Ecstasy Users Research Articles

Substance Use–Related Alterations of Social Decision Making in a Longitudinal Cohort of Young Adults

BackgroundSubstance use disorders are associated with severe negative social and health-related outcomes. Evidence has accumulated that long-term substance use is associated with alterations in social interaction behavior, which likely contributes to the vicious cycle of substance use disorder. However, little is known about whether these social problems originate from contextual factors only or also from the substance use itself—in other words, if they are predisposed or substance induced. MethodsWe studied the causation behind behavioral alterations of substance users over a 9-year period (ages 11–20 years) in an urban age cohort (N = 1002) with a high prevalence of substance use at age 20. We identified common substance use patterns using toxicological hair analysis, examined behavioral alterations with incentivized games, and used teacher assessments across different ages to determine the causes and effects that underlie substance use–related impairments in social interaction. ResultsWe found that opioid and stimulant users showed reduced prosocial behavior compared with nonusers, particularly in interpersonal trust and perspective taking (e.g., they were approximately 50% less likely to trust others). Our longitudinal analyses suggest a causal relationship between the nonmedical use of prescription opioids and impaired social behavior, whereas impairments among stimulant users seem to be partially predisposed. Moreover, women tended to be more severely affected by opioid use than men. However, no behavioral alterations were found among young adult cannabis or ecstasy users. ConclusionsHighly addictive substances such as opioids can impair users’ social behavior by undermining fundamental human interaction, thereby fueling a vicious cycle of substance use and social isolation.

Polydrug Use Typologies of Regular Ecstasy Users Visiting Electronic Dance Music Events: A Latent Class Analysis

Introduction: Polydrug use patterns among young adults using ecstasy vary, as well as their willingness to change them. Polydrug use patterns are likely associated with different adverse health outcomes. It is unknown whether polydrug use patterns of young adults who use ecstasy are similar in different countries. This study aims to identify and compare polydrug use patterns and willingness to change them of young adults that use ecstasy in the United Kingdom (UK) and the Netherlands (NL), two countries with a high prevalence of ecstasy use and a large electronic dance music (EDM) scene. Methods: The data from the online cross-sectional Electronic Music Scene Survey were used in a latent class analysis. The binary indicators used in the estimation were past-year substance use of 21 different substances. The sample consisted of young adult ecstasy users that regularly visit EDM events (age 18–34). Results: A total of 1,077 respondents from the UK (age M = 23.1) and 1,178 from the NL (age M = 23.7) that regularly visit EDM events were included in the analyses. In both countries, three polydrug use patterns of ecstasy users were identified based on Bayesian Information Criterion fit indices: a traditional polydrug use class (UK: 28%; NL: 40%), a stimulant and ketamine polydrug use class (UK: 48%; NL: 52%), and an extensive polydrug use class (UK: 24%; NL: 8%) characterized by substantial use of stimulants, depressant, and psychedelic substances. Overall, young adults that used ecstasy in the UK consumed 3,4-methylenedioxymeth-amphetamine (MDMA) more often as powder/crystalline and at higher dosages compared to young adults in the NL who preferred MDMA tablets. Regardless of polydrug class or country, most respondents indicated that they had the intention to reduce but not quit their use. Conclusion: In both countries, structurally similar polydrug use patterns among young adults that use ecstasy were found, while the use frequencies of individual substances and preferred MDMA form varied between the countries.

Why Do Adolescents Relapse? A Multicenter, Cross-sectional Study.

Adolescents use drugs once, then use them regularly, then start and stop many times. In addiction treatment, relapse is a major barrier to recovery. Relapse is more common among adolescents and is a major problem. Thus, this study aimed to identify the factors impacting the duration of relapse in adolescents. This is a multicenter, cross-sectional study. A total of 157 adolescents who applied to 4 different child and adolescent addiction treatment centers between January 2020 and March 2020 were included in the study. The "Addiction Profile Survey Adolescent Form" was administered to the participants face to face. According to the duration of relapse determined with this form, the cases were analyzed separately as before and after 1 month. The sample consisted of 112 (71.34%) males and 45 (28.66%) females, with a mean age of 17.1 ± 0.8 years. Cannabis use (P = .010), late treatment initiation (P = .003), less psychosocial (P = .001), outpatient (P = .006), and inpatient (P = .006) treatment history were significantly associated with relapse before 1 month. Cannabis users were approximately 4 times more likely to relapse in less than a month, while ecstasy users were approximately 4 times more likely to relapse over a month (OR = 0.26, CI = 0.1-0.69), (OR = 4.16, CI = 1.26-13.78). In the multiple logistic regression analysis performed to determine the factors predicting the duration of relapse, it was found that not attending school (P = .018) and receiving less inpatient treatment (P = .019) predicted relapse occurred within 1 month. This study is considered remarkable in terms of demonstrating the necessity of early interventions and post-treatment care services. Currently, there are very few studies in the literature that investigate the factors that contribute to relapse in addicted adolescents. According to our literature review, no study examined factors affecting relapse duration in adolescents.

Striatal Iron Deposition in Recreational MDMA (Ecstasy) Users

BackgroundThe common club drug MDMA (also known as ecstasy) enhances mood, sensory perception, energy, sociability, and euphoria. While MDMA has been shown to produce neurotoxicity in animal models, research on its potential neurotoxic effects in humans is inconclusive and has focused primarily on the serotonin system. MethodsWe investigated 34 regular, largely pure MDMA users for signs of premature neurodegenerative processes in the form of increased iron load in comparison to a group of 36 age-, sex-, and education-matched MDMA-naïve control subjects. We used quantitative susceptibility mapping, a novel tool able to detect even small tissue (nonheme) iron accumulations. Cortical and relevant subcortical gray matter structures were grouped into 8 regions of interest and analyzed. ResultsSignificantly increased iron deposition in the striatum was evident in the MDMA user group. The effect survived correction for multiple comparisons and remained after controlling for relevant confounding factors, including age, smoking, and stimulant co-use. Although no significant linear relationship between measurements of the amounts of MDMA intake (hair analysis and self-reports) and quantitative susceptibility mapping values was observed, increased striatal iron deposition might nevertheless point to MDMA-induced neurotoxic processes. Additional factors (hyperthermia and simultaneous co-use of other substances) that possibly amplify neurotoxic effects of MDMA during the state of acute intoxication are discussed. ConclusionsThe demonstrated increased striatal iron accumulation may indicate that regular MDMA users have an increased risk potential for neurodegenerative diseases with progressing age.

Sexualized drug use among men who have sex with men in Madrid and Barcelona: The gateway to new drug use?

This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.

Are periodontitis, dental caries and xerostomia more frequently present in recreational ecstasy users?

Objectives The aim of this retrospective study was to determine whether there is a difference in oral health between recreational ecstasy users and non-recreational drug users.Study design In a cross-sectional study, dental records of 149 individuals visiting an academic dental clinic in Amsterdam who reported recreational ecstasy use, defined as no more than twice a week, were systematically analysed and compared to a group of age- and sex-matched non-drug users randomly selected from this institute. The parameters retrieved from the dental records were decayed, missed and filled teeth index (DMFT), number of endodontically treated teeth, presence of active caries lesions, periodontitis, tooth wear, xerostomia and self-reported use of oral hygiene devices.Results Periodontitis, active caries lesions and xerostomia were statistically significantly more present in ecstasy users. Ecstasy users brush their teeth significant less frequently per day than non-recreational drug users. There were no significant differences in DMFT and in the devices used for brushing/interdental cleaning and frequency of use of these interdental devices between both groups.Conclusion Periodontitis, active caries lesions and xerostomia are more frequently present in recreational ecstasy users compared to age- and sex-matched non-users.

Are periodontitis, dental caries and xerostomia more frequently present in recreational ecstasy users?

Objectives The aim of this retrospective study was to determine whether there is a difference in oral health between recreational ecstasy users and non-recreational drug users.Study design In a cross-sectional study, dental records of 149 individuals visiting an academic dental clinic in Amsterdam who reported recreational ecstasy use, defined as no more than twice a week, were systematically analysed and compared to a group of age- and sex-matched non-drug users randomly selected from this institute. The parameters retrieved from the dental records were decayed, missed and filled teeth index (DMFT), number of endodontically treated teeth, presence of active caries lesions, periodontitis, tooth wear, xerostomia and self-reported use of oral hygiene devices.Results Periodontitis, active caries lesions and xerostomia were statistically significantly more present in ecstasy users. Ecstasy users brush their teeth significant less frequently per day than non-recreational drug users. There were no significant differences in DMFT and in the devices used for brushing/interdental cleaning and frequency of use of these interdental devices between both groups.Conclusion Periodontitis, active caries lesions and xerostomia are more frequently present in recreational ecstasy users compared to age- and sex-matched non-users.

The Role of Occipital Cortex Hyperexcitability in Visual Snow Syndrome

INTRODUCTION Visual snow syndrome (VSS) is an emerging clinical entity, mainly characterized by persistent, bilateral, whole-visual field, disturbing, small flickering dots or pixelation, floaters, palinopsia, nyctalopia, photopsia, and photophobia. Patients with VSS also describe associated symptoms such as tinnitus, concentration difficulty, lethargy, depression, anxiety, and irritability, all of which affect the patients' quality of life. The consistency of these visual and nonvisual symptoms has recently led to proposed criteria for VSS. The diagnosis relies on the exclusion of other ophthalmic or neuropsychiatric disorders. Interestingly, many patients may have a comorbid migraine, and the symptoms were previously attributed as a persistent visual phenomenon in migraine. VSS is listed in the International Classification of Headache Disorders-Third Edition Appendix as a complication of migraine; however, VSS is a new disease entity distinct from persistent migraine aura. Some patients with VSS recall exposure to illicit hallucinogenic drugs, amphetamines, cannabis, or Lysergic acid diethylamide (LSD). The stereotypic clinical characteristics of VSS are currently well defined, and the pathophysiology is under investigation. Due to the subjective perceptual descriptions of patients with VSS, objective electrophysiologic parameters and functional brain imaging studies using magnetic resonance imaging and positron emission tomography are warranted for defining the quantifiable and reliable outcome measures. Patients with migraine, idiopathic occipital epilepsies, patients with Alice in Wonderland syndrome, patients with Charles Bonnet syndrome, visual hallucinations in recovery from cortical blindness, and recreational 3,4-methylenedioxymethamphetamine/ecstasy users have been suggested to have occipital cortex hyperexcitability. VSS is attributed to involving a dysfunctional magnocellular pathway, thalamocortical dysrhythmia, dysfunctional central visual processing, and occipital cortex hyperexcitability as possible underlying mechanisms. This review will focus on the role of occipital cortex hyperexcitability in VSS and hopefully provide insight into its pathophysiology and therapeutic strategies.

Atypical longitudinal self-inflicted incised wounds as a cause of death in an ecstasy user.

A 32-year-old chronic drug abuser was found dead at the entrance to his home, covered in blood. Pools of blood, bloody footprints and bloodstains were found across the apartment. A double-edged razor was recovered from the scene. Autopsy revealed multiple incised wounds: two on the palmar aspect of both forearms (37cm and 33cm long, oriented longitudinally). The cuts extended into the subcutaneous adipose tissue, muscles and blood vessels. There was an additional 30cm cut extending across the middle of the torso anteriorly and two more cuts on the anteromedial aspect of the lower legs, set symmetrically (about 23 and 25cm long). These three cuts were more shallow than the upper extremity wounds. No hesitation wounds were identified. Toxicological analysis identified MDMA (ecstasy). The cause of death was exsanguination. The deceased has been using ecstasy for the previous five years and had a history of inpatient psychiatric treatment due to psychosis with delusions and hallucinations. These self-inflicted incised wounds had many atypical features: location (torso, legs and arms), longitudinal orientation and symmetrical distribution, absence of hesitation injuries, use of both dominant and non-dominant hand. The absence of previous suicide attempts and suicide note suggest that these self-inflicted injuries were not planned beforehand, but were abrupt. We hypothesize that this injury pattern is associated with both acute and chronic effects of MDMA.

UNILATERAL CRYSTAL METHAMPHETAMINE LUNG

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Methamphetamine is a drug manufactured from ephedrine and pseudoephedrine mixed with ingredients such as ammonia, lithium, iodine, and phosphorous but adulterants such as alcohol, acetone, and energy drinks have also been used. Smoking is the most common form of abuse with complications such as eosinophilic pneumonia, alveolar hemorrhage, acute interstitial pneumonia, and pulmonary fibrosis. We present an atypical methamphetamine-induced lung injury. CASE PRESENTATION: A 57-year-old female with a 40-pack year smoking history and polysubstance abuse presented with acute onset shortness of breath. On admission, she was hypoxic requiring 25 liters of high flow oxygen. On examination, the patient was afebrile with normal blood pressure. Chest auscultation revealed wheezing, most prominent in the left lung fields, while the rest of the systemic examination was unremarkable. Laboratories showed leukocytosis, normal liver, and renal function test. Sputum culture had no bacterial growth and Covid-19 PCR negative. Urine toxicology was positive for methamphetamine. Contrast CT chest showed diffuse interstitial thickening and ground-glass opacities throughout the right lung but normal left lung parenchyma with narrowing of the distal left mainstem bronchus by an endobronchial mass. The patient's hypoxemia improved with Methylprednisolone. Bronchoscopy showed a left mainstem lesion with near-complete obstruction of the left upper and lower lobes with biopsy revealing squamous cell carcinoma. There was normal airway mucosa on the right lung segments and scant inflammation without malignant cells on biopsy. The patient underwent successful tumor debulking with follow-up PET CT demonstrating decreased but persistence of alveolar septal thickening on the right lung with FDG positive mediastinal lymph nodes. The patient was weaned off supplemental oxygen 4 weeks later. DISCUSSION: Diagnosis of Methamphetamine-induced lung injury depends on the history of recent use, ground-glass opacities on imaging, and exclusion of other infections which was fulfilled by our patient but with the question of left lung sparing. Crystalline particles range in size from less than 250 nm-10 μm, with clusters as large as 80 μm where the obstructing mass may have prevented the flow of the drug vapor. Methamphetamine has also been postulated to release early response cytokines including TNF-alpha and IL-6 leading to recruitment of neutrophils and free radicals release causing acute lung injury. The management is mainly supportive with empiric steroids with improvement via impeding this inflammatory cascade. CONCLUSIONS: Our case demonstrates multiple learning points including particle size factor in passage through an obstructed airway, response to steroids supporting in settings of acute inflammation, and the persistence of residual lung disease on imaging in contrast to clinical improvement 4 weeks post-exposure. REFERENCE #1: Javed A, Nasrullah A, Malik K (February 08, 2021) A Rare Case of Methamphetamine-Induced Lung Injury During the Ongoing COVID-19 Pandemic. Cureus 13(2): e13215. doi:10.7759/cureus.13215 REFERENCE #2: Kinner SA, Degenhardt L. Crystal methamphetamine smoking among regular ecstasy users in Australia: increases in use and associations with harm. Drug Alcohol Rev. 2008 May;27(3):292-300. doi: 10.1080/09595230801919452. PMID: 18368611. REFERENCE #3: Lin SS, Chen YC, Chang YL, Yeh DY, Lin CC. Crystal amphetamine smoking-induced acute eosinophilic pneumonia and diffuse alveolar damage: a case report and literature review. Chin J Physiol. 2014 Oct 31;57(5):295-8. doi: 10.4077/CJP.2014.BAC201. PMID: 25241990. DISCLOSURES: No relevant relationships by Uchit Thapa, source=Web Response

Relationships between patterns of cannabis use, abuse and dependence and recent stimulant use: Evidence from two national surveys in Ireland.

Background and objectivesEpidemiological studies show that the use of cannabis is related to the use of other illicit drugs, including stimulants such as cocaine and ecstasy. However, few studies have examined how patterns of cannabis use relate to the use of stimulants. In this research we determined relationships between patterns of cannabis use and recent stimulant use, drawing on data from two large nationally representative surveys. We also explored how frequency of cannabis use relates to stimulant use and whether subjects with a cannabis use disorder (CUD)–defined as cannabis abuse or dependence–are more likely to be recent users of cocaine or ecstasy.Materials and methodsWe analysed data from Ireland’s 2010/11 and 2014/15 National Drug Prevalence Surveys,which recruited 5,134 and 7,005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported some past cannabis use. Multivariable logistic regression analysis was used to examine associations between patterns of cannabis use and recent stimulant use.ResultsAmong survey participants who had used cannabis in the last month, 17.9% reported recent cocaine use, while almost one-quarter (23.6%) reported recent ecstasy use. There was a significant linear relationship between patterns of cannabis use and recent use of cocaine, ecstasy or any stimulant, with last month cannabis users displaying greater odds (OR = 12.03, 95% CI: 8.15–17.78) of having recent stimulant use compared to last year (OR = 4.48, 95% CI: 2.91–6.91) and former (reference) cannabis users. Greater frequency of cannabis use in the last 30 days was also significantly related to the use of stimulants. In addition, results demonstrated an association between CUD and recent use of cocaine or ecstasy (OR = 2.28, 95% CI: 1.55–3.35).ConclusionsFindings from this study suggest a relationship between patterns and frequency of cannabis use and recent use of stimulants and an association between CUD and stimulant use. As the use of cannabis with stimulants may increase the risk of negative health consequences, education in community and medical settings about polydrug use and its increased risks may be warranted.

Migraine prevalence in visual snow with prior illicit drug use (hallucinogen persisting perception disorder) versus without

Background and purposeThis study was undertaken to investigate migraine prevalence in persons with hallucinogen persisting perception disorder (HPPD) presenting as visual snow syndrome (VSS).MethodsPersons with visual snow as a persisting symptom after illicit drug use (HPPD) were recruited via a Dutch consulting clinic for recreational drug use. A structured interview on (visual) perceptual symptomatology, details of drugs use, and medical and headache history was taken. As a control group, persons with visual snow who had never used illicit drugs prior to onset were included. The primary outcome was lifetime prevalence of migraine. Symptom severity was evaluated by the Visual Snow Handicap Inventory (VHI), a 25‐item questionnaire.ResultsNone of the 24 HPPD participants had migraine, whereas 20 of 37 (54.1%) controls had migraine (p < 0.001). VHI scores did not differ significantly between the two groups; in both groups, the median score was 38 of 100. In most HPPD cases (17/24, 70.9%), visual snow had started after intake of ecstasy; other psychedelic drugs reported included cannabis, psilocybin mushrooms, amphetamine, 4‐fluoroamphetamine, 3‐methylmethcathinone, 4‐Bromo‐2,5‐dimethoxypenethylamine, and nitrous oxide.ConclusionsWhereas none of the HPPD participants had migraine, more than half of the visual snow controls without prior use of illicit drugs had migraine. This suggests that at least partly different pathophysiological factors play a role in these disorders. Users of ecstasy and other hallucinogens should be warned of the risk of visual snow. Further studies are needed to enhance understanding of the underlying neurobiology of HPPD and VSS to enable better management of these conditions.

Web scraping of ecstasy user reports as a novel tool for detecting drug market trends

Open-source intelligence (OSINT) is a technique involving the use of publicly available information for the purpose of addressing a specific intelligence issue. Open-source, user-reported data on ecstasy pills was extracted from a clear-web site known as Pill Reports (available at www.pillreports.net) and analysed to establish whether drug intelligence could be derived to assist law enforcement and policymakers in taking effective action against the illicit ecstasy market. A comprehensive database of 4358 ecstasy pills reported by users in Australia and New Zealand between September 2005 and April 2020 was established. Using this database, intelligence was gathered under two categories: general summary data and geographic movement trends. General summary data included pill characteristics (i.e., logo, colour and shape variations), regional distribution and temporal usage trends. Geographic movement data was used to ascertain whether a common sequence of flow (i.e., trafficking patterns) could be identified both (i) across state lines and (ii) east to west across Australia. Open-source investigation of online ecstasy report data proved to be most effective for obtaining general summary data which was concordant with other more costly and onerous population-wide approaches like wastewater analyses and population surveys. There was some evidence to suggest where MDMA is entering Australian borders, and an east-to-west onshore distribution pathway is suggested, taking approximately one year to run its course. This OSINT technique illustrates a novel strategic approach that can be used to monitor drug trends in real-time.

Could a drug‐checking service increase intention to use ecstasy at a festival?

Calls to provide sanctioned drug-checking (pill testing) at Australian music festivals have been met with resistance from most governments due to concerns that such services would increase use of ecstasy and other drugs. We investigated that concern and used the Theory of Planned Behaviour to examine the determinants of intention to use a drug-checking service. Data were collected over a 3-day period at a music festival in Western Australia. Participants (n=247; 50% male; 52% aged 25-34 years) were presented with three hypothetical pill testing scenarios: no testing provided, onsite testing provided and fixed offsite testing provided. Neither ecstasy users (n=212) nor participants who had never used ecstasy (n=35) reported an increased intention to use ecstasy in scenarios in which drug checking was provided. The combination of attitudes, subjective norms and perceived behavioural control predicted intention to use a fixed site drug-checking service, while only subjective norms predicted intention to use an onsite service. These data do not support the view that offering a drug-checking service at a festival will result in ecstasy use by people who have never used ecstasy or lead to increased use among people who use ecstasy.

Enlightened hedonism? Independent drug checking amongst a group of ecstasy users.

BackgroundResearch indicates that a body of ecstasy users across the globe employ ‘home’ drug testing technologies to learn more about the content of their drugs – a process referred to throughout this article as independent drug checking (IDC). Whilst a small number of studies offer accounts of this process, they do so through a narrow lens of harm reduction, potentially overlooking wider socio-cultural factors which may affect this. In response, this article draws on Slavoj Žižek's political theory of the cultural injunction to enjoy, situating IDC in the wider political economy of neoliberal consumer capitalism to contextualise and interpret its use as integral to pleasure and leisure. MethodsThis empirical study documents the thoughts and experiences of a group of UK ecstasy users who independently use a privately owned drug-testing kit. Drawing on qualitative data generated through 20 semi-structured interviews, the article considers two research questions; what role did drug checking play in the group's drug journeys and leisure activities?; and is drug checking thought to be purposeful? FindingsFor this group of ecstasy users, issues of safety and self-responsibility interweaved with the pursuit of pleasure as they sought to enjoy their drug consumption, but in a way that navigated potential harms. IDC therefore served to maximise pleasure via its ‘guarantee’ of a prolonged, enjoyable, authentic consumer experience whilst simultaneously safeguarding wellbeing via its premise of more responsible and controlled consumption practices. ConclusionIDC allowed this group of drug consumers to partake in ‘enlightened hedonism’ – demonstrating their conformity to the imperatives of capitalism and its social norms. Despite recognising the limitations of IDC and disclosing potentially harmful outcomes, the group's engagement with capitalist markets provided a belief that investment in your consumer experience can both improve it and make it safer – premises that belie the empirical reality.

High Prevalence of Tobacco Product and E-Cigarette Use among Electronic Dance Music Party Attendees

Background: Electronic dance music (EDM) party attendees are at high risk for use of various illegal drugs; however, little is known about their tobacco use. Understanding tobacco use patterns in this population at high risk for illegal drug use can inform multi-product interventions. Objectives: 954 EDM party attendees (ages 18–40) were surveyed in New York City in 2017. We estimated prevalence of use of cigarettes, hookah, cigars, other tobacco, and e-cigarettes and delineated correlates of current (past-month) use using bivariable and multivariable models. Results: Past-month use of cigarettes (36.2%), e-cigarettes (15.6%), cigars (12.5%), and hookah (11.7%) in particular was prevalent. In multivariable models, females were less likely to use e-cigarettes than males (adjusted prevalence ratio [aPR] = 0.63, p = .030), and those who attended graduate school were less likely to use cigarettes (aPR = 0.55, p = .003) and/or e-cigarettes (aPR = 0.33, p = .026). Past-year ecstasy/MDMA/Molly use was a risk factor for past-month use of cigarettes (aPR = 1.38, p = .013) and/or cigars (aPR = 1.61, p = .032), and past-year cocaine use was a risk factor for past-month use of cigarettes (aPR = 1.80, p < .001), cigars (aPR = 1.80, p = .013), other tobacco products (aPR = 3.05, p = .003), and/or e-cigarettes (aPR = 2.39, p = .003). 55.4% of ecstasy users and 60.3% of cocaine users were current cigarette smokers, but use of other products among users of these drugs was less prevalent (9.8–27.9%). Conclusions: Results suggest that current tobacco use is prevalent in this population who is also at high risk for use of drugs such as ecstasy and cocaine. Prevention and cessation efforts need to target tobacco users in this scene while incorporating components addressing illegal drug use.

Comparing ecstasy users and non-users in a population-based and co-twin control design across multiple traits

ObjectiveEcstasy is one of the most commonly used illicit substances in Western countries. The aim of this study is to identify characteristics of ecstasy users in a large population-based sample of adults aged 18–45 years. MethodWith generalized estimating equation models we explored the association between self-reported lifetime ecstasy use and urbanicity, educational attainment, health, wellbeing, stress, other substance use, personality traits and psychopathology in a Dutch twin sample (N = 9578, 66.8% female, 18–45 years). We also explored the nature of the association (underlying genetic factors, shared environmental factors or a causal relationship) with the co-twin control method. ResultsLifetime ecstasy users (N = 945, 9.9%) were more often male, younger, living more often in urban areas, higher educated, less satisfied with life and more stressed than non-users. Ecstasy users scored differently on most personality and psychopathology scales compared to non-users and were more likely to have used every other substance we investigated. Whereas smoking tobacco and alcohol use often preceded first use of ecstasy, first ecstasy use often preceded first use of other illicit substances. A combination of scenarios (both causal and environmental/genetic) explained the strong associations between ecstasy and substance use. ConclusionsEcstasy users differ on many characteristics from non-users, and especially on illicit substance use. Our results indicate that causal effects may play a role in explaining the relationship between ecstasy use and other illicit substance use.

The drug purity discounting task: Ecstasy use likelihood is reduced by probabilistic impurity according to harmfulness of adulterants

BackgroundEcstasy typically contains adulterants in addition to, or in lieu of, MDMA which may pose a greater risk to users than MDMA itself. The current study aimed to evaluate the effectiveness of adulterant-related informational prompts in reducing Ecstasy use using a novel probability discounting task. MethodsAn online sample of past-month Ecstasy users (N = 278) were randomized to one of four different framing prompt conditions: no prompt; a prompt describing MDMA’s effects; a prompt describing adulterants as inert “filler”; or a prompt describing adulterants as pharmacologically-active, potentially-harmful compounds. Each prompt contained general, potential public-health information that was not specifically related to subsequent behavioral tasks. All participants then completed an identical Drug Purity Discounting Task, in which they indicated the likelihood of using a sample of Ecstasy across different probabilities of the sample being impure, and then completed a hypothetical Ecstasy purchasing task. ResultsLikelihood of Ecstasy use decreased as impurity probability increased across conditions. Ecstasy use likelihood was highest in the “inert” prompt condition, whereas pharmacologically-active adulterant or adulterant-nonspecific prompts resulted in comparably low likelihood of use. Ecstasy-use likelihood did not differ among conditions when the likelihood of sample impurity was 0. Ecstasy purchasing did not differ among groups. Inelastic purchasing was associated with greater likelihood of using potentially-impure Ecstasy. ConclusionsAltogether, these data highlight the necessity of education regarding pharmacologically-active, rather than inert, adulterants in Ecstasy, and suggest that increased access to drug checking kits and services may mitigate some of the harms associated with Ecstasy use.

Fatal and non-fatal health incidents related to recreational ecstasy use.

Background:The recreational drug ecstasy (3,4-methylenedioxymethamphetamine) is currently used world-wide. Severe (including fatal) health incidents related to ecstasy have been reported but a risk assessment of acute non-fatal and fatal ecstasy-related health incidents has never been performed.Methods:In the current risk assessment review, national data of non-fatal health incidents collected in the Netherlands were combined with the nationwide exposure to ecstasy, that is, last-year prevalence of ecstasy use. In addition, the annual number of ecstasy-related deaths in Great Britain (Scotland, Wales and England) was used to assess the risk of fatal ecstasy-related cases.Results:In the Netherlands, the estimated risk of a moderate to severe acute health incident following the use of ecstasy is one in 900 pills (0.11%), whereas for cocaine it is one in 1600 doses (0.06%) and for gamma-hydroxybutyrate one in 95 doses (1.05%). With respect to ecstasy-related deaths in Great Britain, the estimated risk of ecstasy alone per user is 0.01–0.06%, which is close to the range of the fatality risk in chronic alcohol users (0.01–0.02%), amphetamine users (0.005%) and cocaine users (0.05%), but much lower than that of opiate use (heroin and morphine: 0.35%).Conclusion:The current review shows that almost no data are available on the health risks of ecstasy use. The few data that are available show that ecstasy is not a safe substance. However, compared to opiates (heroin, morphine), the risk of acute ecstasy-related adverse health incidents per ecstasy user and per ecstasy use session is relatively low.

Drug use and the influence on kissing among men who have sex with men in Melbourne, Australia.

The use of drugs is not uncommon among gay, bisexual and other men who have sex with men (MSM). Kissing has been recently identified as a risk factor for gonorrhoea. This study aimed to examine the proportion of MSM who used drugs and how specific drugs influence the likelihood of kissing. We conducted a cross-sectional survey among MSM attending the Melbourne Sexual Health Centre between March 2016 and February 2017. Participants reported their use of eleven specific drugs in the last three months and whether they felt the drug influenced them to kiss someone. Four thousand, three hundred and ninety-one MSM were included in the analysis; 63.1% ( n = 2772) used at least one drug in the last three months and 36.6% ( n = 1605) used ≥2 drugs. Poppers (44.8%), marijuana (30.8%) and ecstasy (19.1%) were the three most common drugs used among MSM in the last three months. 80.4% of ecstasy users and 74.3% of gammahydroxybutyrate users reported the drug made them much more likely to kiss someone. The majority of MSM reported that the use of heroin (63.6%) and Viagra/Cialis (60.7%) did not influence their kissing behaviour. Drug use is common among sexually active MSM in Melbourne. Most reported the use of ecstasy would increase their likelihood of kissing someone.