All mixed up.

Viagra, ecstasy, crystal, ketamine, and poppers each has its own dangerous effects. But taken together, they create drug combinations that can kill

For most of his 20s, Eddie gay man who asked that his real name not be used) partied heavily. He spun from disco to disco, sampling all the recreational drugs offered to him on the dance floor, until one summer a group of friends told him about GHB. It gave you a sexy rush, they said. And it could kill you.

Though GHB sounded kind of scary, eventually he succumbed to peer pressure and tried it. "It was like ultra-ecstasy but more electric," Eddie says. "It makes you very sexual." As his peers got more and more into the drug, they'd sometimes go on binges for days and nights on end. Then a member of his group died after mixing a bad batch of GHB with alcohol, and two others went into convulsions in a nightclub.

It's an increasingly familiar story. Though Eddie says he has outgrown the drug-taking days of his youth, many gay people are stepping up their use of recreational drugs as a part of their social rituals. The numbers show it too. The U.S. Customs Service recently reported seizing shipments of more than 9 million ecstasy tablets in the year 2000. That's up from 3.5 million tablets in 1999 and only 750,000 in 1998.

The latest addition to the recreational drug cabinet is Viagra, often used to correct the impotency side effects of other drugs, including ecstacy, ketamine, and crystal meth. Not satisfied with one buzz at a time, many gay men are mixing these and other drugs to create a custom-made, sometimes fatal high.

"It is kind of like playing Russian roulette with your body, and you never know what drugs will be the ones to set you over the edge," says Kathy Watt, executive director of Van Ness Recovery House, a nonprofit GLBT counseling service based in Los Angeles, Calif. "It is like being a pharmacist without anything to measure it by, and it is all presented in a very seductive way."

As recreational drug use continues to skyrocket, one of Watt's organization's current efforts is to raise awareness among gay men about the risk of mixing Viagra and amyl nitrite ("poppers"), which led to the deaths of three gay men in West Hollywood, Calif., in 1998.

The increase in emergency episodes related to drug use has not only affected the gay world but people of all sexual orientations. According to a recent study on club drugs from the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, ecstasy was mentioned nearly 3,000 times as the cause for emergency room visits nationwide in 1999, an increase of 150% over 1998. Over the same time period, mention of GHB climbed 131%, and ketamine nearly 90%. Though the study's researchers did not perform a statistically valid analysis of deaths related to club drugs, they report more than 2,600 fatalities attributed to methamphetamines between 1994 and 1998 and 46 deaths involving ketamine, 27 deaths linked to ecstasy, and 12 to GHB in the same time period.

The study also reported that more than 70% of drug-related emergency room visits resulted from simultaneous use. Though alcohol was most frequently mentioned as being used in conjunction with other drugs, 37% of emergency room episodes involving ketamine and 15% involving GHB also included concurrent use of ecstasy.

So just what do these drugs do to you, and why are combinations likely to have serious consequences? According to Ruben Olmedo, chief of the division of toxicology for the emergency medicine department at Mount Sinai Hospital in New York, each drug has its own distinct physiopathology. Some, like crystal meth and ecstasy, are vasoconstrictors, which decrease blood flow to certain parts of the body, driving up blood pressure. Others, like Viagra, poppers, and ketamine, are vasodilators, which increase blood flow.

Each one can have its own dangers. Prescribed Viagra, for instance, has been reported as a possible cause for at least 128 deaths in the United States, according to the Food and Drug Administration. (Pfizer Inc., which manufactures and markets the drug, disputes those claims.) Olmedo says the drug can cause irregularities in heartbeat or heart attack. For their part, poppers temporarily prevents the effective transportation of oxygen in the blood, causing a kind of anemia When the drugs are used together, as in the three West Hollywood deaths, it could result in a sudden drop in blood pressure that could lead to heart failure.

Likewise, mixing a vasoconstrictor with a vasodilator can have bad consequences. For example, combining "[ecstasy] with Viagra, you don't know where the effects will take over and where the effects will occur," Olmedo says. Side effects could include heart attack and stroke, he says. Ecstasy and ketamine, a much more common combination, could lead to similar results. And these risks increase with age.

Not only can recreational drug use be immediately dangerous to one's health, but it can also lead to high-risk sex, Watt says. For example, crystal, while stimulating sexual appetite, also lowers inhibitions and causes psychosis after prolonged use. When taken orally, crystal causes severe ulceration in the mouth, a potential risk for those engaging in unprotected oral sex. When taken anally, it can cause numbness and ulceration in the colon, another possible opportunity for HIV infection.

There are complex psychological motivations for engaging in high-risk drug-taking behavior, psychologists say. "One reason is a total disregard for the self and a wish for self-destruction. They may see themselves in such a poor position that they think, `Why not? I will die, and who cares either way?'" says Stephen Braveman, a sex therapist in Monterey, Calif., whose clientele includes gays, lesbians, and transgendered people. "Another reason why the young will mix drugs is they have a superman mentality and believe that they are indestructible. There is also peer pressure and the sense `I want to be part of the club.'"

Those are observations that Eddie agrees with. "I have thought a lot about this and wondered whether it is inherent in men that they feel invincible and will take all sorts of risks that are just unnatural," he says. Recreational drug use is often the entrance fee to an alluring part of gay culture, he adds, and it "becomes a lifestyle and this whole mindset you get locked into--that this is what being gay is all about."

Find links and more information about these recreational drugs and their side effects at www.advocate.com

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Quittner has contributed to Business Week and The New York Times.