Short communicationShifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014
Introduction
Ecstasy has been one of the most popular party drugs for decades (Johnston et al., 2017, Parrott, 2013). Ecstasy is a common street name for MDMA (3,4-methylenedioxy-methamphetamine) although it can contain similar MDx drugs (Parrott, 2004, Tanner-Smith, 2006) and commonly contains adulterants such as synthetic cathinones (Brunt et al., 2011, Palamar et al., 2016a, Palamar et al., 2017a). Ecstasy use has been associated with acute adverse effects including hyperthermia, nausea/vomiting, bruxism, and muscle aches/headache, and can have adverse after-effects on mood, sleep, and memory (Baylen and Rosenberg, 2006, McCann and Ricaurte, 2007, Parrott, 2013, Taurah et al., 2014). Its use can also have longer-term memory and neurocognitive effects (Parrott, 2013). Recent evidence suggests, however, that MDMA may serve as an effective adjunct to psychotherapy in the treatment of post-traumatic stress disorder (White, 2014). Ecstasy traditionally comes in pill form, but it has increasingly been marketed in the United States (US) in powder/crystalline form as “Molly” (Palamar, 2017).
Various nationally representative surveys of individuals in the US have found that self-reported lifetime and past-year ecstasy use has decreased substantially since 2001 (CBHSQ, 2015; Johnston et al., 2017). For example, a nationally representative study of high school seniors found that past-year prevalence decreased from 9.2% in 2011–2.7% in 2016 (Johnston et al., 2017). However, ecstasy has become more popular in recent years (e.g., mainstream music lyrics, media coverage, use at large dance festivals) despite decreased prevalence of use (Palamar, 2017). According to Drug Abuse Warning Network (DAWN) hospitalization data, ecstasy-related emergency department visits among people age 21 or younger increased from 4460 in 2005 to 10,176 in 2011 (Substance Abuse and Mental Health Services Administration, 2013). Likewise, between 2007 and 2014, the number of major adverse outcomes or deaths reported to Poison Control Centers (PCC) involving hallucinogenic amphetamines (primarily ecstasy) nearly quadrupled from 26 to 101 (Bronstein et al., 2008, Mowry et al., 2015). The Global Drug Survey (GDS), an annual international self-selected sample of drug-using nightlife attendees also reported an increase in self-reported emergency medical treatment following ecstasy use, which tripled from 0.3% in 2013 to 0.9% in 2015 (Global Drug Survey, 2016).
In addition, ecstasy users are commonly polydrug users (Sanudo et al., 2015), that is, using ecstasy as well as various drugs (especially “club drugs” such as ketamine or gamma-hydroxybutyrate [GHB])— within the same period of time or interval (Bruno et al., 2012, Halkitis et al., 2007). Since concurrent drug use may place users at additional health risks, focus is needed on self-reported use of multiple substances.
While ecstasy use appears to be most prevalent in the electronic dance music scene (Hughes et al., 2017, Palamar et al., 2017b), examining recent shifts in demographic characteristics of users can inform potential needed changes to strategies for prevention efforts, public health messages, and harm reduction. User demographics may have shifted over time as the form of the drug has largely changed from pills to powder; individuals who continue to use ecstasy despite decreased prevalence could need focused efforts to reduce related harms. Thus, we examined trends in demographic and other substance use characteristics of ecstasy users in a nationally representative sample of individuals ages 12–34 in the US.
Section snippets
Procedure
The National Survey on Drug Use and Health (NSDUH) is a nationally representative repeated cross-sectional survey of non-institutionalized individuals ages 12 and older in the 50 US states and the District of Columbia (CBHSQ, 2015). The sampling frame is obtained via four stages within each state. Surveys are administered via computer-assisted interviewing conducted by an interviewer and audio computer-assisted self-interviewing to increase honest reporting of sensitive information. Sampling
Results
Prevalence of self-reported past-year ecstasy use was 2.2% in 2007/08, 2.6% in 2009/10, 2.4% in 2011/12, and 2.3% in 2013/14 with no statistically significant absolute or relative change over time (P = 0.693). Table 1 describes demographic characteristics and other substance use characteristics among ecstasy users (N = 7979), reporting absolute and relative difference over time in the proportion of people in each subgroup. The majority of ecstasy users were ages 18–25 (i.e., 60%); this remained
Discussion
This study of a nationally representative and non-institutionalized US population ages 12–34 found that while prevalence of past-year ecstasy use remained stable at 2.2-2.6% from 2007/08 to 2013/14, user characteristics shifted toward young adults with a higher education. Six out of ten users were young adults ages 18–25; the proportion of users ages 26–34 increased over time. Decreases in use among younger participants are consistent with decreases in use of other substances (Johnston et al.,
Conclusions
While prevalence of past-year ecstasy use has remained stable in the US over the past decade, ecstasy users are increasingly young adults with higher education, and thus may require different prevention methods commonly geared to ecstasy-using populations a decade ago. Past-year use of many (≥5) other illegal substances is increasing among ecstasy users, particularly LSD, ketamine, and tryptamine use. The current generation of ecstasy users may require further prevention and harm reduction as
Conflict of interest
No conflict declared.
Contributors
All authors are responsible for this reported research. J. Palamar conceptualized and designed the study, and conducted the statistical analyses. J. Palamar, P. Mauro, B. Han, and S. Martins drafted the initial manuscript, interpreted results, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.
Role of funding source
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers K01DA038800 (PI: Palamar), R01DA037866 (PI: Martins), and T32DA031099 (PI: Hasin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access
Acknowledgment
The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp).
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