Higher and Higher

Drug Cocktails— Pleasures, Risks, and Reasons

"I've seen people do E and when the E doesn't work, they do K and GHB, and drink. And then they fall on the floor in convulsions," said one bartender who has worked at some of the druggiest hot spots in New York. "It's very scary. It's to do with how bad the person's reality is, and how bad they want to escape from it."

Disco polypharmacy involves risk. Nobody knows how safe some of these mixtures really are. Some say that not necessarily all combinations are bad for you— for instance, partygoers claim that swallowing Ecstasy followed by LSD (known as "candy flipping") can be extremely therapeutic. "I've interviewed a lot of people about the practice . . . and I have had no reports of any adverse physical or psychological effects from the combination, other than the limited adverse effects that can be caused by taking each drug separately," says Dr. Katherine Bonson, a psychopharmacologist at the National Institute of Mental Health. But other combos— say, the mix of alcohol, GHB, and ketamine referred to as a "Special K-lude"— appear more fraught with peril.

Still, finding out authoritatively which blends are chancey is difficult because of the paucity of reliable scientific research. What happens, for instance, when you take AIDS medications with MDMA, a common combo in gay clubs? How important is individual genetics in determining how a person metabolizes various drugs? Why can one person die from combining E and K, while a hundred others will swear it's one of the most life-affirming highs available, particularly when you sniff K after ingesting the E? Conclusive answers are not easy to find. For one thing, pharmaceutical companies don't test products for bad reactions with illegal substances.

Chemist and author Dr. Alex "Sasha" Shulgin, who wrote the drug bibles PIHKAL (Phenethylamines I Have Known and Loved) and TIHKAL (Tryptamines I Have Known and Loved) and rediscovered MDMA in the early '70s, points out that "There's been precious little clinical study done on these drugs individually, and in combination, virtually nothing— because of the 'War on Drugs,' no one in a position of authority will approve it. In our day and age, there's no way you can set up a study of the physical-pharmacological action of something that's illegal."

Filling the knowledge gap left by authorities are the inevitable rumors— urban myths about how MDMA drains your spinal fluid, or how acid is cut with rat poison. Of course, there's always the Internet, which features acres of information about illegal pharmaceuticals. But figuring out how much of that info is reliable is frustrating.

"Because it's so difficult to do above-ground research, there's been this flourishing of semi-informed underground research," says Rick Doblin, founder of MAPS (the Multi- Disciplinary Association for Psychedelic Studies), which in 1996 conducted a chemical analysis of Ecstasy samples taken from clubs and raves, and found that roughly half the hits contained no MDMA whatsoever. The good news (available on Doblin's Web site, www.maps.org) is that the stuff the bogus E was cut with— Sudafed, caffeine, cough suppresant, chalk— isn't that harmful.

Dr. Bonson is another source of dependable data. For the last five years, she has conducted an ongoing nonclinical Internet survey (at her e-mail address, kbonson@codon.nih.gov) of people who mix illegal with prescription drugs, focusing on the interaction between hallucinogens and antidepressants.

"If you were on Prozac, or other SSRIs [Seratonin Selective Re-Uptake Inhibitors], what happened was there was a diminishment of response to drugs like LSD and MDMA," she reveals. "That's in contrast to people taking Lithium or a tricyclic antidepressant, who had a much greater response to the hallucinogens, to the point where some lapsed into an unpleasant fugue state where they didn't know where they were."

But the most hazardous concoction she found was Ecstasy and MAO inhibitors like Nardil. "The combinations," she warns, "can produce an extremely dangerous increase in blood pressure known as hypertensive crisis. Which can lead to death."

Alex Shulgin spearheaded the current polydrug boom with his pioneering work in the '60s on the synthesis of new psychoactive substances, which he tested on himself. He and his wife, Ann, also a researcher, submit that drug combinations interact in two different ways: potentiation and synergism. Potentiation is when one drug increases the activity of another; synergism is when each drugs enhances the activity of each other.

As an example of synergism, the Shulgins cite what they regard as the benign practice of taking MDMA followed a couple hours later by other psychedelics like ketamine or 2CB. "The best effect is when coming down off the MDMA, take a lower dose of 2CB," advises Ann. In this way, Ecstasy boosts the action of the 2CB.

By contrast, as an example of potentiation, the Shulgins refer to the popular clubland combo of alcohol and the liquid steroid GHB. Both drugs are depressants which slow down the nervous system. When taken together, the alcohol greatly increases the GHB's potential for inducing a coma.

Like a Boy Scout, Dexter (not his real name) always comes prepared. A self-described high-school nerd who, with aid of gyms and chemicals, blossomed into a sex magnet, he takes his drugs seriously. A typical Saturday night for the thirtysomething software executive begins around 8 p.m. with a hearty meal, to sustain him for the night ahead. Around midnight, back at his apartment, he takes a hit of Ecstasy. He also consumes Ammodium AD (because MDMA gives him diarrhea), followed by Carbo-Force, a liquid carbohydrate supplement.

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