One out of six medical students at a private Midwestern medical school reported prior use of at least one club drug, results from a survey found.

"Therefore, physicians should be cognizant, when treating medical students, physicians, or other health care workers, that we are not excluded from substance abuse," Dr. Alex Horowitz said in an interview after presenting the study as a poster at the annual meeting of the American Academy of Addiction Psychiatry.

"The same principles should be applied when assessing health care workers for substance use as when assessing the rest of the population," he asserted.

In what he said is the first study of its kind, Dr. Horowitz and his associates asked 340 students at a private Midwestern medical school to complete an anonymous survey about their use of and attitudes about club drugs. Generation I club drugs were defined as Cocaine and LSD; generation II club drugs included methylenedioxymethamphetamine (also known as ecstasy), Methamphetamine, gamma hydroxybutyrate (GHB), Rohypnol, Ketamine, and dextromethorphan. Nearly half (46%) of the respondents were first-year medical students; 34% were in their second year; and 20% were third-year students.

The overall prevalence of lifetime club drug use was 17%, with Ecstasy and Cocaine as the most popular agents of choice (12% and 6%, respectively), reported Dr. Horowitz, psychiatric unit chief of the Methadone treatment program at Bellevue Hospital Center, New York.

The prevalence of medical students' lifetime Ecstasy use was similar to that of their peers in the general population, as reported in the National Institute on Drug Abuse's 2004 "Monitoring the Future" survey. However, the use of generation I club drugs by medical students was lower than that of their peers in the general population, an association that remains unclear.

Compared with students aged 21-25 years, those aged 26 and older were more likely to have used the generation I drugs (cocaine, 16% vs. 4%, respectively; LSD, 14% vs. 2%). However, no relationship was found between age and use of generation II club drugs in general.

Students who reported never using club drugs perceived regular Cocaine use as posing the greatest risk to health (89%), followed by Ecstasy (72%). For students who reported lifetime use of at least one club drug, the perceived risk of using Cocaine and Ecstasy regularly was significantly lower (75% and 58%, respectively). The use of club drugs did not differ between men and women, but women found them to be generally more harmful than men did.

"There appears to be a correlation between knowledge/perceived harmfulness of each drug and drug use," said Dr. Horowitz, of the department of psychiatry at New York University, also in New York. "Therefore, increasing formal medical student education on club drugs would help them be aware of dangers of club drug use, and also would help them know how to then assess and treat their patients who use club drugs."

A greater number of students thought it would be necessary to revoke the license of physicians who were currently using generation I club drugs than those who were using generation II club drugs (27% vs. 20%, respectively). Women were more likely than men to endorse license revocation for physicians currently using generation I club drugs (33% vs. 22%, respectively) and for those currently using generation II club drugs (26% vs. 15%, respectively).

Dr. Horowitz acknowledged that the self-reported nature of the study is a limitation. "Some medical students may underreport their drug use for fear of having anyone find out, despite the anonymity of the survey," he said.

Another limitation is that the data were collected in a classroom setting, which means that participants were limited to students more likely to attend class. However, the survey was administered in a class that was considered mandatory.