Rave parties, or raves, began in England in the 1980s and spread to the United States in the early 1990s. These events are marathon dance parties held in clandestine locations, including warehouses, nightclubs, and farm fields, accompanied by extravagant light shows with themes emphasizing harmony, empathy, and a sense of belonging. Club drugs are used to increase feelings of closeness with others and to heighten the experience through sensory enhancement, visual distortion, and illusion [3]. Alcohol is generally not sold at raves, but designer and other drugs are obtainable and affordable. Also, "power drinks" are often sold. These drinks consist of fruit juice mixed with amino acid powders and B vitamins to replenish fluids lost during strenuous marathon dancing [4].

Rave parties, or raves, began in England in the 1980s and spread to the United States in the early 1990s. These events are marathon dance parties held in clandestine locations, including warehouses, nightclubs, and farm fields, accompanied by extravagant light shows with themes emphasizing harmony, empathy, and a sense of belonging. Club drugs are used to increase feelings of closeness with others and to heighten the experience through sensory enhancement, visual distortion, and illusion [3]. Alcohol is generally not sold at raves, but designer and other drugs are obtainable and affordable. Also, "power drinks" are often sold. These drinks consist of fruit juice mixed with amino acid powders and B vitamins to replenish fluids lost during strenuous marathon dancing [4].

Club drug use may be described as a youth movement. While college is frequently the time of first MDMA use, use in high school students has become more common. The Youth Risk Behavior Survey 2019 reported that 3.6% of high school students nationwide had used MDMA at least once during their lifetimes [5,41]. In 2020, a total of 1.8% of high school seniors had consumed MDMA during the previous year, and approximately 0.3% admitted to being current users [40].

In 2019, more than 24.3% of high school seniors stated that MDMA was "fairly easy" or "very easy" to obtain. In 2001, this figure was as high as 61.5% [40]. MDMA use peaked in 2001; in 2003, a sharp drop was noted, probably related to the increased perception of risk [7,40]. The drop in past-year use of MDMA has continued through 2020. The combined past-year rates of students in grades 12, 10, and 8 showed lower rates in 2020 than in 1996, the first year MDMA use was measured [40].

MDMA reaches peak plasma concentration within two to four hours following oral ingestion. Its half-life is approximately eight hours, and metabolism occurs primarily through the hepatic enzyme CYP2D6 [17,18].

The alteration of perception initiated by MDMA use may be experienced as dysphorogenic, and MDMA-naïve subjects have reported anxiety, mild depersonalization or derealization, moderate thought disorder, and poor coordination. MDMA ingestion can trigger psychiatric disturbances, including depression, panic attacks, and persisting perception disorder ("flashbacks"). It has been proposed that these disturbances are more likely to emerge in individuals with a vulnerability to mental illness [2]. Experienced MDMA users taking the drug under controlled conditions have frequently reported impaired decision-making ability, difficulty in concentrating, and decreased mathematics performance [8].

Patients admitted to the emergency department for MDMA toxicity typically present with agitation, anxiety, tachycardia, hypertension, or hyperthermia. There is no antidote for MDMA toxicity; treatment is limited to supportive care [9,20].

GHB increases brain dopamine, serotonin, and acetylcholine and interacts with the opioid system. It is involved in the regulation of GABA, serotonin, and acetylcholine. GHB also disinhibits dopamine release and activates tyrosine hydroxylase, which together act to increase the central dopamine levels associated with the reinforcing effects of GHB [2].

Low doses of ketamine are associated with feelings of relaxation, while higher doses can produce dreamlike states, hallucinations, visual distortions, and unpleasant sensations of near-death experience. Some common effects of ketamine use are delirium, amnesia, and depression. Adverse effects include nausea, immobility, abnormally low body temperature, anxiety, dissociation, depression, recurrent flashbacks, impaired attention, learning disability, and symptoms of schizophrenia. Cognitive dysfunction related to attention, learning, and memory can result from chronic abuse [2].

Several club drugs have been implicated for use in sexual assault because victims have difficulty resisting the attack due to the profoundly sedating and intoxicating drug effects. GHB has effects that are similar to alcohol, and a combination of alcohol and GHB puts a potential victim at heightened risk of loss of consciousness. Flunitrazepam causes similar symptoms. Due to its anterograde amnestic effects (inability to recall events taking place while under the influence of the drug), flunitrazepam is more commonly used in drug-induced sexual assault [2,9]. The memory problems associated with both drugs and the fact that GHB clears from the body within 12 hours make detection difficult and increase the complexity of attempts to prosecute perpetrators utilizing these drugs [22]. In addition to GHB and flunitrazepam, ketamine is being used increasingly as a "date rape drug" due to its dissociative effect [17].