or alcohol are involved. Like other benzodiazepines, chronic use of Rohypnol can produce tolerance, physical dependence, and addiction. There have been reports of people binging on ketamine, a behavior similar to that seen in some cocaine- or amphetamine-dependent individuals. Ketamine users can develop signs of tolerance and cravings for the drug.\n\nUncertainties about the sources, chemicals, and possible contaminants used to manufacture many club drugs make it extremely difficult to determine toxicity and associated medical consequences. Nonetheless, coma and seizures can occur following use of GHB. Combined use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB has been involved in poisonings, overdoses, date rapes, and deaths. Rohypnol may be lethal when mixed with alcohol or other central nervous system depressants. Ketamine, in high doses, can cause impaired motor function, high blood pressure, and potentially fatal respiratory problems."