Club drugs are psychoactive substances linked to rave and private party’s cultures, which have been proliferating since 1990. They have remained, over the years, a challenge for public health practitioners, particularly because of their spread among adolescents and young adults [1, 2].

The U.S. National Institute on Drug Abuse [3] in its “Community Alert on Club Drugs” identified four main psychoactive drugs in club drugs: Ecstasy (MDMA), ketamine, methamphetamine, and Lysergic acid Diethylamide (LSD). A growing body of international research highlights the use of club drugs to be associated with serious physical health problems and psychiatric disorders [4-6], risky sexual behaviour [7] and violence and crime [8, 9].

The health problems associated with the use of synthetic substances include both acute effects resulting from their use and long-term health damage, which is often different for other types of commonly abused drugs. For example, the consumption of illegal methamphetamines has been associated with various acute adverse effects, including anxiety, headache, tremors, nausea, abdominal cramps, sweating, dizziness, and decreased appetite [10]. MDMA, which initially causes euphoria and mental stimulation, can produce adverse reactions such as hypothermia, seizures, and other problems of multiorgan deficiencies [11]. Long-term damage from synthetic drug use, particularly observed from ketamine use, includes addiction problems among chronic users, urinary problems, and other physical forms of harm [12]. In general, consumers with a history of mental health problems are exposed to a higher risk of acute psychological and psychiatric adverse effects, ranging from mood loss, anxiety and aggression, to forms of depression and psychosis [4].

Synthetic drugs have only recently entered the European market [10]. Although their use in the general population is low compared to more traditional drugs, such as cocaine, heroin, and cannabis, they have the potential to penetrate some population groups, especially young people who attend particular social events in nightlife [13].

In fact, epidemiological studies have shown that factors associated with loisir, or recreational nightlife, such as certain music preferences and the choice of particular places of entertainment, are important predictors of illegal drug use in several European countries [14]. The use of psychotropic drugs is widespread especially among clubbers and ravers [15, 16]. Several surveys have shown that these “subcultures” have significantly more experience with drugs than the general population, with England reporting 90% of drug use among clubbers compared to 10% of young people in the general population [10, 17]. In particular, some authors [18] have identified a positive correlation between the use of synthetic drugs and alternative music styles in the electronic music scenario. For example, one study [19] showed that individuals who prefer dance music, compared to those who like other genres such as rock or funk, are at greater risk of using illegal drugs.

In Italy, the use of club drugs was observed in a survey [20] of 18- to 30-year-old individuals attending five nightclubs in Rome: of the participants, 78% had a lifetime history of consuming drugs, and 39% had consumed a drug in the previous 12 hours. The researchers found that LSD was most commonly used at 24%, followed by mephedrone at 18.8%, ketamine at 18%, and psylocybin at 4% [20].

An Italian survey [13] analysing wastewater showed an increase in ketamine use from 2010 to 2014, especially in the major towns of northern and central Italy. The concentrations of ketamine detected are similar to those in Spain and Belgium and higher than those found in the United States and in the Czech Republic. They have increased over time, particularly in several major urban areas such as Milan, Rome, Turin, and Bologna. The concentration of this substance seems to have increased in some small cities such as Cagliari, Gorizia, Bari, and Potenza as well. These findings suggest, in line with the EMCDDA report [10], that a general increase in synthetic drug use is related to night-time loisir. In fact, the use of MDMA increasing over the weekends and decreasing on weekdays [21] suggest a relationship between the “darkness world” of nightlife and the consumption of synthetic drugs. Another important phenomenon, common among many subcultures including ravers, is the polydrug use of narcotic substances. A study [22] reported that 75% of dance club attendees use an average of five drugs at the rave. An Italian survey [2] has also shown that there is a high proportion of polydrug users in night-time loisir. Polydrug use presents a challenge to public health due to the unpredictable pharmacological, toxicological, and psychopathological effects of the interaction between different substances on vulnerable individuals. Furthermore, in investigating the relationship between individuals, locations, and choices of consumption, the motivations linked to consumption play an important role [23]. According to the social learning theory, expectations about drug use are defined as beliefs about the effects of consumption and influence when and how an individual decides to take or not take a certain substance [24]. Expectations depend on many factors, including social norms, perceived effect in other people, personal experience with consumption, and affected consumption behaviour. Expectations about the effects are strong predictors of intentions to use some categories of drugs [25] and motivate consumption behaviour. The literature shows different reasons for drug use [26]. Among these, relaxation, intoxication, improvement in socialization, and alleviation of negative moods seem to be the main ones [27]. The wish to use drugs to feel better with others [28], as well as to increase the amount of time spent with others [29], is associated with an increase in consumption. In addition, some “motivational” contexts can influence patterns of consumption of certain drugs as well [30]. The use of synthetic drugs amplifies the sensations of the rave environment, such as the light and music; facilitates socialization; or creates the sense of “being united” [31]. For some consumers, participating in the rave experience can become a spiritual experience [32], which is sought after to feel a sense of belonging to particular social groups [33].

At present, little data is available in the peer-reviewed scientific literature and health professionals have limited knowledge on the subject of polydrug use. In particular, synthetic drugs have an important social impact and contribute significantly to the global burden of diseases [34].

For the above-mentioned reasons, increasing the amount of knowledge on the consumption styles of some subcultures of synthetic drug users and examining their demographic characteristics to understand their motivations and contexts are of particular interest in terms of public health.

The aim of the present survey is to explore the sociodemographic characteristics, consumption styles, motivations, contexts of use, representations of risk factors, and degree of overall satisfaction with life in a sample of synthetic drug users.

Accurate data on the behaviours of club drug users are difficult to obtain due to the illegal and stigmatising nature of their behaviour, as consumers may be reluctant to participate in large-scale structured research. For this reason, the literature has proposed more suitable approaches, namely, targeted sampling, to balance recruitment effectiveness and an adequate representation of specific subgroups [35]. Specifically, the ethnographic method has proved effective as a recruitment technique for consumer populations. Consumers of club drugs tend to gather at specific locations, such as nightclubs, bars, and rave parties [36]. The target population was then locked into its “natural environment,” which is a nonprobabilistic sampling method used with hard-to-reach populations.

Our preliminary results show a high frequency of polydrug use in the population of ravers under investigation. Almost the entire sample consumed MDMA, speed, and LSD at a very high declared frequency. The picture that emerges is that of a target group of young adults, both men and women, who are poorly integrated into their social contexts. More than three-fourths of the sample have a low level of education, and only about 10% have a full-time job. According to some authors [37], polydrug consumption of substances is more widespread among disadvantaged socioeconomic classes.

Even the most popular leisure activities describe a “passive” population that is more involved in leisure activities than in structured sports or hobbies, eg, team games and writing. This “passivity” could be linked to a widespread unemployment situation or to an unsatisfactory employment and economic situation. Some studies [38] have reported that the use of synthetic drugs seems to be more represented among young people with a low socioeconomic level.

Among synthetic drugs, every user reported having a lifetime history with MDMA and used it the most frequently in accordance with studies that, in Italy, see consumption increasing, especially in the north of the country and especially on weekends [21]. Similar to other surveys [39], our study sample reported frequent use of more traditional illicit drugs, particularly cocaine, along with the use of more synthetic drugs.

As far as the perception of risk factors is concerned, it is interesting to note that it is precisely the contexts of primary and secondary socialization, e.g., family and friends, that are indicated as favouring the use of synthetic substances by consumers themselves. Barnes and his colleagues [40] argued that socialisation is the cornerstone of individual and cultural psychological factors when problematic behaviours begin. There are also mechanisms through which a family’s influences can increase children’s exposure to risky situations.

With respect to the contexts of consumption, participants listed “illegal party or self-managed rave” as the most frequent answer among the other contexts. We need to consider that this type of party, which is illegal, can have a fairly complex organization behind it. Therefore, these social contexts are directly linked to the consumption of club drugs [15]. Only a small percentage of users said they use synthetic drugs alone, and according to other studies [39], the group factor, combined with the sought-after effect of entertainment, is an element that encourages use among young adults. Amusement is the main motivation for the use of synthetic drugs. It should be noted that all consumption motivations received high scores that were well above the middle of the range of the scale. As is well known, novelty-seeking and sensation-seeking [41] behaviours are individual motivational factors that can determine the conduct of drug abuse.

The analysis of correlations shows interesting consumer profiles: The more respondents reported using MDMA, the more likely they were to consume speed and LSD as well. Furthermore, LSD consumption is directly proportional to ketamine use as well. Crossing from one substance to another, a pattern of use we saw in the consumption styles of our subjects can be fatally dangerous. MDMA and speed, in particular, are two substances capable of increasing serotonin and dopamine concentration levels in the central nervous system. Ketamine and LSD are two psychedelic substances whose summative effect can lead to an unpredictable trigger of the hallucinatory or “trip” experience.

Consumers seem to choose substances belonging to the same “family,” MDMA and speed as methamphetamines and ketamine and LSD as psychedelic substances, probably to pursue their specific effects. In particular, ketamine and LSD, as channels to experiment with alternative worlds, i.e, dissociation from reality, correlate directly with the desire to break away from the routine of one’s day. The perceived vulnerability of young people and their low expectations for the future, e.g., job insecurity leading to a prolonged moratorium, amplify the need to try experiences that distract them from reality [42].

Moreover, for some, drug use is a means to fight or modulate emotions, feelings of discomfort, boredom, and dissatisfaction. The correlation between the frequency of mephedrone consumption and dissatisfaction with one’s current situation highlights this [27].

The main motivation behind the choice of a rave event may be related to the type of music proposed at these parties, e.g, goa, trance, jungle, techno, and hard-core music, as well as the free availability and accessibility of substances. According to the literature [18], music, dancing, and the use of synthetic substances are constituent features of a rave event.

The motivation to “feel fit and more strong” could be configured as a performance need induced by the type of context [30]. The rhythm, sounds, and psychedelic lights, possibly combined with illegal substances, not only increase performance (such as drug speed), but also raise serotonin levels and, at the same time, reduce the feeling of fatigue so that an individual can dance all night. Because techno music mainly comprises steady beats and a repetitive melody, where every musical moment feels the same, or at least very similar, to the previous one and the next, a listener may be induced into a trance-like state.” This makes a listener feel like time is frozen. Trance, besides a specific genre of electronic music, also means a modified state of consciousness. Rouget [43] defined it as a state of transient consciousness characterized by phenomena such as insensitivity to external stimuli, attenuation of consciousness, and psychic dissociation. Ketamine use positively correlates with the desire to “reach a state of trance” and the desire to “not think about problems.” LSD positively correlates with the motivation “to do things that I would not otherwise do,” and MDMA and speed positively correlate with the want to “search for alternative worlds” and “to get in tune with others.” The use of substances opening towards the unconscious (entactogen) and towards others (empathogen) is typical of rituals where music acts as a promoter for modified states of consciousness. The link between music, the ability to induce such states, and the intake of psychoactive substances is very close and can lead to seeing rave parties as real workshops of dissociation [44]. For Fontaine and Fontana [45], the aim of a rave experience is to “exit” from one’s regulated social life and live “an escape.” Salvatore [46] argued that those who participate in a rave try to cancel their individual identities to feel part of the group. Individuals are pursuing the experience of “collective fusion.”

From the survey data, some areas of daily life, e.g, job satisfaction, income, sentimental relations, and relations with the family of origin, were correlated with dissatisfaction. On the contrary, areas with the highest level of satisfaction were leisure and peer groups. Almost half of the sample lived with their friends, probably to share their daily lives and prolong their studies and life habits, eg, studying, socialization spaces, and consumption styles. Some individuals choose hedonism and nightlife at the expense of other areas of life.

Finally, work is supposed to act as a protective factor against the use of synthetic substances. Employed individuals tend to consume less MDMA. Compared to the quality of life, those who work are usually more satisfied in all areas of life than those who do not work, except in the areas of friendship and leisure.

Interestingly, people who are employed and people who do not take drugs for different motivations. Those who do not work consume drugs because they are not satisfied with their current situations and would like to disconnect from everyday life, whereas those who work consume them because they are stressed by work [47, 48]. This phenomenon manifests as a negative circuit in which drugs seem to be able to “respond” to a wide range of human needs [49, 50].

This survey has several limitations. First, the study’s limited number of participants are not generalizable. The ad hoc self-report only allows a first exploratory survey and lacks information related to substance dependence, health status, and personality variables, which could better clarify the vulnerability of the sample. The correlational investigations and the comparison between groups only allow researchers to analyse co-occurrences and are insufficient in investigating causal relationships.

However, although this is a pilot study, the preliminary results seem to be in line with those of other studies on synthetic drug use and night-time loisir [2]. The survey has not only made it possible to trace some consumption profiles and increase knowledge on what effects are sought by which substances but has done so in contexts of consumption that are difficult to access.

Despite the high levels of drug use observed in some recreational settings, only 11 European countries report the adoption of harm prevention and harm reduction actions in such settings [10]. A recent Italian study [51] showed that emergency services need access to reliable training on new synthetic drugs. Future surveys should contribute to this field by studying target groups, such as ravers, with a new methodological frame (including more structured assessment tools), to design effective intervention strategies for people with problematic recreational drug use within particular youth meeting environments.