Volume 3, Number 4 June 2002

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Improving Childhood Asthma Outcomes in the U.S.

Jury Awards $9 Million in Asthma Death

Recreational Drug Sites on the Internet

Stepped-Up Vigilance Needed for School Food Safety

CDC Sees School Health Role in Skin Cancer Prevention

Elementary School Intervention Seen Affecting Sexual Behavior at 21

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Just a Click Away: Recreational Drug Sites on the Internet

Health care providers who care for adolescents should be aware of the content of drug sites on the Internet that provide alluring information about the newest recreational drugs, information that it may be hard or impossible to find in the medical literature, according to an article in the June issue of the journal Pediatrics.

"Adolescents, who are often adept at navigating these Internet resources, may be particularly susceptible to these communications. Knowledge about what teens are viewing may help health care practitioners better understand their patients’ own informational data bank, stay informed about the latest trends in drug abuse, and position themselves as more credible resources to their patients," suggests medical technologist Dr. Paul Wax of the Good Samaritan Regional Medical Center in Phoenix, Arizona.

There has been a dramatic change in the past decade in the types of recreational drugs that are currently being used by young people in the United States, with a new generation of illicit drugs including methylenedioxymethamphetamine (MDMA: Ecstasy), hydroxybutyrate (GHB), and ketamine increasingly available to young people at low cost and perceived safety. A report of the Drug Abuse Warning Network released in December 2000 indicated that emergency department episodes related to MDMA, GHB, and ketamine increased significantly in the period from 1994 to 1999. In a 2000 survey, 8 percent of high school seniors (14 percent in the West) reported that they use or have used MDMA; and surveys from 1994 to 1999 demonstrate a sharp rise in MDMA use by college students.

Given that level of interest, it is not surprising that websites focused on recreational drug use have sprouted on the Internet, Dr. Wax notes. Some of the sites, sponsored by government entities such as the National Institute on Drug Abuse or by private groups, try to educate the public about the potential harmful effects of drug abuse, but other sites glamorize and appear to condone drug use, with frequent use of buzzwords such as "safe drug use" and "responsible drug use."

To illustrate that adolescent use of these websites can have a direct impact on drug-taking behavior, the article describes two cases in which adolescents presented to hospital emergency rooms with seizures, hallucinations, and irrational behavior after recreational drug-taking that was directed by suggestions on Internet websites, one involving a new designer drug that was unfamiliar to the regional poison control center and medical toxicologists.

It is not at all hard to find Internet sites with information about recreational drugs—anyone with Internet access can do it, by typing in the name of an address or, alternatively, simply typing in the name of a drug on a search engine such as Yahoo, which will provide connections to many sites. Dr. Wax summarizes the information that’s available on a number of the most widely used sites, including:

  • Vaults of Erowid (www.erowid.org), "one of the most encyclopedic of all the Internet drug-related websites." Started in 1995, the site has more than 13,000 pages of information and receives hits from 18,000 visitors a day. In the "About Erowid" introductory page, the site notes that "Although the risks and problems are widely discussed, it is clear that psychoactive plants and chemicals have played a positive role in many people’s lives." Information is provided on more than 170 different chemicals, plants, herbs, pharmaceuticals, and smart drugs, some familiar to health care providers (cocaine, heroin, alcohol, tobacco) but others likely to be unknown, such as derivatives used as hallucinogens. For many of the drugs, Erowid provides information about dose, effects, health, images, legal aspects, chemistry, experiences, drug testing, spiritual and ritual aspects, cultivation, books, journal articles, media, and medical uses. There are numerous links to other websites on the Internet.
  • Lycaeum (www.lycaeum.org), another well organized and comprehensive site, says it "works to promote public education about all aspects of psychoactive drugs and drug use, including, but not limited to, visionary and entheogenic aspects of drug use, harm reduction, and health and legal risks of drug use." The site includes more than 800 "trip reports" of drug experiences submitted by readers, some depicting problems associated with drug use but others citing the benefits of the drug trip and offering dosing recommendations.
  • DanceSafe (www.dancesafe.org) discusses extensively the use of many recreational drugs, especially those used at dance and rave parties. It reminds the reader that many of the drugs at raves are illicit but conveys the message that if proper precautions are taken, drugs can be used safely. Drug information is provided on Ecstasy, cannabis, cocaine, GHB, ketamine, nitrous oxide, tobacco, 2CB, mushrooms, alcohol, speed, and LSD. For Ecstasy, the site offers an adulterant screening or "pill testing" program, billed as a "harm reduction" service because it attempts to identify harmful substances that may be sold as or mixed with Ecstasy.

The Pediatrics article suggests that health care providers consider referring adolescent patients and their parents to websites provided by the medical community, such as the NIDA’s www.clubdrugs.org, for additional information on many of those drugs. Other websites that convey an anti-drug message include www.projectghb.org, www.drugs.indiana.edu/druginfo, and www.ghbkills.com.

Reprints of the article "Just a Click Away: Recreational Drug Web Sites on the Internet," by Paul M. Wax, MD, published in the June 2002 issue of Pediatrics, are available by e-mail from paulwax@bannerhealth.com.

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