Pharmacological content of tablets sold as “ecstasy”: Results from an online testing service

Abstract

Purpose

This study examined the pharmacological content of tablets sold as ecstasy, the variation of tablet content by geographic region, and change in tablet content between 1999 and 2005.

Methods

The sample was comprised of tablets anonymously submitted for laboratory testing between 1999 and 2005 (n = 1214). Tablet height, width, geographic region, and year of submission were all used to predict the pharmacological content of the tablets.

Results

Overall, 39% of the tablets were comprised of MDMA only, 46% only contained substances other than MDMA and 15% were mixtures of MDMA and other substances. Tablet height and width were inversely related to tablet purity. Ecstasy tablets from California and Florida had decreased likelihoods of containing non-MDMA substances. The purity of tablets decreased over time, which was largely a result of an increasing number of tablets comprised of MDMA along with other substances.

Conclusions

Ecstasy users may be putting themselves at increased risk of substance-induced anxiety, mood, and psychotic disorders by unknowingly ingesting substances other than MDMA. To decrease detrimental health effects, prevention programs should emphasize the impurity of ecstasy tablets and focus on the health impacts of these substances, particularly for populations at high-risk of substance-induced disorders.

Introduction

Although the use of 3,4-methylenedioxymethamphetamine (MDMA) or “ecstasy” in the United States is stabilizing or declining, an estimated 2–4% of U.S. adolescents and young adults report annual use of MDMA (Johnston et al., 2005, Strote et al., 2002). Despite the low prevalence of MDMA use in the general population, MDMA is and remains popular as a “club drug” in the rave community. The few extant MDMA prevalence studies of U.S. rave attendees indicate that between 13 and 30% of sampled rave attendees report two-day ecstasy use (Arria et al., 2002, Yacoubian et al., 2003, Yacoubian et al., 2004). MDMA use is also prevalent in Australia, Canada, and other European countries (Degenhardt et al., 2005, Gross et al., 2002, Landry, 2002), again, particularly for adolescents and young adults involved in the rave scene (Barrett et al., 2005, Engels and ter Bogt, 2004, Lenton et al., 1997, Wijngaart et al., 1999).

Given that many adolescents and young adults report lifetime as well as regular use of MDMA, it is no surprise that researchers have increasingly focused on the negative cognitive, psychological, and neurological effects of MDMA. There is great debate within the scientific community as to whether MDMA leads to long-term neurotoxicity in users (Morton, 2005), but evidence suggests that hyperthermia and hyponatraemia are potential acute adverse effects of ecstasy use (Gowing et al., 2002). In addition to the negative cognitive, psychological, and neurological effects of MDMA, another facet of ecstasy use that has important public health implications is the fact that many tablets sold as ecstasy contain a variety of substances in addition to or instead of MDMA (Cheng et al., 2003, Cole et al., 2002, Kalasinsky et al., 2004, Parrott, 2004). This is not to suggest that the detrimental health effects of MDMA are unimportant, but rather that they only comprise part of the risk associated with ecstasy use. For although users may be aware of the risks associated with MDMA (Gamma et al., 2005), they may be unaware of the risks associated with the other drugs they could be (unknowingly) ingesting. Ecstasy tablets may include substances such as caffeine that have few serious health repercussions in small doses (Daly and Fredholm, 1998), or substances such as ketamine, methamphetamine, or paramethoxyamphetamine that are unsafe alone or in combination with other drugs (Baggott et al., 2000, Renfroe, 1986, Sherlock et al., 1999). Moreover, the contamination of ecstasy tablets is particularly troublesome for users with certain predisposing factors for addictions and/or psychiatric disorders (Chen et al., 2003). Given these public health implications, the systematic study of ecstasy tablets’ pharmacological content provides valuable information for researchers and health professionals alike.

To date, several studies have empirically examined the pharmacological content of ecstasy tablets, relying primarily on samples of tablets from police seizures (Cheng et al., 2003, Cole et al., 2002), anonymous submissions by individuals (Baggott et al., 2000, Renfroe, 1986, Spruit, 2001) or comparisons of self-reports to scalp hair analysis (Kalasinsky et al., 2004). However, given the variability in sampling methods, limited sample sizes, and limited heterogeneity of samples, the extant literature has yielded inconsistent findings regarding ecstasy tablet contamination.

For example, several empirical studies have reported considerable levels of ecstasy tablet contamination. One of the first empirical analyses of ecstasy tablet content was that of Renfroe (1986), which reported the content of 101 tablets anonymously submitted between 1973 and 1985 to the U.S. drug testing service Analysis Anonymous. The results indicated that 58% of the alleged ecstasy tablets contained MDMA only, 24% contained MDMA as well as other drugs, 16% contained drugs other than MDMA, and 2% contained no identifiable substances; one of the primary adulterants in the ecstasy tablets was methylenedioxyamphetamine (MDA) (Renfroe, 1986). Over a decade later, Baggott et al. (2000) analyzed the pharmacological content of 107 ecstasy tablets submitted anonymously to the U.S. organization DanceSafe between February 1999 and March 2000. The results indicated that 63% of the sample contained MDMA, 29% contained substances other than MDMA, and 8% contained no identifiable drugs; primary adulterants included dextromethorphan (DXM), caffeine, ephedrine, and pseudo-ephedrine (Baggott et al., 2000).

In another recent study, Cheng et al. (2003) identified the primary ingredients of ecstasy tablets seized in Hong Kong between 2000 and 2001. In a sample of 212 different types of ecstasy tablets, approximately 55% contained primarily MDMA, 40% contained primarily methamphetamine, 5% contained primarily MDA, and 5% contained primarily amphetamine. Moreover, the percentage of tablets comprised primarily of MDMA decreased significantly between 2000 and 2001, while the percentage of methamphetamine and MDA tablets significantly increased. Finally, although only 12% of the 2000 sample included tablets that were comprised of MDMA and ketamine, 42% of the 2001 sample included tablets that were a mixture of MDMA and ketamine—thus indicating increased tablet contamination between 2000 and 2001 (Cheng et al., 2003).

Other empirical studies, however, have reported lower levels of ecstasy tablet contamination, suggesting higher levels of purity. For example, Cole et al. (2002) analyzed the content of 80 ecstasy tablets sampled from a large police seizure of approximately 160,000 ecstasy tablets in the United Kingdom, as well as the content of ecstasy tablets analyzed by the Forensic Science Service in the United Kingdom. Interestingly, all of the tablets contained MDMA, although some tablets also contained portions of methylendioxyethamphetamine (MDEA). Despite the relative purity of the ecstasy tablets in this sample, the MDMA content of ecstasy tablets decreased over time, from 102 mg in 1991 to 73 mg in 2001 (Cole et al., 2002).

Using data from the Drug Information and Monitoring System (DIMS) in the Netherlands, Spruit, 1999, Spruit, 2001 analyzed over 10,000 ecstasy tablets submitted to DIMS for chemical analysis. The DIMS project was one of the first formal initiatives for harm reduction through pill testing, originating in 1992 with the support of the Dutch government. The DIMS sample of ecstasy tablets (submitted primarily by anonymous users) indicated that between 1993 and 1996 approximately 48–60% of the tablets were comprised of MDMA only, 7–13% were comprised of MDMA as well as other substances, and 2–7% were comprised of non-MDMA substances only (Spruit, 2001). Tablet purity decreased substantially in 1997, when 34% of tablets contained MDMA only and 14% contained MDMA as well as other substances (Spruit, 1999, Spruit, 2001). Tablet purity rebounded in 1998 and 1999 however, when 75 and 81% of pills were comprised of MDMA, respectively (Spruit, 1999, Spruit, 2001). So although purity levels were quite low in the early 1990s, they increased during the late 1990s.

In a more recent literature review, Parrott (2004) discussed the findings of numerous studies on ecstasy tablet purity ranging from the mid-1970s to the early 2000s. Parrott's (2004) comprehensive review summarized the results from the aforementioned studies, but also reviewed several smaller (n < 100) pharmacological analyses of ecstasy tablets, survey studies of ecstasy users’ subjective reports of tablet purity, and toxicological analyses of ecstasy attributed deaths (e.g., Milroy et al., 1996, Saunders, 1995, Sherlock et al., 1999). Overall, Parrott (2004) reported that ecstasy tablets in the 1980s were of high quality and purity (90–98% containing MDMA), although a small amount of tablets did contain MDA. In the early 1990s, ecstasy tablet purity declined, and many tablets contained substances other than MDMA (50–80% containing MDMA). Finally, Parrott (2004) reported that the proportion of ecstasy tablets containing MDMA increased to 80–90% in the late 1990s, and increased to between 90 and 100% in the early 2000s.

Thus, the previous empirical literature suggests that ecstasy tablets often include substances other than MDMA, although estimates of tablet contamination have varied considerably across time and space. Unfortunately, previous studies have suffered common flaws that have left the need for more systematic research on the topic. For instance, due to limitations in data availability, many empirical studies’ samples included tablets from a span of only one or two years, therefore precluding researchers’ ability to analyze trends over time (with the notable exception of Spruit, 1999, Spruit, 2001). Second, previous empirical studies have also relied on largely homogeneous samples of ecstasy tablets (e.g., from police seizures), thus providing little information about variation in tablet purity. Moreover, the understandable reliance on small samples has limited researchers’ ability to conduct multivariate analysis or analysis of trends in tablet purity across geographic regions. Finally, most recent empirical studies have relied on European tablet samples (see Parrott, 2004), thereby restricting generalizations to the purity of U.S. ecstasy tablets. The current study attempts to fill these gaps in the literature by analyzing a large sample of ecstasy tablets anonymously submitted to an online testing service in the United States over a span of six years.