Just as LSD came to be associated in the public's mind with the culture of the 1960s, two other hallucinogenic drugs, ecstasy and ketamine, have come to be associated with the so-called rave culture of the late twentieth and early twenty-first centuries. These two drugs, which the DEA classifies as hallucinogens, are popular among those who attend impromptu wide-open parties called raves. "Ravers" who take ecstasy and ketamine claim that although these drugs produce perceptual distortions, the effects are mild enough to allow them to dance and converse with friends. Users of ecstasy and ketamine believe that within the rave environment these drugs enhance the experience of dancing to loud music and light shows as well as the enjoyment of being emotionally connected with the large numbers of people who attend raves.
In particular, ecstasy has a reputation among young people for creating an emotional openness and euphoria that leads to an increased feeling of friendship and empathy for others, relief from everyday stress and worries, and decreased inhibitions. For this reason, psychologists call ecstasy an empathogen, a clinical term for any substance that triggers strong feelings of empathy and emotional closeness to others, as well as an entactogen, a clinical term for substances that engender an inner sense that all is well with the world.
Acting as an empathogen, ecstasy has the effect of breaking down personal communication barriers such as shyness or insecurity. Users of ecstasy report feeling much more at ease talking to others and that any inhibitions about expressing their feelings toward others, both friends and strangers, seem to disappear. Many people use ecstasy primarily for this effect, reporting that it makes potentially awkward or uncomfortable social situations much more easy to deal with. This effect is so powerful and common that ecstasy is known as a "hug drug." Dan, a raver, recalls experiencing this phenomenon:
We were all trancing pretty heavily, and as I stood with my arms around my two buddies, looking at the ground, I felt that familiar rush of good vibes coming on. All of a sudden, I looked up and found that we were surrounded by 20–30 other people, all hugging in on us, creating a huge circle, the most gigantic hug I have ever been in, and everyone just pouring their love and good vibes.23
In addition to this sense of closeness to others, people on ecstasy often describe feelings of being at peace with the world or of experiencing a generalized sense of happiness. Mundane objects may seem to be abnormally beautiful or interesting. People who take ecstasy at raves say that this entactogenic quality enhances the dancing experience. One raver recounts both the empathogenic and entactogenic feelings he experienced:
A wave of warmth overcame me on my way down. For the first time in my life, I knew what empathy felt like. I thought that everyone was my friend, simply due to the fact that those around me (even if I didn't know them) shared and enhanced this feeling just by being around me. The world seemed like a better place. There was no war, no poverty, no pain while I was rolling. I have never felt closer to my friends who were there until then also. We were sharing something that we all knew the others were feeling. We were all in tune with each other's thoughts, feeling, emotions.24
Researchers who have studied ecstasy believe that these highly emotional outpourings result from raised levels of serotonin that elevate people's moods. All hallucinogens change levels of serotonin, but ecstasy acts a bit differently. According to Dr. John Morgan, a professor of pharmacology at the City University of New York, other hallucinogens increase levels of serotonin in the synapses by inhibiting its re-uptake in the neurons of the brain. Ecstasy, however, rather than inhibiting re-uptake, actually pulls serotonin out of the neurons' storage locations. This unusual phenomenon results in the synapses of the brain being flooded with a higher concentration of serotonin than they would be when other hallucinogens are used.
Raves are cultural phenomena that have sprung up in nearly every urban setting in America and Europe. Hundreds of rave websites promote the parties and provide information about the rave culture, personal experiences, and rave paraphernalia. Initially, raves were known for their remote natural settings at beaches and wooded mountain retreats. They rarely started before midnight, and they frequently kept going until dawn. Now raves occur in nightclubs, empty warehouses, and occasionally sports stadiums capable of accommodating tens of thousands of partygoers. Sometimes they rage nonstop for several days and nights.
In the midst of a rave, partygoers claim that taking ecstasy or ketamine heightens the experience, making it more than just a party with throbbing techno music and lasers and strobe lights. They say it becomes something like a huge family gathering where people feel comfortable with each other without fears of violence.
Physical Effects of Ecstasy
The physical effects of a standard dose of between 80 and 150 milligrams of ecstasy are subtle and variable. Some users report dryness of mouth, jaw clenching, teeth grinding, mild eye twitching, sweating, or nausea. Others report feelings of profound physical relaxation. At higher doses, the physical effects of ecstasy resemble those of amphetamines: fast or pounding heartbeat, sweating, dizziness, and restlessness.
Researchers do not yet conclusively know if ecstasy causes longterm neurological changes in humans, although animal tests have suggested there is reason for concern. Scientists hold differing views of the implications of using ecstasy, however. Dr. George Ricaurte of the Johns Hopkins Medical Institutions in Baltimore warns, "We now know that brain damage is still present in monkeys seven years after discontinuing the drug [ecstasy]. We don't know just yet if we're dealing with such a long-lasting effect in people."25 Dr. Charles Grob, an associate professor of psychiatry and pediatrics at the University of California Los Angeles School of Medicine, noted in 1995, "There's no apparent pattern of clinical neural degeneration syndromes reported in millions of people who've taken MDMA [ecstasy] over the last 20 years."26 However, Richard Glennon, a professor of medical chemistry at the Medical College of Virginia School of Pharmacology, strikes a more cautious note regarding the possible harmful effects of MDMA by stating, "Nobody really has any idea."27
Whether it is called ecstasy, E, or XTC, this chemical compound is only available illegally. This was not always the case, however. Ecstasy was first widely used in the mid-1970s as an appetite suppressant, but by the 1980s, psychiatrists also found therapeutic value in the drug's tendency to make people feel happier and boost their self-confidence. Psychiatrists who were treating patients with mild to moderate depression and anxiety reported that their patients said they were increasing their circle of friends and engaging in more group activities.
The success of ecstasy in treating depression prompted more psychiatrists to prescribe the drug for many other ailments. Doctors prescribed ecstasy for complaints ranging from common phobias such as the fear of meeting new people or the fear of flying to nonspecific complaints of unhappiness. Because it seemed to help almost everyone without any noticeable side effects, physicians prescribed it widely. By the early 1980s, with so many doctors writing prescriptions for ecstasy, gradually some of the pills found their way to the illegal street marketplace, where its use mushroomed. Ecstasy's illicit use spread so fast that in 1985 the U.S. government banned its prescription use as well as most of its clinical research.
In spite of the drug's illegal status, ecstasy use among Americans continues to expand. According to a 2001 DEA report on ecstasy, "Recent reports estimate that over 2 million tablets are smuggled into the U.S. each week. Current estimates suggest that within the Newark, New York, and Jersey Shore corridor over 750,000 dosage units are being consumed each week."28 In terms of seizures, the U.S. Customs Service reports that they seized 750,000 tablets of ecstasy in 1998, 3.5 million in 1999, and 9.3 million in 2000.
Despite this phenomenal growth in the use of ecstasy, instances of serious injury or death directly connected to ingesting the drug itself have been relatively rare. According to U.S. coroner's reports filed in 1998, there were nine deaths involving ecstasy. Six of them involved multiple illicit drugs found in the deceaseds' bloodstream, and the three that involved ecstasy alone were all the result of dehydration at all-night raves. Yet growth in the drug's use has been accompanied by a growth in problems. According to the Drug Abuse Warning Network (DAWN), an agency of the federal government that reports on drug use, nationwide hospital emergency room admissions for ecstasy complications rose from 70 in 1993 to 2,850 in 1999.
Loss of Inhibition
Another danger comes from the loss of inhibition that users experience. In the free-wheeling environment of a rave, users often give in to the temptation to engage in unprotected sex. Moreover, users may also find themselves physically unable to resist unwanted sexual advances.
In addition to the risks associated with unprotected sex and the dangers of rape, some enjoying the ecstasy experience have been treated in hospitals for hypothermia—a dangerous drop in body temperature—as a result of removing their clothes and running around outside naked. This phenomenon seems to be unique to ecstasy and is explained by experts as being the result of the sense of well-being induced by the drug. Although there have been no deaths reported from exposure while under the influence of ecstasy, emergency room doctors believe that death from hypothermia in such cases is a possibility.
Deaths associated with ecstasy have occurred from dehydration. Ecstasy causes a rapid loss of body fluids, and when combined with strenuous and long-term dancing in warm environments, that fluid loss becomes extreme. Emergency room doctors who have treated many ecstasy users report that dehydration is one of the major health risks associated with the drug.
Ecstasy and Gang Violence
Whatever the risks associated with using ecstasy might be, society is faced with other problems created by the drug. For example, the growing popularity of ecstasy has sparked violence in America's big cities among gangs who fight for control over the trafficking of the drug.
In San Francisco, a growing number of partygoers have found themselves in one of the city's hospitals after ingesting unknown drugs at an all-night rave. Not everyone recovers from the effects of contaminated rave drugs.
In 1999, a man named Emmanuel Spirios founded the nonprofit company DanceSafe, in San Francisco in response to the contaminated pill problem. DanceSafe addresses this dilemma with a free pill-testing service at the major rave venues. There are currently twelve DanceSafe chapters across America, with plans to expand to twenty.
When raves are located, volunteers working for DanceSafe set up a table and offer to test anyone's pills to determine if, for example, they are ecstasy. A worker applies a chemical to a sliver of a pill. If it turns a dark purple color immediately, that means that MDMA, the active substance in ecstasy, is present. Another color indicates the presence of some other substance. DanceSafe volunteers have identified thousands of pills that did not turn dark purple. However, a positive test for ecstasy is not a guarantee of safety. Even though the test can positively identify ecstasy, it still cannot measure the dose.
Not everyone is happy with the DanceSafe program. Some believe that providing the pill-testing service merely condones the practice of using illegal drugs and that more ravers will use ecstasy knowing that there is a safe test for it.
In part, the problem lies in the fact that ecstasy is highly profitable. Pills that cost no more than fifty cents to manufacture sell for fifty times that amount on the street. Bridget Brennan, a special narcotics prosecutor for New York City, said in an interview, "With drugs, it's always about the money and the dealers are starting to see there is so much money in ecstasy that more people are getting involved, and with that comes more violence."29
With money and gang violence come deaths. Gang-related homicides related to ecstasy have occurred in most of America's big cities. Most of these homicides are committed by rival street gangs, but police have reason to believe that organized crime may be behind some of the murders.
In May 2001, New York police arrested a former Gambino crime family hit man, Salvatore Gravano, who later pleaded guilty to running a multimillion-dollar ecstasy ring in Arizona. According to the New York Times, "Court documents showed that Mr. Gravano was accused of hatching four homicide plots to consolidate his control of the Arizona drug market, and that his organization was being supplied by Ilan Zarger, a drug dealer based in Brooklyn who had ties to the Israeli mob."30
If authorities are becoming increasingly concerned about problems associated with ecstasy, other drugs that are part of the rave scene compete for their attention. Another hallucinogen commonly used at raves is ketamine. Virtually unknown to the public until the 1990s, it nonetheless has experienced a rapid rise in popularity among young people.
Ketamine produces very different effects than ecstasy does. Unlike the friendly social effect of ecstasy, ketamine, commonly referred to as Special-K, K, or Vitamin K, is known at low dosages, between 25 and 100 milligrams, for its quieting and at times calming effects that place users in meditative and introspective moods. The mild sense of inebriation, dreamy thinking, and a sense of the world as being temporary and unimportant is somewhat similar to the effects of LSD, although ketamine's effects are not as long-lasting, wearing off in about an hour.
At higher doses, however—between 100 and 300 milligrams—ketamine becomes unlike any other hallucinogen. At these doses, ketamine can induce a mild anesthetic state, causing the user to feel tired and dizzy. These effects, combined with hallucinations, frequently cause users to experience a sense of disorientation. One user's recollection of his experience on ketamine is typical:
What I was feeling at this point: very disoriented, normal reality had just disappeared, physically dizzy and unable to walk without bumping against walls, a bit of paranoia that I was going to die because I had taken way too much . . . mixed with periodic flashes wherein my surroundings would hang motionless and appear really beautiful and I felt totally painless. And sounds were incredibly amplified—I felt like I was in a machine shop or factory. I was pretty confused about what was real. I was too dizzy to stand up, I crashed out on the living room cushions. I started to space on the ceiling, which was flowing. I was cold. I cautioned my friends that they should keep a close eye on me because I might die without them noticing—I couldn't feel if I was breathing (they were watching me the whole time). I could hear them talking but couldn't respond.31
Like many other hallucinogens, ketamine affects the user's perception of time. Users report feeling as though time was slowing down to a crawl. Seconds become minutes, minutes become hours, and eventually, as the effect of the drug peaks, some users report that time seems to stop or ceases to have any meaning whatsoever.
Although many of ketamine's effects can be found in other hallucinogens such as LSD, one is unique to the ketamine experience—a sense of dissociation in which the mind seems to leave the body and float in space. Ketamine users often refer to this experience as entering a "Khole."
Although this experience can be frightening, most users want to experience it and intentionally take a high dose to induce dissociation. The experience of dissociation is, almost by definition, surreal. One user named Paul writes about one of his dissociative experiences:
In this space I experience myself as a Museum exhibition. I am a life-size statue, with my back to one of the walls, floating about 20 meters from the ground. As I look down, I can see people wandering in and out of the Museum.32
Others report that dissociation held some surprises that were not always pleasant:
Then suddenly, I was back in my body, lying on my bed. "Wow," I thought, "it's over. How abrupt!" I tried to sit up. Suddenly my body was gone again and the room dissolved into the blackness of the void, my reality being quickly pulled out from underneath my feet. . . . This process was actually a little scary, as I had some fear of never making it back to conscious reality, my body lying in a hospital in a vegetative state as my consciousness stayed stuck in a weird, repeating loop.33
For some users, dissociation resembles near-death experiences. They report leaving their physical body and sometimes mystically traveling through a tunnel toward "the light." Ketamine can reproduce all aspects of a near-death experience. Many users who have written about their experiences report the conviction of being dead, talking directly to God, seeing heavenly visions, seeing their bodies down below on Earth, entering other realities, and seeing a replay of their life's experiences. Some ketamine users report that they enjoy toying with the idea that they may not return. At the same time, ketamine users have the contradictory experience of knowing that they are not physically near death. Kevin, a regular ketamine user, reports,
I was in a state in which I thought there was a reasonable chance that this time I'd gone too far, and would not come back. I did not feel anxiety about this, just some slight concern (about ending my life with so much still to do). From time to time I would check that my heart was still beating, that I was still breathing and that I could move my hands; each time everything seemed OK, so I was reassured that I had not died.34
Research scientists and psychiatrists are intrigued by claims of near-death experiences (NDEs). They have heard many NDE claims in which people have described crossing over into the next life, seeing a white light, and talking to God. Researchers conduct studies to determine the nature of near-death experiences and what occurs in the brain to create them.
Most researchers believe their studies support the conclusion that NDEs have no spiritual basis. For example, in England, Dr. Karl Jansen has successfully induced NDEs by administering doses of ketamine to volunteers. Jansen's research has focused on the connection between NDEs and elevated levels of serotonin, and his experiments have documented significant increases in serotonin while his volunteers are in the midst of their NDEs.
Michael A. Persinger, a neuroscientist at Laurentian University in Sudbury, Canada, has induced many of the characteristics of an NDE by electrically stimulating the brain' s right temporal lobe, the area responsible for perception. In March 1997, an article in U.S. News & World Report quoted Persinger as saying that "There's nothing magical about the NDE."
Sherwin Nuland, author of How We Die, believes NDEs are caused by opiate-like compounds known as endorphins, which are released by the brain at times of great stress to deaden pain and alleviate fear. Nuland disagrees with those who view NDEs as a temporary bridge to an afterlife: "I think that the mind is just trying to save itself from the horror of unbelievable trauma."
Physical Effects of Ketamine
As with other hallucinogens, ketamine's psychological effects are unpredictable, being somewhat dependent on the individual user. The physical effects, however, are quite consistent. Ketamine begins to take effect about four to five minutes after injection or ten to fifteen minutes if swallowed in pill form. Initial effects include increased heart rate, elevated blood pressure, difficulty speaking, and loss of coordination. For all its similarities to other hallucinogens, in one way, ketamine is unique: If a large dose is taken, muscle rigidity, respiratory distress, paralysis, cardiac distress, coma, and even death can result.
These dangerous effects of ketamine are rooted in the fact that the drug was originally developed in the 1960s as an anesthetic for use on small animals. At the time, veterinarians were experiencing a high rate of death among animals on which they were operating. For the most part, this was because available anesthetics often caused the animals to stop breathing. As a consequence, researchers began looking for drugs capable of anesthetizing small animals without impairing their respiratory systems. Ketamine was the product of this research, and in 1962 was introduced to veterinarians with great success.
The success of ketamine in cutting death rates among small animals caught the attention of pediatricians, who saw the same need for an anesthetic that would be safe for children. By 1965, ketamine had been approved for use on small children and was hailed by pediatricians as safe and effective.
Thanks to the drug's apparent safety, ketamine's use as an anesthetic continued to expand. During the late stages of the Vietnam War, ketamine became a commonly used anesthetic on the battlefield because it could be administered relatively safely even by nonmedical personnel. This was because an accidental overdose large enough to kill the patient was much less likely to occur than with more potent anesthetics. These wounded soldiers were the first large pool of adults to experience the effects of ketamine, and their stories of hallucinations and mysterious out-of-body experiences caught many medical professionals by surprise.
Word spread of these side effects, and by the 1980s, ketamine's reputation as a hallucinogen and producer of near-death experiences was becoming known throughout Europe as well as America. As a consequence, its use as a recreational drug grew. Recreational users would go to the veterinarian supply companies and purchase the liquid form of ketamine, which they often injected to produce a stronger reaction than snorting the powder form.
With increased use of ketamine came increased reports of problems, although, as with other hallucinogens, the numbers are low compared with other drugs. According to DAWN, nationwide hospital emergency room admissions for ketamine complications rose from 19 in 1994 to 396 in 1999. According to U.S. coroner's reports filed in 1998, there were ten deaths involving ketamine mixed with other drugs, but none of the statistics indicated how many of the deaths involved ketamine exclusively. Although ketamine's anesthetic properties mean it can be dangerous, those in the medical profession familiar with the effects of ketamine mostly warn users to avoid driving and to remain around sober friends who monitor their behavior and render aid in case of an accident.
One problem with ketamine is that it is one of a growing number of what are known as date rape drugs. Ketamine is odorless and colorless, so it can be added to a drink without being detected. Thus, a victim could unknowingly ingest ketamine, making him or her vulnerable to sexual assault. According to the National Clearinghouse for Alcohol and Drug Information (NCADI), "Because of its anesthetic properties, Ketamine is considered to be one of the 'date rape' drugs, substances that can be slipped into a person's drink to render him or her unconscious."35
Furthermore, because of ketamine's numbing properties, which make it an effective anesthetic, and its tendency to induce temporary amnesia, victims frequently have difficulty remembering details about the rape incident. As a result, police and prosecutors have difficulty convicting perpetrators of date rape.
Neurotransmitter Russian Roulette
Perhaps the greatest danger for those who use ketamine is from mixing it with other drugs, which is a potentially deadly matter. National health organizations that study drug illnesses, overdoses, and deaths are universal in their admonition that more Americans die each year as a result of the reckless blending of multiple drugs than from ingesting individual illicit drugs.
According to Dr. Katherine Bronson, a pharmacologist working at the National Institute of Mental Health, people who mix drugs such as ketamine with other substances without the advice of a physician are playing a game of Russian roulette with their neurotransmitters. Hallucinogens affect levels of the neurotransmitter serotonin, as do, for example, most antidepressants commonly prescribed by doctors. When people taking antidepressants add ketamine, for example, the combination can increase the amount of serotonin to the point where it overwhelms the brain's ability to maintain chemical balance.
Mixing drugs that activate different neurotransmitters can also create deadly combinations. Some illicit drug users are in the habit of engaging in what they call "rolling," taking one different drug after another to see what their effects will be. Combining ketamine with a drug such as cocaine, which inhibits the re-uptake of the neurotransmitter dopamine, creates a toxic combination in the synapses that can kill the neurons. According to researcher Dr. William White, "Any combination of drugs with ketamine is extremely dangerous."36
Although the dangers of illicit ketamine use have been sounded by many experts, many psychiatrists believe that ketamine still has legitimate uses. In particular, research has focused on helping alcoholics and drug addicts and on curing some forms of depression. Specifically, researchers believe that the near-death experiences can have therapeutic value in helping users acquire renewed interests in self-improvement, spiritual contentment, social recognition, achievement of life goals, and improvement of family and social life. According to Dr. K. L. R. Jansen, "After-effects [of ketamine] can include an enhanced joy in living, reduced fear of death, increased concern for others, reduced levels of anxiety and neurosis, reduced addiction, improved health and a resolution of various symptoms."37 Yet despite their recognition of ketamine's legitimate applications, the drug continues to concern authorities. The Drug Enforcement Administration keeps track of this and all other hallucinogens and controls access to them.