Publication Guide: Ecstasy/MDMA

Below are some citations and abstracts from publications from the library’s database :

Barratt, M. J., Bruno, R., Ezard, N., & Ritter, A. (2018). Pill testing or drug checking in Australia: Acceptability of service design features. Drug and Alcohol Review, 37(2), 226–236

Introduction and Aims. This study aimed to determine design features of a drug‐checking service that would be feasible, attractive and likely to be used by Australian festival and nightlife attendees.

Design and Methods. Web survey of 851 Australians reporting use of psychostimulants and/or hallucinogens and attendance at licensed venues past midnight and/or festivals in the past year (70% male; median age 23 years).

Results. A drug‐checking service located at festivals or clubs would be used by 94%; a fixed‐site service external to such events by 85%. Most (80%) were willing to wait an hour for their result. Almost all (94%) would not use a service if there was a possibility of arrest, and a majority (64%) would not use a service that did not provide individual feedback of results. Drug‐checking results were only slightly more attractive if they provided comprehensive quantitative results compared with qualitative results of key ingredients. Most (93%) were willing to pay up to $5, and 68% up to $10, per test. One‐third (33%) reported willingness to donate a whole dose for testing: they were more likely to be male, younger, less experienced, use drugs more frequently and attend venues/festivals less frequently. Discussion and

Conclusions. In this sample, festival‐ or club‐based drug‐checking services with low wait times and low cost appear broadly attractive under conditions of legal amnesty and individualised feedback. Quantitative analysis of ecstasy pills requiring surrender of a whole pill may appeal to a minority in Australia where pills are more expensive than elsewhere.

Champion, K. E., Newton, N. C., Stapinski, L. A., & Teesson, M. (2016). Effectiveness of a universal internet‐based prevention program for ecstasy and new psychoactive substances: a cluster randomized controlled trial. Addiction, 111(8), 1396–1405.

To evaluate the effectiveness of an online school‐based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS). Cluster randomized controlled trial with two groups (intervention and control). Eleven secondary schools in Australia. A total of 1126 students (mean age: 14.9 years). The internet‐based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4‐week period, during health education classes. Control schools received health education as usual. Primary outcomes were self‐reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life‐time use of ecstasy and NPS. Surveys were administered at baseline, post‐intervention and 6 and 12 month post‐baseline. At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31–78.91]. However, students’ intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01–34.73). There was a significant group difference in the change from baseline to post‐test for NPS knowledge (β = −0.42, 95% CI = −0.62 to −0.21, Cohen’s d= 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post‐test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = −0.54, 95% CI = −0.97 to −0.12, P= 0.01, d= 0.73). The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school‐based prevention program, appeared to reduce students’ intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term.

Grigg, J., Barratt, M. J., & Lenton, S. (2018). Double dropping down under: Correlates of simultaneous consumption of two ecstasy pills in a sample of Australian outdoor music festival attendees. Drug and Alcohol Review, 37(7), 851–855

The term ‘double dropping’ refers to a person consuming two drugs simultaneously, typically two ecstasy pills. This practice has been reported in numerous countries, including Australia; however, the prevalence and correlates of double dropping among ecstasy users is unknown. Double dropping is particularly risky when adulteration of ‘ecstasy’ with novel substances and higher dosages of MDMA in pure ecstasy pills have both been increasingly reported. This paper investigates the prevalence and correlates of double dropping in a purposive sample of Australian festival‐goers who used ecstasy at the last festival they attended. A web survey was completed by almost 2000 Australian festival‐goers. The analytic sample (n =777) was 59% male and had a median age of 20 years (interquartile range 19–23). Almost half (48%) of respondents who used ecstasy pills reported double dropping in association with the last festival attended. Multivariable logistic regression found respondents who were younger, male, more frequent ecstasy users, more frequent festival‐goers, had a preference for electronic dance music, attended a multi‐day festival and used ecstasy in pill form were at greater odds of reporting double dropping at the last festival attended. Double dropping was a commonly reported practice among festival‐goers in this purposive sample. While this practice may reflect historically low‐dose ecstasy pills in Australia, the changing contexts of novel drugs and increasing MDMA purity may warrant consideration of harm‐reduction interventions and drug‐checking services which could help festival‐goers make more informed decisions about drug dosage.

Kinner, S. A., George, J., Johnston, J., Dunn, M., & Degenhardt, L. (2012). Pills and pints: Risky drinking and alcohol‐related harms among regular ecstasy users in Australia. Drug and Alcohol Review, 31(3), 273–280.

Introduction and Aims. A significant proportion of young Australians engage in risky alcohol consumption, and an increasing minority are regular ecstasy (3,4‐methylenedioxymethamphetamine) users. Risky alcohol use, alone or in combination with ecstasy, is associated with a range of acute and chronic health risks. The aim of this study was to document the incidence and some health‐related correlates of alcohol use, and concurrent alcohol and ecstasy use, among a large, national sample of regular ecstasy users (REU) in Australia.

Design and Methods. National, cross‐sectional surveys of REU in Australia 2003–2008. Among REU in 2008 (n = 678) usual alcohol use, psychological distress and health‐related quality of life were measured using the Alcohol Use Disorders Identification Test, Kessler Psychological Distress Scale and Short Form‐8 Survey respectively.

Results. Among REU in 2008, 36% reported high‐risk patterns of usual alcohol consumption, 62% reported usually consuming more than five standard drinks with ecstasy, and 24% reported currently experiencing high or very high levels of psychological distress. Controlling for age and education, high‐risk drinking among REU was associated with higher levels of psychological distress and poorer health‐related functioning; however, the associations between concurrent alcohol and ecstasy use, and health outcomes, were not significant (P > 0.05).

Discussion and Conclusions. A large and increasing proportion of REU in Australia engage in high‐risk patterns of alcohol consumption, including in combination with ecstasy. High‐risk alcohol consumption among this group is associated with adverse health‐related outcomes. Prevention and harm reduction interventions for REU should incorporate messages about the risks associated with alcohol use. There is an ongoing need for youth‐specific, coordinated alcohol and other drug and mental health services.

Kurtz, S. P., Surratt, H. L., Buttram, M. E., Levi-Minzi, M. A., & Chen, M. (2013). Interview as intervention: The case of young adult multidrug users in the club scene. Journal of Substance Abuse Treatment, 44(3), 301–308

This paper reports on changes in substance use and substance dependence symptoms—without intervention—among young adult multidrug users in the club scene, ages 18–29, (N=444) who participated in a natural history study. Computer-assisted personal interviews at baseline and 6-, 12-, and 18-month follow-ups included well-tested measures of substance use and dependence. Changes in substance dependence symptoms and drug use frequencies were calculated using Cohen’s dstatistic. Mean age was 22; 40% were female; 58% were Hispanic, 17% White, and 21% Black. At 18-month follow-up assessment, participants reported significantly fewer days of cocaine (d=−.85 at 18months), ecstasy (d=−.93), benzodiazepine (d=−.82), and prescription opioid (d=−.81) use, as well as reduced substance dependence symptoms (d=−.42). These results, together with data from focus groups with completers, suggest that comprehensive health and social risk assessments may have quite strong intervention effects among young adult multidrug users.

Peacock, A., Sindicich, N., Dunn, M., Whittaker, E., Sutherland, R., Entwistle, G., … Bruno, R. (2016). Co‐ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy. Drug and Alcohol Review, 35(3), 352–358.

Despite the potential harms of mixing unregulated drugs with energy drinks (ED), research to date has primarily been focused on EDs co‐ingested with alcohol. Consequently, the aim of the present study was to explore the rate of use, harms and correlates of EDs co‐ingested with alcohol and other drugs among a sample of people who regularly use illicit stimulant drugs. In 2010, 693 Australians who regularly used ecstasy completed a 1‐h interview about their past six‐month ED and drug use. Three‐quarters of the sample (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug‐related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One‐half (52%) and one‐quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post‐consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%). Co‐ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co‐ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction.

Vrolijk, R. Q., Brunt, T. M., Vreeker, A., & Niesink, R. J. M. (2017). Is online information on ecstasy tablet content safe? Addiction, 112(1), 94–100.

In recent years, the prevalence of ecstasy use has increased in most European countries. Users can acquire information on ecstasy tablet composition through the internet. This study compares online information from two websites, Pillreports and Partyflock, to the validated Dutch Drugs Information and Monitoring System (DIMS) database, and aims to measure its accuracy and potential danger or value. The drug‐related information posted on and between 1 January 2014 and 31 December 2015 was investigated for accuracy and several information characteristics such as picture inclusion and dose range inclusion. In total, 471 informatory statements on ecstasy tablet content were analysed relative to the Dutch ecstasy market. Informatory statements on the content of specific ecstasy tablets were scored as ‘too high’ or ‘too low’ if their concentrations deviated > 10 mg from the entries in the DIMS database within a 12‐week time‐frame, and scored as ‘dangerous’ if their concentration was > 40 mg too low. Unreported substances were scored as ‘dangerous’ if listed as an illegal or dangerous substance in the DIMS database and if present in relevant quantities. Also scored were the report characteristics ‘picture inclusion’, ‘spread inclusion’ and ‘website source’, which were tested for their association with report safety/danger. On average, reports on ecstasy tablets from Pillreports and Partyflock show concentrations which are 10.6 mg too high [95% confidence interval (CI) = 6.7–14.4]. Qualitatively, 39.7% of the reports scored as ‘too high’ (95% CI = 35.2–44.4), 17.6% scored as ‘too low’ (95% CI = 14.0–21.2) and 15.5% had ‘unreported substances’ (95% CI = 12.3–18.9), resulting overall in 15.3% of the reports being scored as ‘dangerous’ (95% CI = 11.9–18.5). The report characteristic ‘spread inclusion’ associated inversely with report danger [Exp(b) = 0.511, 95% CI = 0.307–0.850, P= 0.01]. Information from the popular Pillreports and Partyflock websites tends to overestimate 3,4‐methylenedioxymethamphetamine (MDMA) concentrations in ecstasy tablets. In addition, 15.3% of the reports omit the relevant concentration spread, fail to report additional illegal or dangerous substances contained in the tablets or underestimate MDMA concentration by > 40 mg.

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