Club drugs include Ecstasy (MDMA), the ‘date rape drug’ (Rohypnol), Crystal meth or Speed (Methamphetamine), acid (LSD), Special K (Ketamine) and Poppers (amyl nitrates). Increasingly the dangers of these drugs are escalated by taking more than one at the same time.
Typically taken at raves, parties, and clubs, these drugs are used to enhance or distort sensations and perceptions, to feel euphoric, and experience greater enjoyment. They are perceived to increase self-confidence and physical energy.
Of course these drugs are illegal for a reason. They have adverse effects and can be dangerous, even fatal. Problems arise from toxicity due to excessive dose, from interactions, and due to impurities. Illegal drugs are not monitored for quality.
The FDA (US Food and Drug Administration) which regulates and licences new medications, does not stipulate any assessment of pharmacological interactions of new medicines with commonly used illicit drugs. Adverse effects of illegal drugs commonly go unreported.
Direct research on drug interactions with illegal drugs would not obtain ethical approval and is not conducted. Evidence regarding interactions, or possible interactions, comes from case reports, and is sparse.
Recreational substances are also being taken in conjunction with erectile dysfunction (ED) medicines: phosphodiesterase-5 (PDE5) inhibitors such as Viagra / sildenafil, Cialis, Levitra and Spedra. Some men take ED medication to counteract ecstasy and methamphetamine’s side effect of reduction of sexual function. Other illicit drugs such as heroin, cocaine, and marijuana may also affect sexual function, prompting co-usage of ED medications.
Men with no medical requirement for these medications seek a heightened sexual experience and find they can have intercourse more times per night. “Sextasy” is a very descriptive expression. Men may mistakenly take erectile dysfunction medicines, as a club drug, to enhance mood. ED medicines have physical effects; they are not psychoactive. The only psychological effect they might have is by boosting sexual confidence.
Risks
Potentially dangerous interactions are a real risk. Serotonin syndrome (a type of poisoning) can occur when taking Viagra-type drugs and ecstasy together. Due to increased levels of serotonin, disorientation and tremors can escalate to hallucinations, seizures, and loss of consciousness and coma.
One publication reports a heart attack following combined use of cocaine, alcohol, sildenafil, and having sexual intercourse. The role of each possible factor is unknown.
Viagra and Poppers
A well-known potentially fatal drug combination is an erectile dysfunction medication together with amyl nitrate, popularly known as ‘poppers’. Both drugs dilate blood vessels causing a drop in blood pressure. Depending on the degree of blood pressure lowering, people may experience light-headedness or fainting, but the consequences can be more serious. If the heart does not get enough blood flow and oxygen levels fall, the result is a heart attack – for the brain the result is a stroke.
Viagra and Ecstasy
The interaction between MDMA (Ecstasy) and the Viagra-type medicines (PDE5 inhibitors) is less well understood. Although there are no documented adverse outcomes there are theoretical issues. MDMA stimulates the cardiovascular system: increasing heart rate, blood pressure, and body temperature. Viagra (sildenafil) type drugs are vasodilators, which has the opposite effect on blood pressure. The heart beats faster in response in an attempt to normalise the blood pressure. Rather than cancelling each other out, the effects of both could cause a dangerously high pulse rate, especially in someone with pre-existing heart disease.
Another possible interaction between MDMA and PDE5 inhibitors could be beneficial. Spanish research in 2011 demonstrated that giving Sildenafil (generic Viagra) twenty-four hours prior to high, usually neurotoxic doses of MDMA, reduced the damage to the rats’ brains. The authors write: “Our findings indicate that sildenafil afforded significant protection against MDMA-induced 5-HT.” Of course humans are not rats and the doses of MDMA were much higher than those commonly used by people. Whether taking an ED medication alongside MDMA would decrease neurological symptoms such as tiredness or low mood is not known, nor is it advisable to try.
Priapism
Priapism is a medical emergency. It is a prolonged, often painful erection. Blood fills the spongy tissue of the penis creating an erection. The pressure in the erect penis disrupts the normal blood supply, depriving oxygen supply. Medical assistance should be sought if an erection lasts for more than four hours. Treatment is aspiration: removing the blood in the penis with a needle and syringe. If left untreated permanent damage can occur, resulting in future erectile dysfunction.
There are several causes of priapism, but all the tablets for erectile dysfunction such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, discontinued February 2023), and avanafil (Spedra) are implicated, and combinations particularly with alcohol, marijuana, or cocaine are postulated to increase the risk.
Risky sexual behaviour
Another issue is risk-taking behaviour. Having sex whilst high, when one or more club drug has been taken, is associated with taking less precautions and thus a greater risk of HIV. Side effects of drugs can increase the risk too – dehydration due to Speed decreases lubrication and increases the chance of tears of the anus or vagina and thus of HIV infection.
Women are effected too – illicit Viagra is being taken by both sexes.
Legal medicine supplies
When obtaining Viagra from a doctor, your GP, or online, your medical history and other medications will be checked to ensure compatibility. Getting any medication on the street or in clubs without being medically evaluated can be risky. Another issue with illegal supplies of medication is impure or fake medication. These can cause accidental overdoses or other toxicity. Not only the club drugs, but unlicenced erectile dysfunction medicines can be harmful. Fake Viagra pills can be made in unregulated, non-sterile locations and may even contain toxic chemicals such as arsenic and lead. Thus sildenafil from a non-regulated website can be dangerous, even without taking party drugs.
For all of the reasons above, use drugs safely. Do not use illegal drugs as they have unknown including adverse effects on your mind, body, wallet, and life. Take prescription medicines only if prescribed for yourself and at the recommended doses. Get medicines from fully regulated sources.
Taking Viagra if you don’t have erectile dysfunction
Dr Graham Jackson, a consultant cardiologist at Guy’s hospital, who was part of the research team when Pfizer developed Viagra, states:
Nothing much would happen if someone without erectile dysfunction took Viagra, although they might think they feel better, psychologically. But it would make a difference if you took it along with other drugs. Cocaine, marijuana, ecstasy, alcohol, nicotine, crystal meth – they all can cause erection problems. Viagra dilates the blood vessels and allows blood to flow into the penis when these drugs are stopping it.
For most young people, taking Viagra won’t do any harm. Nothing much would happen.
From Everything you need for an all-night party … his and hers Viagra.