Drug use at the nightclub: 5 questions for drug epidemiologist Joseph Palamar

Palamar discusses what data from the club scene can tell us about drug use and public health

Growing up on Long Island in the nineties, Joseph Palamar came from a long line of civil servants, so he thought he’d grow up to serve and protect — perhaps an NYPD officer, or an FBI agent. But in his teens, he got interested in house music and became something of a fixture in New York’s booming underground club scene, where he was often the only one of his friends not using drugs. By the time he was 20, the NYPD had promised him a job once he reached their minimum hiring age of 21, but he realized that wasn’t what he wanted after all. “I thought, ‘What am I supposed to do, go in and arrest my friends?’” Instead, Palamar finished his undergraduate degree in psychology at City University of New York, then was hired to work on a club drug study in 2001. 

Palamar went on to earn a doctorate degree in public health and a master’s in educational psychology. Today, he’s an associate professor of population health at New York University studying drug use epidemiology in nightclubs. The Microdose spoke with him about his work and what data from the club scene can tell us about drug use and public health.

How do researchers traditionally measure drug use, and why might nightclubs be a good place to probe for data?

Surveys are the main way to estimate prevalence of drug use. And if you want to determine what percentage of people use X drug, it goes back to surveys. But there’s a weakness there: most of these major national surveys don’t directly ask about specific drugs, but have one big miscellaneous category that includes psychedelics.

We call nightclubs a sentinel population: we might want to follow what’s going on there because we can identify trends before they become more general. For example, remember when molly was a big thing? Before that, MDMA was always in ecstasy pills, but then molly powder started coming in. I saw that in the club scene in 2003; that’s going back 20 years. But then all of a sudden, years later, molly hit the mainstream. Party trends might be able to help you forecast what might happen elsewhere. 

What trends are you seeing in the clubs now that might give us clues about what’s next?

Ketamine use has been increasing — it’s not super high yet, but it’s been going up over the last five, six, seven years. It doesn’t appear to be increasing in prevalence in the general population yet. But with the way things are going, I think it might. Psilocybin is also increasing in prevalence, and lesser known psychedelics like 2C-B. (Reporter’s note: 2C-B is a psychedelic similar to mescaline, but in the club, it can be something else entirely: “tucibi” is often marketed as “pink cocaine,” and while it does sometimes contain mescaline, it also can contain a cocktail of other drugs, including ketamine, MDMA, and caffeine.)

How does data collection at the club work, and what are you measuring? 

The data is collected by people in my lab, typically undergrads or recent graduates from NYU. And they don’t go into the club — they survey people around the block or in front of the club, as people are about to enter or leave. We ask people to participate and give them an incentive, usually a bit of money — say $10 for a 10 minute survey. People are generally pretty receptive and enthusiastic about participating; in some of our studies we have had up to a 75% response rate.

Our main assessment of prevalence of use of drugs over their lifetime, the past year, and past month. In the second iteration of our study, we also collected hair samples, which allow us to test for drug use over the last few weeks or months, and we’re actually about to start the third iteration, which also collects saliva samples. 

What are you hoping to find from these saliva samples? 

They help us see what people are really exposed to and compare it to what they reported in their survey results. For instance, in one paper we just published using hair samples, we detected five cases of a novel synthetic cannabinoid. None of those people reported using a cannabinoid but all of them reported using marijuana, so we suspect that perhaps they were all unknowingly exposed. With the hair samples, that exposure could’ve been any time in the last few months, but with saliva samples, that shows us exposure in the last 48 or so hours, so it could theoretically be useful in detecting these kinds of drug exposures and alerting participants.  

At that point, they’ve already been exposed, but we hope that it will help inform their future behavior. The aim is not intervention, necessarily, but maybe if you learned you were exposed unknowingly, you’ll be more likely to test your drugs or stop buying drugs from the same source. We’re also going to ask about adverse effects from that night — if we try to follow up with them a day or two later, did they notice any negative effects from those exposures? And we can also refer them to poison control if they still don’t feel well and want to talk to a medical doctor. 

Do you see the data itself being a form of harm reduction?

I don't think there's anything wrong with telling people that there could be something wrong with a particular batch or drug; I don't think there's anything wrong with trying to get some people just not to use anymore. At the same time, I don't think there's really anything wrong with saying, Okay, if you want to use a drug, please use it safely. Then we can show them the latest statistics — like we've been finding that X percent of people who think they've been using ecstasy have been testing positive for exposure to bath salts or methamphetamine. People need to know these things, and there’s a way you can give people the right information without presenting it in a scary manner. 

Currently, we're in the fentanyl age, and who knows what the next drug is going to be that's out there? Right now, ketamine is popping up in drugs, and in the U.S., we have a mysterious pink powder called 2C-B. People really don’t know what’s in it; more than 90% of the time it has ketamine in it, but it's pretty much always mixed with ecstasy or cocaine or meth, or sometimes opioids. I'm worried that fentanyl is going to wind up in there, too. People in the party scene don’t always overlap with other drug users; people who use cocaine and heroin and fentanyl tend to be in different circles than people who go dancing at a nightclub on a weekend and come across these drugs. They don’t want or expect fentanyl in their cocaine or ecstasy, so I’m hoping these drugs do not wind up in the supply. That’s the scene I come from; these are the people I care about, because this was me when I was younger.

This interview has been edited and condensed for clarity and length.