Elsevier

Drug and Alcohol Dependence

Volume 181, 1 December 2017, Pages 20-24
Drug and Alcohol Dependence

Short communication
Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

https://doi.org/10.1016/j.drugalcdep.2017.09.011Get rights and content

Highlights

  • Past-year prevalence of ecstasy use was stable at 2% from 2007/2008 to 2014/2015.

  • Over time, users tended to be older (age 26–34), more educated, and not married.

  • Over time, users were less likely to be younger (age 12–17) or black.

  • Over time, users were less likely to report lower income or be less educated.

  • Past-year other drug use increased over time, particularly tryptamine (DMT/AMT/Foxy) use.

Abstract

Background

Ecstasy/MDMA has been one of the most prevalent party drugs for decades, and powder ecstasy recently increased in popularity. We examined trends in use to determine who to best target for prevention and harm reduction.

Methods

Secondary analysis of the 2007–2014 National Survey on Drug Use and Health, a repeated cross-sectional, nationally representative probability sample, was conducted. Linear trends in past-year ecstasy use and trends in demographic and other past-year substance use characteristics among ecstasy users were examined among participants ages 12–34 (N = 332,560).

Results

Past-year prevalence of ecstasy use was stable across years at 2% (P = 0.693). Over time, the proportion of ecstasy users with a college degree increased from 11.5% in 2007/08 to 24.5% in 2013/14 (P < 0.001). The proportion of users who were age 12–17 decreased, as did proportions of users who are non-Hispanic black, and reported income <$20,000/year (Ps < 0.001). Prevalence of past-year use of marijuana, LSD, ketamine, and DMT/AMT/Foxy increased among ecstasy users (Ps < 0.05); DMT/AMT/Foxy use increased more than four-fold from 2.1% in 2007/08 to 8.7% in 2013/14. Perception of great risk associated with LSD use decreased among users and ease of obtaining LSD increased (Ps < 0.05). Past-year use of 5 or more other substances also increased over time (P < 0.05).

Conclusions

Ecstasy use in the US appears to be increasing among those with college degrees and use of other substances among ecstasy users is growing—particularly use of otherwise rare substances such as tryptamines.

Results inform prevention and harm reduction strategies in this increasingly shifting group of ecstasy users.

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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