increase in blood pressure, spasms and dehydration are all common side effects of mdma and methamphetamine. breathing and respiratory issues, drowsiness, nausea and confusion are common side effects of said drugs. they can also make the user anxious, stressed and panicked, or even hallucinate. withdrawal is also a risk with many club drugs. drug cravings as the chemical leaves the user's body can be complicated by sleep deprivation, dehydration and hypoglycaemia to result in debilitating 'come downs' which can result in depression-like symptoms. in the worst instance, club drugs result in the death of the user from cardiac arrest or water intoxication due to the increase in heart rate and thirstiness induced. inconsistency in the strength and exact composition of the supplied drug causing users to overdose. wide variance in the measured rate of deaths caused by drugs such as ecstasy across countries suggest that user and societal/environmental factors may also affect the lethality of club drugs. drug interactions another risk is drug interactions. some club drug users take multiple drugs at the same time. "club drugs often are taken together, with alcohol, or with other drugs to enhance their effect." drug interactions can cause hazardous side effects. when club drug users are in a liquor-licensed nightclub, users may mix pills or powders (mdma, 2c-b, ghb, ketamine) with consumption of alcoholic drinks such as beer, wine or hard liquor. some depressants, such as rohypnol, are dangerous to take while drinking alcohol. "ketamine often is taken in "trail mixes" of methamphetamine, phencyclidine, cocaine, sildenafil citrate (viagra), morphine or heroin." injury or death due to risky behaviour another risk with club drugs is one shared by all drugs, from legal drugs like alcohol to abused over-the-counter drugs (taking large amounts of dextromethorphan cough syrup) and illegal drugs (bzp, amphetamines, etc.): while impaired, the user is more likely to be injured, engage in dangerous or risky behaviour (e.g., unsafe sex) or, if she or he drives, have an accident resulting in injury or death due to impaired driving. misrepresentation a tablet sold as mdma. it contained no mdma; instead, it contained benzylpiperazine (bzp), methamphetamine, and caffeine. in many cases, illegal club drugs are misrepresented. that is, a dealer will tell a purchaser that she/he has a certain illegal drug for sale, while in fact the dealer's pills, capsules or bags of powder do not contain that chemical. for example, mdma ("ecstasy") is very hard to synthesize in illegal underground labs, and methamphetamine is much easier (it can be made from household chemicals and over-the-counter cold remedies containing pseudoephedrine). as such, what dealers sell as mdma is often methamphetamine powder. similarly, pills sold by drug dealers as lsd, a drug which only the top chemists have the training to synthesize, most often contain no lsd; instead, they often contain pcp, a veterinary tranquilizer which produces dissociation and hallucinations in humans. in some cases, the dealer has intentionally substituted a less expensive, more available illegal drug for another drug. in other cases, the substitution was made by a higher-level drug cartel or organization, and the dealer may in fact believe that the bogus product is mdma or lsd. "cutting", adulteration and "spiking" baggies of cocaine adulterated with fruit-flavoured powder and colouring. with the exception of marijuana, which typically is uncut and unlaced, many illegal drugs, especially those which come in a powder or pill form are "cut" with other substances or "spiked" with other drugs. cocaine, amphetamines and other stimulants often have caffeine powder added, as this increases the dealer's profit by bulking out the powder, so that less expensive cocaine or amphetamine has to be used in making the product. some substances used to "cut" illegal drugs are not inherently harmful, as they are just used to "pad" or "bulk out" a quantity of the illegal drug and increase profits, such as lactose (milk sugar), a white powder often added to heroin. even fairly innocuous powders that are added to illegal drugs, though, can have adverse effects with some routes of illegal drug administration, such as injection. with some drugs, adulterants are sometimes added to make the product more appealing. for example, "flavoured cocaine" has flavoured powder added to the drug. whereas the main goal of "cutting" is to bulk out a quantity of pure, expensive illegal drugs with an innocuous and not overly harmful substance (lactose) or fairly low-impact product (e.g., caffeine in amphetamine pills), the goal of "spiking" is to try to make lower-quality illegal drug or a lower-potency source of illegal drugs give the user the type of "high" or psychedelic experience she or he is seeking. while it was earlier stated that marijuana is most often uncut and un-spiked, some dealers add pcp to marijuana (this is nicknamed "wet marijuana"), because adding this dissociative psychedelic to low-grade, low-thc marijuana can convert it into a cannabis that creates striking hallucinogenic effects. drug researchers learned that some dealers were spiking marijuana when they tested us teens who stated that they had only used a single illegal drug (marijuana) and the teens tested positive for marijuana and pcp. some dealers who have a very small quantity of mdma powder to sell "spike" it with less expensive and easier to produce methamphetamine powder. street cocaine is often adulterated or "cut" with talc, lactose, sucrose, glucose, mannitol, inositol, caffeine, procaine, phencyclidine, phenytoin, lignocaine, strychnine, amphetamine, or heroin. a common methamphetamine adulterant is dimethyl sulfone, a solvent and cosmetic base without known effect on the nervous system; other adulterants include dimethylamphetamine hcl, ephedrine hcl, sodium thiosulfate, sodium chloride, sodium glutamate, and a mixture of caffeine with sodium benzoate. addiction not all club drugs are addictive (e.g. nitrous oxide). however, some club drugs are addictive. amphetamine heavily used in recreational fashion pose a risk of addiction. cocaine addiction is a psychological desire to use cocaine regularly. cocaine overdose may result in cardiovascular and brain damage, such as: constricting blood vessels in the brain, causing strokes and constricting arteries in the heart; causing heart attacks. the use of cocaine creates euphoria and high amounts of energy. if taken in large, unsafe doses, it is possible to cause mood swings, paranoia, insomnia, psychosis, high blood pressure, a fast heart rate, panic attacks, cognitive impairments and drastic changes in personality. the symptoms of cocaine withdrawal (also known as comedown or crash) range from moderate to severe: dysphoria, depression, anxiety, psychological and physical weakness, pain, and compulsive cravings. ghb addiction occurs when repeated drug use disrupts the normal balance of brain circuits that control rewards, memory and cognition, ultimately leading to compulsive drug taking. although there have been reported fatalities due to ghb withdrawal, reports are inconclusive and further research is needed. ketamine risks ketamine use as a recreational drug has been implicated in deaths globally, with more than 90 deaths in england and wales in the years of 2005–2013. they include accidental poisonings, drownings, traffic accidents, and suicides. the majority of deaths were among young people. this has led to increased regulation (e.g., upgrading ketamine from a class c to a class b banned substance in the u.k.). at sufficiently high doses, ketamine users may experience what is called the "k-hole", a state of extreme dissociation with visual and auditory hallucinations. acute treatment a music fan who has had a drug overdose at the woodstock music festival is placed onto a wheeled cot by paramedics. the main treatment for individuals facing acute medical issues due to club drug consumption or overdoses is "cardiorespiratory maintenance". since club drug users may have consumed multiple drugs, a mix of alcohol and other drugs, or a drug adulterated with other chemicals, it is hard for doctors to know what type of overdose to treat for, even if the user is conscious and can tell the medical team what drug they think they took. a doctor recommends "cardiac monitoring, pulse oximetry, urinalysis, and performance of a comprehensive chemistry panel to check for electrolyte imbalance, renal toxicity, and possible underlying disorders" and preventing "seizures". some doctors use activated charcoal and a cathartic" to detoxify the drugs in the gastrointestinal system. cooling the victim is recommended to avoid hyperthermia. if the victim overdosed on rohypnol, the antidote flumazenil can be given; this is the only club drug for which there is an antidote. history in the mid to late-1970s disco club scene, there was a thriving drug subculture, particularly for drugs that would enhance the experience of dancing to the loud dance music and the flashing lights on the dancefloor. substances such as cocaine (nicknamed "blow"), amyl nitrite ("poppers"), and quaaludes. quaaludes were described as "...other quintessential 1970s club drug", which suspends motor coordination.") according to peter braunstein, "massive quantities of drugs were ingested in discothèques." throughout the 1980s, the use of club drugs expanded into colleges, social parties, and raves. as raves grew in popularity through the late 1980s and into the late 1990s, drug usage, especially mdma, grew with them. much like discos, raves made use of flashing lights, loud techno/electronic dance music to enhance the user experience. before their scheduling, some club drugs (especially designer drugs referred to as research chemicals) were advertised as alcohol-free and drug-free. another reason that drug producers create new drugs is to avoid drug laws. since the early 2000s, medical professionals have acknowledged and addressed the problem of the increasing consumption of alcoholic drinks and club drugs (such as mdma, cocaine, rohypnol, ghb, ketamine, pcp, lsd, and methamphetamine) associated with rave culture among adolescents and young adults in the western world. studies have shown that adolescents are more likely than young adults to use multiple drugs, and the consumption of club drugs is highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence. in australia club drugs are used in australia in a variety of dance clubs and nightclubs. one in ten australians have used mdma at least once in their lifetime; one in thirty have used mdma in the past 12 months. one in a hundred australians has used ketamine at least once in their lives and one in five hundred over the past 12 months. one in two hundred australians have used ghb at least once in their lives and one in one thousand in the past 12 months. regarding the entire australian population, seven per cent of australians have used cocaine at least once in their lifetime and two per cent of australians have used it in the past 12 months. today, these drugs are widely used across age and socioeconomic groups and often sold in nightclubs and pubs throughout australia.