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December 2005

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Prevention

Research

Quarterly

Current

evidence

evaluated

Prevention,

ecstasy and

related drugs

ISSN 1832-6013


Prevention Research Quarterly: current evidence evaluated

ISSN 1832-6013

© DrugInfo Clearinghouse 2005

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Dr Cameron Duff, Research Lead, Vancouver Coastal Health, Canada

Dr Louisa Degenhardt, National Drug and Alcohol Research Centre

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Contents

Prevention, ecstasy and related drugs

Prevention research evaluation report no. 16 3

Prevention research summaries no. 15 23

Reading and resource list no. 16 27


Prevention research evaluation report

Number 16 December 2005

Ecstasy

Mr Netzach Goren, Centre for Youth Drug Studies, Australian Drug

Foundation

Party drug use has become a worldwide phenomenon of club and dance youth culture. The

term “party drug” usually refers to drugs such as GHB, ketamine, Rohypnol and ecstasy. While

research-based evidence regarding the negative side effects of GHB, ketamine and Rohypnol

is still evolving, the side effects of ecstasy use are better documented. The aim of the current

report is to examine the cumulative, scientific-based knowledge regarding the most “popular” and

frequently used party drug, ecstasy.

Introduction

Approximately two decades ago, a new illicit drug,

3, 4- methylenedioxymethamphetamine, known by

the street names ecstasy, E, XTC or MDMA (Walters,

Foy & Castro 2003; Pape & Rossow 2004) began

to emerge within isolated pockets of youth and

adolescent populations around the globe. Recent

epidemiological evidence points to the growing

global popularity of ecstasy in this population and,

increasingly, the drug is being consumed within a

broad range of social contexts (Duff 2005; Johnston

O’Malley, Bachman & Schulenberg. 2004a, PDPC

2004). Recent Australian data indicates that ecstasy

is the third most-commonly used illicit drug in

Australia (Degenhardt, Copeland & Dillon 2005),

with approximately 20 per cent of young people

aged 20–29 years having experimented with ecstasy

at least once (Breen et al. 2004). According to the

Australian National Drug Strategy Household Survey

(AIHW 2004), approximately 1.2 million Australians

have used ecstasy. Compared with other Englishspeaking

countries (Canada, New Zealand, United

Kingdom and the United States), Australia has the

highest rates of ecstasy use among the population

aged 15 years and over (Global Illicit Drug Trends,

United Nations 2004), with approximately 4.5 per

cent of young people reporting ecstasy use during

the previous 12 months. In the United States,

10 per cent of high school seniors reported lifetime

ecstasy use (Yacoubian 2003). These figures, in

conjunction with laboratory and epidemiological

findings, have led many researchers to explore

the various physiological and psychological harms

potentially associated with ecstasy use (see Maxwell

2005). This research has also highlighted the need

to develop and deliver effective prevention and

harm-minimisation programs in order to combat this

increasing trend in use.

The aim of the current issue of Prevention Research

Quarterly is to tell the story of ecstasy. The most

recent scientific evidence associated with ecstasy is

reviewed. In addition, as in previous issues, our aim

is to provide readers with a global understanding of

different aspects of ecstasy use and related risks

and harms. Therefore, while considerable weight is

given to recent scientific research findings, we also

examine practitioners’ views (health professionals),

and the perspective of ecstasy users. Telephone

interviews were conducted with eight practitioners

regarding their views on current prevention

and harm-minimisation strategies in Australia.

Table 1: Frequency of ecstasy use among

Victorian users during the past 12 months

Once only 12%

Once a week or more 10%

Once a month 24%

Every few months 30%

Once or twice a year 24%

Source: PDPC 2004


Prevention, ecstasy and related drugs

In addition, interviews were also undertaken with

ecstasy users in different dance clubs in Victoria.

This paper provides readers with a brief description

of ecstasy’s history, followed by a discussion of

recent findings on the physiological and psychological

harms associated with ecstasy use. Next, based on

cumulative research findings, we attempt to illustrate

the characteristics of ecstasy users. The dance/rave

scene associated with ecstasy use is broadly outlined

in this section. It will become apparent to the reader

that while ecstasy has historically been associated

with specific populations (for example, white “Anglo”

populations) and settings (clubs and raves), it is

currently moving beyond these specific domains

to broader contexts. Consequently, the health

and wellbeing of an enormous number of users is

increasingly becoming a significant societal issue.

Patterns of, and reasons for, use among high school

students is discussed next. Then the focus moves to

current prevention and harm-reduction strategies.

From the review of the available strategies, it is

apparent that there is a pressing need for both an

improved understanding of available harm-reduction

techniques, and the appropriate ways of employing

them. To conclude, an outline of an ecstasy specific

prevention program is sketched, and suggestions are

made concerning future research directions aimed at

deterring young people from ecstasy misuse.

The history of ecstasy

Ecstasy, initially referred to as MDMA, was first

synthesised in 1912 and was later patented in

Germany by Merck in 1914 (Gowing, Proudfoot,

Henry-Edwards & Teesson 2001; Walters et al.

2003. Although MDMA was designed to function as

an appetite suppressant, it was never marketed in

this capacity, nor was it subject to human research

trials (Gowing et al. 2001; Conductier, Crosson, Hen,

Bockaert et al. 2005).

Interestingly, human research trials were only

initiated during the 1950s by the United States

government as part of its army’s exploration of

chemical warfare. During the 1970s, psychiatrists

and psychotherapists familiar with the field of

psychedelic psychotherapy, prescribed the drug

to patients who were considered to be overly

inhibited. They suggested that it might be a useful

tool to treat a wide range of conditions such as

post traumatic stress, depression and relationship

difficulties, among others (Grob 2000). Therapists

were impressed by the fact that MDMA was able

to create feelings of intimacy and euphoria, and to

increase communication skills without the overt and

substantial side effects (for example, hallucinations)

associated with other drugs such as LSD (Grob

2000). In the early 1980s, the drug began to be used

non-medically, particularly in Texas, under the name

“ecstasy”. It was specifically marketed in bars and

nightclubs. In 1985 the United States Food and Drug

Administration criminalised the use of the drug. In

1988, ecstasy was classified as a Schedule I drug

under the Controlled Substances Act.

Following the United States’ decision, in 1987 it

became illegal to import ecstasy to Australia.

Global ecstasy market

Since then, ecstasy has been marketed underground

across various street drug markets and youth

cultures, and there has been a dramatic increase

in its demand (Agar & Reisinger 2003). Ecstasy

has gained popularity among ravers and within

the club scene in the United Kingdom, United

States, Australia, Paris, Ibiza, Israel and in many

other developed countries (Agar & Reisinger

2003; Sanders, 2005; Riley & Hayward 2004). It

is estimated that the use of ecstasy in the United

Kingdom increased by more than 4000 per cent

between 1990 and 1995.

Ecstasy subculture

Numerous researchers argue that the ecstasy scene

has become a subculture in itself; a culture that is

not deviant from conventional society (Hammersley,

Khan & Ditton 2002). Furthermore, as Anleu (1999)

suggests, the members of this subculture do not

typically present with the problems of addiction or

crime that are usually related to illicit drug use.

What makes ecstasy so popular and

unique

From a review of the literature, it appears that four

main factors and myths may have contributed to the


Prevention research evaluation report

Number 16 December 2005

popularity of ecstasy among young people. Firstly,

many users characterised the effect of the drug

as “euphoric” and “love inducing” (Walters et al.

2003). Secondly, unlike heroin, which is associated

with an individual experience, or cocaine, which is

expensive, ecstasy is relatively affordable and is

linked to clubs, music and fun (Yacoubian, Deutsch

& Schumacher 2004; Winstock, Griffiths & Stewart

2001). Consequently, ecstasy is the “perfect” drug

for young people who want to socialise. Thirdly, the

low number of observable, short-term side effects,

compared to other drugs, in conjunction with the

relatively low risk of overdose, appear to contribute

to ecstasy’s popularity (Walters et al. 2003). Finally,

in order to differentiate their product from other

drugs, producers usually imprint ecstasy tablets

with symbols of popular culture, such as smiley

faces, the “Playboy” symbol or brand names such

as “Mitsubishi”. These recognisable logos contribute

to the notion that ecstasy is a relatively harmless

drug. A user’s description of the positive experience

associated with ecstasy is presented in Box 1.

Box 1: Positive experience of ecstasy

user

“Well, you just generally want to talk a lot

more … You’re more open to just share

stuff with just random people that you’ve

just met, and that you’ll probably never see

again… you can actually sort of feel for the

person… it’s almost like an emotion sort of

thing… I had an absolutely great night, it

was like the best feeling I’d ever had in my

life and sort of like… I was like chilled out

and relaxed and like open to everyone… so

yeah I think the relationships you develop

with people and loss of inhibition [make it so

popular]…”

Practitioners’ views

Consistent with the research literature, all

practitioners indicated that, compared with other

drugs, the “safe to use” features and the positive

feelings induced by ecstasy contribute to the drug’s

popularity. The following comments by a volunteer

whose organisation provides information to users

and performs pill testing on site (for example, at

raves and clubs), demonstrates some of the merits

of the drug as perceived by users:

“Initially there are relatively few side effects

from it [ecstasy] compared to other drugs. No

hangover [alcohol], or such a come down as

with speed use or cocaine. This does come,

but with more use. But because the initial

effects are so pleasurable with so little pay

back, it makes it attractive. In addition, the

psychological effect of feelings of connection

contrasts to the people’s everyday work-life

which is often intense. They have less time to

be with their friends and to invest in significant

relationships. So to be able to focus this time

with MDMA which allows them to be emphatic,

sharing, honest and outgoing… it fits very well

with the modern life style. So it’s basically the

minimal side effects and the social context.”

Another interesting opinion came from a dance music

journalist:

“Kids are naturally inquisitive, they like to break

rules, and they like to step out side of the

boundaries. I think with ecstasy it’s perceived

as pretty safe; it generally makes you feel

good and it gives you energy. So I think that

when kids are using it with the music scene,

they feel that they are expressing a side of

themself which is a bit more caring, loving. I

think therefore it’s much more like a situational

attraction of being with a large group of people.

It’s very attractive to a lot of youth and of

course it goes wonderfully with dance music.”

Ecstasy—brain chemistry

Ecstasy has been hypothesised as representing

a new class of psychoactive agent, called

“entactogens” (Baggott 2002). In its “pure” form,

ecstasy is usually referred to as MDMA. However,

laboratory tests suggest that in most cases ecstasy

purchased on the street bears little similarity

to “pure” MDMA (Walters et al. 2003). Street

ecstasy typically contains other chemicals such as

amphetamine, ketamine, caffeine and ephedrine

(PDPC 2004).


Prevention, ecstasy and related drugs

The nerve pathway that is predominantly affected

by ecstasy is called the serotonin pathway. This

pathway is involved in the regulation of several

processes within the brain, such as emotions,

mood, aggression, sleep, appetite, perception

and memory (Britt & MCCance-Katz 2005; Morton

2005). Ecstasy mostly binds to the serotonin

transporters, which in turn lead to higher amounts of

serotonin in the synaptic space, with more serotonin

receptors becoming activated in the brain (Morton

2005; Colado, O’Shea & Green 2004; Wolff, Hay

& Sherlock 1995). In addition, ecstasy affects two

other molecular sites, dopamine and noradrenalin

(Simantov 2004).

Effects of ecstasy

Over the past 20 years, scientific interest in

researching the potential effects of ecstasy has

increased significantly from eight published papers

in 1986 to more than 100 per year in the new

millennium (Green 2004). Obviously, the increase

in knowledge about ecstasy is valuable, as it is only

through such knowledge that potential users will

be able to make informed choices regarding future

ecstasy use. As epidemiological studies report,

ecstasy related deaths are fairly rare. Weir (2000)

estimates that, out of one million users, there were

40 ecstasy related deaths in England during 1994.

It appears that non-fatal adverse events are more

common. The following section focuses on the long

and short-term effects of ecstasy on humans.

Short-term acute physiological

effects of ecstasy use

As with many other substances, ecstasy produces a

period of acute intoxication that results in a range of

psychological and physical changes in the body and

mind. The drug creates a variety of positive feelings

as well as negative side effects. The effects of

ecstasy can be felt approximately 20 to 40 minutes

after consumption (Ghodse & Kreek 1997). The

“high” usually lasts 4–6 hours. Studies that employ

in-depth interviews and self-report questionnaires

with users could provide the research community

with a good indication regarding the positive

and negative effects of the drug. Positive effects

associated with ecstasy include feelings of euphoria,

loving and warmth toward others, increased selfconfidence,

lack of inhibition, happiness, feelings of

relaxation, wellbeing, exhilaration, self-exploration,

emotional openness and increased energy, and some

users also report experiencing spiritual insights (Fry

& Miller 2002). These effects are linked to the effect

of ecstasy on the serotonergic pathway in the brain.

Meanwhile, different studies examining the negative

effects on users have largely produced consistent

findings. These include loss of appetite, jaw

clenching, teeth grinding, nausea, muscle aches,

stiffness, ataxia (impairment of motor control),

blurred vision, increased sweating, increased heart

rate, insomnia and fatigue. Most of these side effects

subside within 24 hours (Davison & Parrott 1997;

Greer & Tolbert 1986; Topp et al. 2002; Liechti &

Vollenweider 2000 Fry & Miller 2002).

The predominant toxicity patterns that emerge from

emergency rooms and death reports are fulminant

hyperthermia convulsions, disseminated intravascular

coagulation (DIC) (blood clotting in the blood

vessels), rhabdomyolysis (dissolution of skeletal

muscle) and acute renal (kidney) failure. In fulminant

hyperthermia, the ecstasy user experiences high

body temperature that leads to multiple organ

failure, and in some cases death. In most cases,

when the user’s body temperature rises above 42°C,

the reaction is fatal (Cole & Sumnall 2003). There

is also some evidence to suggest that hyperthermia

caused by ecstasy intake may cause liver damage

(Andreu, Mas & Brugura 1998; Jones & Simpson

1999).

Ecstasy intoxication has also been linked to

hyponatremia, a condition to which young

women appear to be more susceptible than men

(Budisavljevic, Stewart, Sahn & Ploth 2003). The

pathogenesis of MDMA-associated hyponatremia

involves excessive water intake, and inappropriately

elevated antidiuretic hormone (ADH) levels. Many

ecstasy users participate in raves, dancing for hours,

usually in large crowds and in hot temperatures.

In order to combat dehydration, it was initially

recommended to ravers that they be aware of

water consumption (Finch, Sell & Arnold 1996).

Many ravers then drank water excessively, which

in turn led to hypothermia and cerebral oedema

(Box, Prescott & Freestone. 1997). Moreover, to


Prevention research evaluation report

Number 16 December 2005

strengthen the effects of the drug, many users

also began to consume “energy drinks” containing

vitamins and amino acids, which increase the

potential toxicity (Maxwell 2005). Currently,

ecstasy users in raves/clubs are advised to drink

isotonic sport drinks and small amounts of water in

conjunction with salty foods.

Practitioners’ views

Ambulance paramedics are often the first to

approach and assist ecstasy users who experience

medical problems. Therefore, their knowledge of the

short-term side effects of ecstasy use is extremely

valuable and reliable. An ambulance paramedic who

frequently treats ravers on-site describes the shortterm

medical effects as follows:

“The most common serious side effects are

water intoxication and the seizures associated

with it. Another common effect [of ecstasy] is

sexual disinhibition, which often leads to risky

sexual activity. So from a clinical point of view,

this is probably the most common side effect.

We also see a bit of paranoia and palpitations…

Overall, there is a significant amount of ecstasy

Box 2: Personal experiences of negative

side effects of ecstasy use

“I used to get really anxious on pills, like to

the degree where I had to teach myself a

mind control method where I was just able

to control myself, that’s what I felt like.”

“I think dehydration is a big thing. I know

you are supposed to drink water and I still

don’t drink enough water. I am still lazy with

it. But it is not to the degree that I need to

be hospitalized due to dehydration… Monday

or Tuesday after [taking pills] I will get

headaches because I am dehydrated. I think

the biggest issue that I’d love to know how

to fix, is the teeth grinding thing…”

“The first one I was like throwing up,

headache, I just felt like I wanted everyone

to leave me alone…”

available, but as far as direct cost to emergency

health care, it creates very little work for us

and it causes less acute clinical presentations

compared to a wide variety of other drugs.”

In addition to health professionals, another source

of information concerning the negative effects

of ecstasy is provided by interviews with users.

Box 2 relates ecstasy users’ personal experiences,

perceptions and myths about the side effects

associated with ecstasy.

Long-term effects of ecstasy use

Ecstasy is considered a relatively “young” drug.

Consequently, substantial gaps in knowledge exist

regarding the long-term effects of the drug on

humans. With time and research, a more reliable and

accurate picture will undoubtedly emerge.

Ecstasy exposure and neurotoxicity

Most of the findings relating to the effects of

ecstasy on the central nervous system focus on

the serotonergic pathways. Laboratory studies

have reported a decrease in the number of 5-HT

sites in the brain (Reneman, Booij, Schmand, van

den Brink et al. 2001; Semple, Ebmeier & Glabus

1999). However, these changes have been found

to be temporary. Other studies have found lower

levels of 5-HIAA in the CSF among ecstasy users,

compared to those in control groups (for example,

Grob 2000; McCann 1994). This may point toward

some dysfunction in the serotonergic pathway among

users. Overall, due to the ethical issues associated

with the provision of ecstasy to users for scientific

study, this line of research produces inconsistent

results, and as such, long-term effects are not

known.

Ecstasy and cognitive deficit

As with the neurotoxicity effect of ecstasy on users’

brains, there is still uncertainty as to how dangerous

ecstasy is for users (Saunders 1998). However,

probably the most consistent findings link ecstasy to

A watery fluid, continuously produced and absorbed,

which flows in the cavities within the brain and around

the surface of the brain and spinal cord.


Prevention, ecstasy and related drugs

learning and memory deficits (Bhattachary & Powell

2001; Gouzoulis-Mayfrank, Daumann, Tuchtenhagen,

Pelz et al. 2000; Reneman, Booij et al. 2001, 2001b;

Verkes, Gigsman, Pieters, Schoemaker et al. 2001).

Other studies have examined possible effects of

ecstasy on level of impulsivity and aggression

(Travers & Lyvers 2005) and verbal memory

deficits (Reneman, Lavalaye, Schmand, de Wolff

et al. 2001). However, no consistent results were

obtained. In Box 3, an ecstasy user describes some

of his cognitive abilities in the days following drug

consumption.

Box 3: User’s description of cognitive

performance post ecstasy use

“I mean, you’re not in any position to start

writing a major report or anything like that,

you can go to class, you can take notes but

if you have a test where you need to be

thinking through problems and shit like that,

you’re not in your finest state, you’re at a C

grade not an A grade.”

Psychological effects

Ecstasy users report a wide range of psychological

effects, positive (as mentioned above) and negative,

which include anxiety, depression, depersonalisation,

confusion, perceptual side effects such as

“flashbacks” and hallucinations, aggression and

impulsivity, motivational deficits, panic attacks and

paranoia (Montoya, Sorrentino, Lukas & Price 2002).

Many of these psychological effects seem to be

consistent with the cumulative evidence that ecstasy

has toxic effects on serotonergic pathways in the

brain (Morgan, Mofie, Fleetwood & Robinson 2002).

The most commonly reported symptoms are panic

attacks/anxiety and toxic psychoses. Panic attacks

usually tend to occur within the first hour of ecstasy

consumption (Williamson, Gossop, Powis, Griffiths

et al. 1997). According to McCann and Ricaurte

(1991), individuals with genetic predisposition to

panic attacks are more vulnerable to experiencing

an attack while using ecstasy. In such cases, the

risk is that ecstasy use may trigger panic disorder.

With regard to toxic psychoses, Gouzoulis, von

Bardeleben, Rupp, Kovar et al. (1993) showed that

ecstasy caused psychosis when given to a healthy

volunteer. While other cases have been reported

(self reports), it is known that these individuals also

presented with premorbid psychological dysfunctions

(Gamma et al. 2000). In another study, heavy

ecstasy users indicated significantly higher scores

on a psychological symptoms list, compared to nonusers.

These include obsessive-compulsive patterns,

anxiety, psychosis, somatisation and loss of pleasure

from sexual activity (Parrott 2001). Further findings

suggest high levels of depression among users

(MacInnes, Handley & Harding 2001; Verheyden,

Maidment & Curran 2003). Gender differences were

also identified, with women being more susceptible

than men to “flashbacks”, hallucinations (Liechti

& Vollenwieder 2001) and low mood following a

weekend of ecstasy use (Verheyden et al. 2002;

Maxwell 2005). In conclusion, it would appear that

more is unknown rather than known with regard to

the long-term effects of ecstasy on humans, and

further well-designed research is needed to clarify

such effects.

Characteristics of ecstasy users

Recent studies in Europe, Australia and the United

States have consistently reported high levels of

ecstasy use among young people (AIHW 2004;

Johnston et al. 2004a, 2004b; PDPC 2004; Maxwell

2005; Riley & Hayward 2004). In order to create

effective prevention or harm-reduction strategies,

the identification of ecstasy users, and whether

there are some common characteristics among the

members of this group, is necessary. Most of the

information regarding user-group characteristics has

been derived from epidemiological studies based

on large numbers of participants. This section aims

to gather and relate the most recent information

regarding user characteristics. From a cultural or

sociological point of view, ecstasy use has always

been associated with raves and dance scenes.

Therefore, the reader is provided with a brief history

of raves and the electronic music associated with

them. The link between the dance scene (raves and

club parties) and ecstasy is also discussed. Finally,


Prevention research evaluation report

Number 16 December 2005

the focus expands to include the characteristics of

ecstasy users within the general population.

Rave parties

Raves are outdoor dance events at which DJs play

electronic dance music. They may start and finish

over the course of a night, or last several days.

The term “rave” describes the party phenomenon

and subculture that grew out of the acid house

movement. Raves first emerged in Europe during

the mid-1980s (Hammersley, Khan & Ditton 2002),

and while the birthplace of the modern rave is

unknown, we do know that “ravers” share similar

characteristics to the “flower power” children of the

1960s and ‘70s, with both groups emphasising the

values of love, unity, freedom and connectedness

(Boeri, Sterk & Elifson 2004). Toward the beginning

of the 1990s, many British young people made

raving an integral part of their life, with thousands of

people attending each party. During this period and

beyond, rave parities started to spread into other

parts of the world, with thousands attending New

Year’s Eve parties in Goa (India; mostly European

backpackers), Israel, Australia, the Spanish island

of Ibiza and on Koh Phangan beaches in Thailand.

In Berlin’s Love Parade Festival, approximately one

million ravers and visitors danced in the central

streets of the city (Reynolds 1998). Findings show

that raves are most commonly the site for firsttime

ecstasy experimentation (Forsyth 1996). Box 4

presents perceptions and attitudes of ecstasy users

on raves.

The music

The music played at raves is usually non-vocal

and computer generated. It includes a variety of

different subgenres such as techno, house, acid

ambient or trance (Hitzler 2002). For instance,

“trance” is based on a 4x4 drum beat with repetitive

structure and with many layers making up the

melody in a rhythmical fashion. This subgenre

became the leading category within electronic

music during the mid-1990s and, as a “trance”

raver described, this music creates some form of a

meditative state: “Dance is like an active meditation.

You stop thinking. You just become one with your

body…” Indeed, there is evidence to suggest that

Box 4: Perceptions of rave parties by

ecstasy users and their link to ecstasy

“It’s like everyone’s there for a purpose,

and everyone’s just there to dance and have

a good night, but it’s like, sort of united,

everyone sort of feels united because

they’re all sort of on the same page. Um,

I don’t know how to describe the feeling,

just…”

“I found it through the rave scene. Like

I started going to raves. Started loving

electronic music… my first time was in a

full moon party and it was so cool… the

mountains, the music and the drug…”

the synergy effect of the drugs, music (especially

the drums) and dancing in a hot environment may

produce an altered state of consciousness (Nencini

2002). Goa Gill, a rave DJ, describes trance as “the

concept of redefining the ancient tribal rituals for the

21st Century… It’s nothing new, every tribal group

since the beginning of time has been practising

these things [music and dance]”. The comparison

of primitive and modern settings of intoxication,

such as religious shamanic rituals and rave parties,

has also been made by Nencini (2002). Today,

trance music has become the most dominant and

bestselling dance genre (Ter Bogt, Engels, Hibbel,

VanWel et al. 2002).

The link and the characteristics: raves and

ecstasy

When analysing the link between raves and ecstasy

use, one needs to take into account three factors.

These are the initial messages beyond raves, the

reasons that young people attend these parties and

the effects of ecstasy. As previously mentioned,

some of the initial messages of raves were those of

peace, love and connectedness. Thus, these naive

messages created a perfect environment in which

young people could socialise, dance all night and

have fun. In addition, ecstasy creates feelings of

confidence, euphoria, improved communication,

empathy and energy (Forsyth 1996), thus enabling


Prevention, ecstasy and related drugs

users to achieve some of their expectations during

the party. In fact, these two factors (dance parties

and ecstasy) worked symbiotically. The dance scene

needed minimal advertising, principally because the

ecstasy alone successfully promoted the parties (Ter

Bogt et al. 2002). Recent findings suggest a higher

proportion of ecstasy consumption in clubs and

raves, compared to other settings (Siokou 2002).

Epidemiological studies, both in the United States

and Australia, which investigated the characteristics

of ecstasy users, reported similar patterns. The

picture of “generic users” that emerged from these

studies, is that of young (mean age approximately

21 years), educated and employed, white middle

to upper-class people with no criminal record (Duff

2003, 2005; PDPC 2004; Yacoubian et al. 2004).

However, it is worth mentioning that national studies

in the United States have shown an increase in use

by non-white young people as well (Johnston et al.

2004a). A recent British study that focused on young

clubbers found that 45 per cent of the participants

had started using ecstasy in the previous three

years (n=4042), and that the mean age for users

was 19.5 years (Sherlock & Conner 1999; pattern

of ecstasy use among club goers). In addition,

Sherlock and Conner (1999) found that 39 per cent

of their research participants used ecstasy on a

weekly basis, with men using significantly more than

women. While these studies provide valuable input

regarding the characteristics of a specific group, the

next section attempts to clarify the characteristics of

the general population of ecstasy users.

Ecstasy users within the general population

While ecstasy is primarily associated with the

dance scene, other venues of use include private

residences, music concerts, bars, hip hop clubs,

parks and streets (Boeri et al. 2004). The fact that

ecstasy use has spread to other youth settings

increases the probability that other groups, which

are less interested in raves and parties, will

experiment with the drug. Furthermore, the evidence

that ecstasy is primarily an “Anglo” drug has been

found to be less accurate when user characteristics

are explored in non-rave sites. In the United States,

an increase in ecstasy use has been observed among

African-American and Hispanic populations (Boeri

et al. 2004; Maxwell & Spence 2003).

Duff (2003) points out that ecstasy use in Victoria

(Australia) has spread into a range of culturally

and linguistically diverse communities, as well as

within gay and lesbian communities. While the most

common claim is that ecstasy users are ordinary,

well-adjusted, successful and goal-oriented young

persons, Norwegian research would appear to

contradict this claim, providing evidence that most

users come from less favourable family backgrounds,

and that they present with more mental health

problems and anti-social behaviour compared to nonusers

(Pape & Rossow 2004). To conclude, although

ecstasy is mainly associated with the dance scene,

recent and emerging research suggests that ecstasy

is increasingly a non-culturally specific drug, and it

is spreading among a variety of groups and socio

economic strata.

Ecstasy use among school students and

teenagers

Given that there is substantial evidence to suggest

that the prevalence of ecstasy use is increasing

among young people aged 20–29 years, with first

ecstasy ingestion occurring at approximately 21

years of age, it is clear that one of the aims of

prevention programs should be to focus on younger

age groups in order to prevent or delay future drug

misuse. Thus, it is crucial to first understand the

prevalence of ecstasy use among the younger age

groups, and especially among high school students.

While most existing studies have explored the

prevalence of ecstasy use among older age groups,

a small number of research projects have sought to

broaden the focus to include school student samples

as well. For instance, in a study that examined

the prevalence of illicit drug use among Australian

school students aged 12 to 17 (Lynskey, White, Hill,

Letcher et al. 1999), 3.6 per cent reported ecstasy

use (n=29447), with male students being more

likely than female students to report use. A more

recent Australian survey (White & Hayman 2004)

that focused on the same age group (n=23.417),

found that 5 per cent of students reported having

experimented with ecstasy. This was most common

among students aged 16 to 17 years. A comparison

of the 1999 and the 2002 studies suggested no

significant difference in the proportion of users

(White & Hayman 2004). Overall, these findings

10


Prevention research evaluation report

Number 16 December 2005

provide evidence that ecstasy use does exist among

Australian pupils, and given that ecstasy intake in

Australia tends to increase with age (AIHW 2004;

White & Hayman 2004), there is reason for both

concern and the implementation of preventive

programs.

Other studies that were conducted both in the United

States (for example, Yacoubian 2003) and Europe

(for example, McIntosh, MacDonald & McKeganey

2005) also pointed out that ecstasy use is increasing

among high school students. For example, the United

States’ Monitoring the Future Survey reported an

increase in ecstasy use among Grade 10 students,

from 3.3 per cent in 1988 to 4.4 per cent in 1999

(Johnston et al. 2001). Further analyses suggested

that ecstasy users were significantly more likely to

be white, non-religious polydrug users, and were

significantly more likely to have received a speeding

ticket in the previous 12 months (Yacoubian 2003).

In Turkey, a country with a predominantly Islamic

population, a recent study (Çorapçıo & Ögel 2004)

revealed a significant increase of 25 per cent in

ecstasy use among Grade 10 students between the

years 1998 to 2001, and an increase in use among

students from lower socio-economic backgrounds.

Significant predictors of ecstasy use were “not

sharing problems with parents” and “absence of

more than 5 days from school with no justified

reason”. In summary, these findings suggest

there is evidence that increasingly, ecstasy use

is commencing at a younger age, among school

students, from different races, socio-economic

backgrounds, religions and nations.

Practitioners’ views

In keeping with the literature, practitioners’

perceptions of the typical users were divided into

two groups. On one hand, ecstasy users were

categorised as a more homogenous group, as the

following practitioner claimed:

“They are all well educated in uni or have

finished uni, from a variety of geographical

areas around Melbourne, mostly people in their

20s but still people who are older are going

to use it but not as frequently as people in

their 20s.”

On the other hand, the following practitioners who

work as volunteers for a harm-reduction project took

the perspective that ecstasy is a mainstream drug

consumed by a heterogenous population:

“I don’t know if we can (characterise the

users), I think that these days it crosses many

boundaries, gender, class, race, age and

sexuality. Obviously, it’s more often used by

younger people.”

“Young people, but within this group there

are no boundaries like religion, education,

social class, not at all um… I’m not saying that

every young person is on it, but it is a pretty

indicative slice.”

Ecstasy: prohibition, prevention and

harm reduction

During the early 1990s, authorities in different

countries responded to the increasing illegal use

of ecstasy by employing two main strategies. As

with other drugs, the first was the prohibition

and banning of raves (for example, in the United

Kingdom, Israel and France). In the United Kingdom,

rave organisers faced fines and up to 6 months’

imprisonment. In Israel, police shut down and

removed sound equipment from rave venues. In both

cases, a “knock-up” effect was produced; that is,

ravers moved to clubs, which in turn increased the

risk of mixing drugs with alcohol (Weir 2000) and

fatal hyperthermia.

The aims of current prevention strategies, in the

form of mass-media campaigns, are to discourage

young people from experimentation with drugs,

and/or encouraging drug users to stop using. Issues

regarding such prevention tactics are reviewed in

the next section. From a review of the literature, it

is apparent that there is a significant international

trend and interest toward implementing harmreduction

strategies. The recent focus of The

European Monitoring Centre for Drugs and Drug

Addiction in evaluating the effectiveness of harmreduction

programs reflects this growing interest

(Kriener et al. 2001), and acknowledges the need

for harm-reduction strategies that target ecstasy

users. Therefore, following the prevention section,

11


Prevention, ecstasy and related drugs

a detailed review of current harm-reduction

strategies is provided.

Prevention of ecstasy use—primary

prevention strategies

Mass media campaigns

From a review of the scientific literature, it is evident

that ecstasy prevention programs in Australia and

the United States have usually been applied in the

form of mass media campaigns . Within the drug

and alcohol sector, the effectiveness of this method

has always been controversial. As indicated in our

previous report on social marketing and prevention

(Goren 2005), the success of a campaign to achieve

a desirable behavioural change is determined by

a variety of factors, such as the types of message

used and the integration of a campaign within

community based programs.

One message type frequently used in drug

campaigns is fear arousal. The difficulty with

this type of message is that it may increase the

undesired behaviour and make it more resistant to

change. Therefore, rules of thumb include:

a) the proposed threat should not be excessively

extreme

b) it has to create feelings of personal relevancy

among the target audience.

Unfortunately, anti-ecstasy campaigns both in the

United States and in Australia have tended to use

exaggerated fear appeal messages that focus on

the most severe (and extremely rare) negative

side effects. As a consequence, minimal personal

relevance is created and the audience (in this case,

those who use ecstasy or potential users) is not

provided with practical and relevant information.

The most recent United States anti-ecstasy campaign

was launched in 2000. That campaign included

some research findings of negative consequences

of ecstasy use in conjunction with real-life case

histories of young people who had died from ecstasy

use. Critics of the United States government’s

While it is possible that some preventative programs

(within schools or within the wider community)

addressing the issue of ecstasy use exist, these were

not documented in the scientific literature reviewed.

campaign pointed out that the use of exaggerated

fear massages, focusing on rare side effects, could

backfire.

Media intervention as a stand-alone can be

effective in raising awareness and disseminating

information. However, when the objective is to

change attitudes or behaviour, it is more effective

to back up the campaign with other programs at

the community level, such as educational programs

and peer education. Unfortunately, previous ecstasy

campaigns in Australia have relied solely on mass

media strategies that were not reinforced by planned

and well-designed community based programs,

thereby reducing the likelihood of achieving desirable

change among users.

Moreover, we were unable to find research that

evaluated the level of effectiveness of previous

ecstasy campaigns, on users and potential users.

The absence of available evaluative data is

problematic, as such research input is incredibly

important, especially for improving and refining

future campaigns. Interestingly, in a study that

investigated ecstasy use among college students

in the United States, participants commented that

the use of the “just don’t use” prevention strategy;

that is, bombarding students with inaccurate or

exaggerated information regarding the fatal side

effects on the brain, is ineffective and does not

provide them with maximal tools for informed

decision making (Levy, O’Grady, Wish & Arria 2005).

In summary, to our knowledge, to date, no efficient

and tested prevention program at the national level

has been applied.

Practitioners’ views on current prevention

programs

Practitioners’ views largely highlight the problematic

angles associated with ecstasy campaigns:

“The only one that I know about is the national

ad campaign… I guess I’m a bit sceptical

about the effect of it. They may possibly deter

younger people that haven’t yet been exposed

to other information, but, it might even backfire

by encouraging the teenagers to try the

drug... but I think they put off side people who

have actually used ecstasy. They find it quite

12


Prevention research evaluation report

Number 16 December 2005

insulting that there is no acknowledgement

that people can make a rational decision to use

the drug. I am wondering whether the focus

should be preventive use especially given the

normalisation of ecstasy use in some parts of

society

Another practitioner pointed out the fear appeal

messages used in such campaigns:

“I don’t think the ads on television are harm

reducing, I think they’re scare tactics and

unfortunately all the ecstasy users know

that they’re focusing in on one in 100,000

occurrences.”

Finally, another practitioner stated that:

“Based on the evidence it appears that it’s hard

to prevent drug use, but certainly we can help

people to delay their use, or to use it in a less

harmful way. So that might be more useful than

prevention.”

Overall, it seems that the general opinion among the

practitioners interviewed was that of dissatisfaction

with the current prevention strategies applied in

Australia. To approach the issue from the targeted

group’s (ecstasy users) perspective, Box 5 provides

us with a user’s opinion regarding the currently

available prevention programs.

Box 5: Ecstasy users’ opinions on antiecstasy

mass media campaigns

They’re really unrealistic… if they’re going

to make “Say no to ecstasy ads” they

should be a little bit more realistic than that

you’re going to overdose—because you’re

less likely to overdose than anything else…

Like I’ve never heard of one person having

anything like that ever happen to them…

So, you know what I mean It’s probably

not going to deter people that are already

taking it anyway.”

Harm reduction

What is harm reduction

On a continuum, with the prohibition strategy on one

end, and drug legalisation at the other end, harm

reduction would be placed somewhere in between.

This is a philosophy which incorporates policies and

strategies that support individuals in improving

their health and lives, by reducing the harm that

can result from their behaviours and circumstances.

Thus, it aims to improve health, social and economic

outcomes, for both the individual and the community.

The strategy recognises the existence of drug use

behaviours and aims to minimise the associated

harms. Harm reduction began during the mid-1980s

in Europe, in response to AIDS and other drugrelated

public health concerns. The model deals with

drug-related issues and consequences (for example,

safe sex, STI, crime) more humanely and effectively;

for example, through needle syringe exchange

programs, hygienic injection rooms and treatment.

To date, a variety of strategies have been applied,

mostly in Western Europe, to minimise the harms

associated with ecstasy intake. These have included

the provision of adequate information and education

about health effects; tips for safer ecstasy use and/

or on-site pill testing (Fromberg 1990; Benschop,

Rabes & Korf 2002; Weir 2000). In the following

section, a brief description of the main available

strategies is provided.

The educational component

The use of educational strategies to reduce harm

is vital. By the provision of factual and accurate

information to ecstasy users and potential users,

the dual aims of prevention and harm reduction

can be achieved. For instance, the educational

component could highlight the possibility that

ecstasy purchased may actually contain other, more

dangerous substances. This, in conjunction with

other strategies (see Table 2), will enable users to

adopt a responsible and informed decision-making

process (Fromberg 1990). The evaluation of the

“London Dance Safety” campaign found that the

target audience (ecstasy users), expressed positive

opinions about the philosophy behind the campaign

(harm reduction), and were impressed by the quality

13


Prevention, ecstasy and related drugs

of the campaign’s safety guidelines (Branigan &

Wellings 1999).

Table 2: Possible educational harm reduction

guidelines

• Possible educational harm reduction guidelines

• Not using is safest.

• If you do use, learn the ways to reduce your

risk.

• There is less risk with less use, more risk with

more use.

• Be aware of the side effects and symptoms of

toxicity.

• Know the exact amount of fluids and sodium

to consume.

• Avoid using other drugs at the same time

(including alcohol).

• Do it with friends.

• Take breaks from dancing.

• Bring a cell phone.

• Driving a vehicle when taking ecstasy is

always dangerous.

The RaveSafe program is an example of a harmreduction

model that aims to improve the safety of

the local rave scene and its attendants in Australia.

It provides educational information (verbal and

written) at raves in order to reduce the risks of

illicit drugs. In Victoria the program is funded by

the Department of Human Services, while in South

Australia the organisation relies heavily on donations.

An ecstasy user’s opinion on the harm-reduction

approach and RaveSafe, compared to the “just don’t

do it” approach, is presented in Box 6.

On-site pill testing

On-site pill testing projects are increasingly common

in Europe, and are conducted informally and on a

smaller scale in Australia. A recent report conducted

on behalf of the European Monitoring Centre for

This information was gathered from a variety of official

websites, worldwide.

Box 6: Opinions of ecstasy user on harm

reduction and prevention programs

“They’re cool! I think RaveSafe is how all

drug education should be. All the scare

tactics just don’t work. You go through

primary school and are taught that if you

have a pill you will die. I really don’t like

the ads on TV because they show all these

scary things. You get to Year 10 or 11 and

you see five or six of your friends taking

pills and 90% of your friends smoking pot.

You are looking at the ads and hearing this

stuff in the school saying that if you do

this stuff you will die. Then you think every

single one of my friends is on drugs and

they’re not dying. If they took the RaveSafe

approach and they educated you on harm

minimisation and what the pills do people

will be safer.”

Drugs and Drug Addiction provided some indications

of the usefulness of on-site pill testing:

“Broadly, pill testing aims to warn against very

harmful and unexpected substances on site or

via the Internet and to provide an attractive

way of contacting potential consumers of illicit

substances to offer information and counseling…

it is one of the few existing methods to

approach consumers and to directly transmit

them ‘safer-use’ messages that cover a variety

of topics such as acute and short-term hazards

to health (e.g. dehydration, overdoses), longterm

hazards to health and addiction, legal risks

and safer driving messages.” (Kriener, Billeth,

Gollner, Lachout et al. 2001 p. 4)

Recent studies undertaken at large dance parties in

Hanover (Vienna) and Amsterdam, investigating the

impact of pill testing on users, showed that users

whose pills were tested were found to be more

knowledgeable regarding safe use, compared to nontesters.

Testers also indicated that they informed

their friends in the case of identification of pills that

had tested as dangerous. In addition, they perceived

the on-site testing as the most trustworthy and

credible source of information, when compared with

14


Prevention research evaluation report

Number 16 December 2005

other sources such as drug information flyers, the

Internet, newspapers and friends (Jamin, Korf &

Rabes 2003).

The Internet

Another strategy to reduce harms associated with

ecstasy use is by provision of information through

the Internet. Indeed, many organisations (for

example, Australian Drug Foundation, Public Health

Department—Seattle and King County in the United

States and many others) use the Internet to provide

young people and potential users with accurate

information. However, many other unofficial websites

contain unreliable information. Such inaccurate

information may prompt naïve users toward

irresponsible drug use. Examples of partial and/

or inaccurate information include the ingestion of

ecstasy with Prozac, vitamin C or L-tyrosine with the

purpose of reducing neurotoxicity (Jones & Volans

1999).

Practitioner’s views—the harm-reduction

approach

All practitioners were highly positive regarding the

harm-reduction approach. Mostly, they focused

on the fact that ecstasy is increasingly being used

in Australia and, therefore, more effort should be

made to minimise the harms that young people may

be exposed to through the use of ecstasy. Two of

the practitioners explored some of the reasons for

using the harm-reduction approach and the needs

associated with it:

“I think education and harm reduction is the

only way to go, given the kids will continue

to take these substances they continue to be

illegally imported and illegally consumed… um

I think what is required is less media beat up of

the issue and a greater sense of understanding

of what the drug does. More time should be

spent on safe usage guidelines, because with

the drug being illegal, people will not talk about

it a great deal, and as a result there is no ability

to communicate, particularly with a drug that

is relatively new to this generation… like my

parents were never exposed to it, they have no

relevant information to pass on to the kids.”

And:

“I believe that harm reduction should be at the

forefront as an approach. I think that it’s more

realistic and credible. By using that approach

you might be able to encourage people to use it

more safely or to stop using it. I think we need

to know more about why people decide to stop

using or why people decide not to use at all,

and by that, we will have a more effective ideas

about prevention.”

In keeping with the literature, another practitioner

explored some of the advantages associated with

on-site pill testing:

“On-site testing, that’s a good environment you

can actually talk to people as well, you give

them the information, do the test for them, you

can explain the test… it’s very difficult to do in

night club settings because it’s very, very loud.”

Another practitioner provided some input regarding

the users’ responses to on-site pill testing:

“They are very, very responsive, I mean they

love it. They want us to test their pills and they

also want to know as much as they can and

there is also a huge response to our web site

that provides information to users… people want

to know.”

Finally, it is vital to understand what users know

about harm reduction and how they act in order to

minimise the potential harms of the drug. In Box 7,

users’ attitudes are displayed.

Conclusions and recommendations

The findings presented in this report indicate

that ecstasy is frequently used by young people

worldwide, with usage rates being particularly high

in Australia compared with other countries. By

integrating information from both research findings

and health professionals familiar with the field of

ecstasy, the current report presents a somewhat

more unique and unusual perspective on ecstasy

related issues, compared to other, purely researchoriented

papers. Taken together, the abovementioned

findings can be reduced into two main

15


Prevention, ecstasy and related drugs

Box 7: Users’ perceived safety guidelines

“There are ways to minimize it too, though,

like from not buying from strangers, like we

never buy it at clubs or when we go out.

Always go out with what you have, if you

run out or you lose it, then tough luck…

In England, I know that they have the pill

testing machines… So put a pill tester in

clubs to reduce the amount of people who

are either going to overdose or have a bad

experience so they know what they’re on…

that’s cool pill testing isn’t it!”

“Mostly on the internet… To read up what is

in ecstasy, what it can do to you, what are

the possible short term, long term effects.

Read up about testing, and so on.”

What are responsible ways of using it

“Drink plenty of water.

“Don’t go crazy on it. Yeah, don’t have too

many.”

“Don’t mix drugs.”

“Just don’t be alone when you’re coming

down as well. I think that’s another thing.”

categories: topics about which a good deal is known

about ecstasy and other areas where far less is

known.

The explored

Certainly, there are some aspects of the “ecstasy

story” that are well known. For example, it is now

clear that ecstasy use is on the rise in many parts

of the world. Indeed, millions of young people

(including school-aged young people), worldwide

consume ecstasy. As a result, they are at higher risk

(compared to non-users) of experiencing a variety

of acute, short-term symptoms, both psychological

and physiological. In addition, there is accumulative

evidence to suggest some long-term negative

effects of ecstasy use, such as learning and memory

deficits. Similarly, there is a good deal of evidence

now from many parts of the world regarding the

characteristics of users within specific settings (for

example, clubs and raves) and within the general

population. However, ongoing research efforts will be

needed to monitor changes in ecstasy trends.

The unexplored

Unfortunately, there are still many issues and

problems relating to ecstasy use within youth

populations that require further research. These

include the long-term neurotoxicity associated with

ecstasy use. While suggestive evidence has been

reported, the overall picture concerning neurotoxicity

is unclear and better designed research is required.

Furthermore, given the ethical considerations

associated with human research and drugs, coupled

with the fact that sustained ecstasy use has only

emerged in the general population over the past

two decades, it might be that many years will elapse

before clear answers are uncovered.

It is also clear that much more research is needed

into ecstasy specific prevention and harm-reduction

strategies, both in Australia and elsewhere.

The research findings outlined in this report, in

conjunction with practitioners’ and users’ views,

indicate that effective, well-designed and focused

prevention strategies are currently uncommon with

respect to ecstasy and related drugs. With millions

of young users, a significant proportion of which

are among the ranks of high school students, it is

recommended that policy makers consider some

alternatives to the more generic drug prevention

programs currently available. Effective programs

should integrate different aspects, such as reduction

of ecstasy supply and harms associated with ecstasy

intake. In addition, preventative approaches should

include the development of other, less harmful

alternatives for young people in order to increase

their social and personal wellbeing. Furthermore,

different prevention programs should be designed

to target the diverse groups of young people. For

instance, a potential program may target young

non-user school students, with the primary aim of

preventing them from initiating ecstasy use, and

with the secondary aim of delaying the initiation of

use (as young people are more susceptible to the

negative consequences of drug use). Such programs

16


Prevention research evaluation report

Number 16 December 2005

may involve the introduction of a prevention program

within schools as part of the formal educational

curriculum. Unlike mass media campaigns, which are

indirect and leave space for uncertainty, a school

prevention program could provide students with

accurate information while the presenters would

be able to attend to their questions and clarify

issues raised. In addition, wider community based

prevention programs, outside of the school context,

should be developed with the aim of targeting high

school students who experiment with ecstasy.

As previous research within the drug and alcohol

domain suggests, mass media interventions play

an important role in achieving behavioural change

and, as such, should not be ignored when targeting

ecstasy users (or potential users). If choosing to

employ mass media campaigns, targeted campaigns

are more effective than those adopting a blanket

approach. Thus, campaign designers should tailor

campaign messages to a specific population (for

example, potential users or recreational users or

those who use ecstasy excessively). Furthermore,

to increase their effectiveness, such media

interventions should be backed up by community

based programs, and any initiative needs to be pretested

in order to effectively contribute to the huge

gaps in this field.

As is evident in this report, many young people

use ecstasy without specific knowledge regarding

how to reduce the harms associated with this

drug use. In this light, it is likely that a range of

stratified and carefully targeted prevention programs

will be needed. Including multiple integrated

components delivered across various social settings,

these prevention programs will need to target

different users in different stages of use, such as

experimental and recreational users or those who

regularly “binge” on ecstasy, with the primary aim

of reducing harm and with the secondary aim of

preventing future use. In these instances, different

messages should be formed to target each group.

In addition, in order to improve the quality of

the intervention, there is a vital need to better

understand users’ perceptions, values and needs.

Thus, more qualitative research is needed. This

may include in-depth interviews and focus group

methods.

Ecstasy specific, harm-reduction strategies also have

the potential to address users’ issues. Considering

the practitioners’ views in isolation, it appears

that this cohort is in favour of the harm-reduction

approach. While some ecstasy related harmreduction

organisations already exist in Australia,

many of them are unofficial and thus lack the

funding to provide better services to their clients.

Furthermore, to date, very little is known regarding

the effectiveness of such programs. However, given

the increasing number of people using ecstasy and

related drugs (for example, GHB, ketamine and

Rohypnol), and the near-zero prevention and harmreduction

programs currently available, it is vital to

conduct evaluations and to assess the effectiveness

of ecstasy related harm-reduction programs.

Furthermore, it is essential that the most effective

programs be implemented. Policy makers and the

wider society should bear in mind the massive

number of ecstasy users nationally, and that the

absence of planned prevention and harm reduction

strategies, simply means more harm.

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Andreu V, Mas A & Brugura M 1998 “Ecstasy:

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Prevention, ecstasy and related drugs

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Drugs and Crime Prevention Committee 2004

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Number 16 December 2005

Ghodse AH & Kreek MJ 1997 “A rave at ecstasy”,

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Prevention, ecstasy and related drugs

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drugs and the prevention of harm”, Canadian Medical

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Prevention research evaluation report

Number 16 December 2005

White V & Hayman J 2004 Australian secondary

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stimulant drugs in a community sample of drug

users”, Drug Alcohol Dependence 44, pp. 87–94

Winstock AR, Griffiths P & Stewart D 2001 “Drugs

and the dance music scene: A survey of current

drug use patterns among a sample of dance music

enthusiasts in the UK”, Drug and Alcohol Dependence

64, pp. 9–17

Wolff K, Hay AM & Sherlock K 1995 “Contents of

‘ecstasy’”, Lancet 346, pp. 1100–101

Yacoubian GS, Jr 2003 “Correlates of ecstasy

use among high school seniors surveyed through

Monitoring the Future’, Drugs: Education, Prevention

and Policy 10:1, pp. 65–72

Yacoubian GS Jr, Deutsch JK & Schumacher EJ 2004

“Estimating the prevalence of ecstasy use among

club rave attendees”, Contemporary Drug Problems

Spring 31:1, Academic Research Library, p. 163

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Prevention, ecstasy and related drugs

22


Prevention research summaries

Number 15 December 2005

Ecstasy

Research summaries prepared by Mr Netzach Goren, Research Officer,

Centre for Youth Drug Studies, Australian Drug Foundation

Given the increasing number of peer-reviewed, ecstasy related publications over the past decade, in

presenting the following summaries we hope to provide the reader with an understanding of recent directions

in the field, and the common limitations associated with ecstasy research. Eight studies, covering four

main topics are presented. The first four studies examined both neurotoxciticy and psychological effects

associated with exposure to ecstasy. The next study employed focus group methodology in order to examine

the “ecstasy experience”. Patterns of use and user characteristics are the focus of the last four studies.

A general comment regarding the main limitations of ecstasy-related research concludes this section of

prevention research summaries.

Neurotoxicity and psychological

effects of exposure to ecstasy

Reneman L, Booij J, Schmand B, Van

den Brink W & Gunning B 2000 “Memory

disturbances in ‘ecstasy’’ users are correlated with

an altered brain serotonin neurotransmission”,

Psychopharmacology 148, p. 322–24

Key findings This study aimed to assess the effect

of ecstasy on both serotonin 5 HT2 receptors and

related memory disturbances. Five abstinent ecstasy

users (two months’ abstinence), with a consumption

history in the range 50–500 tablets, and nine healthy

control participants took part in the research.

The study employed both medical examination of

receptor functioning (assessing brain serotonin

transporter levels), and administration of the RAVLT

verbal memory test. Results indicated significantly

lower performance among ecstasy users on the

memory test, consistent with the receptors’ impaired

functioning. The results provide further evidence that

ecstasy users are at risk for both neurotoxicity and

memory disturbances.

Study quality was moderate, with the study

having two main strengths: the use of a control

group and the strict exclusion criteria. Volunteers

who had used substances that may cause serotonin

toxicity, pregnant participants and those who had

experienced severe medical or neurological serotonin

related illness were excluded. On the other hand,

the analysis relied on brain serotonin transporter

levels as an indicator of neurotoxicity. The reliability

and validity of this method is not well established.

Furthermore, the study employed a small sample

size; therefore the results can not be generalised

to the larger population. Further study is needed

to assess the relationship between serotonin 5 HT2

receptors and memory disturbances.

McCardle K, Luebbers S, Carter JD & Croft RJ

2004 “Chronic MDMA (ecstasy) use, cognition and

mood psychopharmacology”, Psychopharmacology

173, pp. 434–39

Key findings Using a wide battery of cognitive

tests, this study examined the effect of chronic

ecstasy use on mood and cognitive performance by

comparing a group of abstinent ecstasy users with a

control group. This quasi-experimental behavioural

study is an example of an alternative way to assess

long-term effects of ecstasy intake. Findings suggest

that users displayed higher levels of depression

(BDI-II), and poorer cognitive performance (for

example, verbal learning and attention span). The

findings were obtained by statistically controlling (for

example, covariate) for the effects of other drugs

(for example, cannabis).

Study quality was high. The researchers of this

well-designed study used a wide range of cognitive

tests and a reliable self-report mood inventory to

assess their hypotheses. Moreover, the similarity

23


Prevention, ecstasy and related drugs

among the groups on parameters such as gender,

age, educational level and IQ further contribute

to the reliability of the findings. However, the low

number of participants, 17 users and 15 controls,

does not permit generalisation of the results to the

general population of ecstasy users. In addition, as

with most ecstasy related studies, it is impossible

to confirm whether the ecstasy tablets used by the

participants contained other substances rather than

pure MDMA, or whether an issue of reporter error

may have affected the results.

Travers KR & Lyvers M 2005 “Mood and

impulsivity of recreational ecstasy users in the week

following a ‘rave’”, Addiction Research and Theory

13:1 pp. 43–52

Key findings This Australian study compared

regular ecstasy users who consumed ecstasy on the

weekend at raves, to non-ecstasy users. The aim of

the study was to investigate the effects of ecstasy

on mood and impulsivity two days following a rave

(assessed via self-report questionnaires). Exclusion

criteria included premorbid psychiatric disorders

and serious medical conditions, as well as polydrug

use during the dance party. Results indicated that

ecstasy use at a dance venue was associated

with a higher depression score two days after the

drug intake (compared to the control group). No

significant difference was observed between ecstasy

users and non-users on impulsivity.

Study quality was moderate to high. The

comparison of ecstasy users to controls who

attended the same events, thereby ensuring that all

participants were exposed to similar environmental

conditions, substantially increases the reliability of

the obtained results. The low response rate of users

(25.3 per cent) raises some concern for possible

selection bias, and whether the results can be

generalised. For instance, it may have been that

users who did not respond were too depressed to

do so, and thus had lower motivation to complete

and return the questionnaires. In addition, an

assessment of the participants’ depression/

impulsivity level before and after the rave could have

produced more reliable results.

Raffaella M, Milani AC, Parrott J & Turner JD

2004 “Gender differences in self-reported anxiety,

depression and somatization among ecstasy/MDMA

polydrug users, alcohol/tobacco users, and non drug

users”, Addictive Behaviors 29: 5, pp. 965–71

Key findings This study highlighted the possibility

of gender differences in the etiology of drug-related

psychopathology. A non-clinical sample (n = 768) of

young adults from Italy and the United Kingdom was

categorised post hoc into the following six groups:

1) non-drug users; 2) alcohol and/or nicotine users;

3) cannabis users; 4) illicit polydrug users who had

never taken ecstasy; 5) light ecstasy polydrug users;

and 6) heavy ecstasy polydrug users. A significant

gender difference was found on the depression subscale

(SCL-90) for the light ecstasy polydrug user

group. Moreover, compared to non-users, higher

pathology scores were identified among both ecstasy

polydrug users and non-ecstasy polydrug users.

Study quality was low. While the study

further contributed to the understanding of the

relationship between gender, substances use and

psychopathology, it suffered from two critical

limitations. Firstly, as a cross sectional study, the

data cannot to be interpreted as causative. This

means that it is unclear whether the drug use

triggered psychological symptoms or vice versa.

Moreover, the researchers did not assess psychiatric

history among the participants. Secondly, the

complexity and the relatively wide range of the

drug categories (with the exception of the cannabis

group), made it difficult to draw clear conclusions or

to link a specific drug to a specific pathology. Future

well designed longitudinal research, may produce

less ambiguous results.

Qualitative analysis of ecstasy

related topics

Kira B, Levy KE, O’Grady ED, Wish ED &

Arria AM 2005 “An in-depth qualitative examination

of the ecstasy experience: Results of a focus group

with ecstasy-using college students’ substance use

& misuse”, Substance Use and Misuse 40:9–10,

pp. 1427–41

Key findings This study aimed to examine a range

of ecstasy related issues among college students

24


Prevention research summaries

Number 15 December 2005

via four in-depth focus groups (n = 6-10 per

group). Participants were well informed about the

impurity of ecstasy tablets, yet this information did

not discourage ecstasy intake. Positive effect on

mood, social pressure and boredom were among

the key reasons participants cited as motivating

experimentation with ecstasy. All participants were

aware that the drug might have harmful effects.

However, participants stated uncertainty regarding

the exact nature of the associated harms. Finally,

motivational factors to quit were: negative personal

experience, health concerns, loss of interest, related

expenses and fear of criminal record.

Study quality was moderate. The authors

employed a creative methodology to assess

ecstasy users’ views and attitudes. The study

explored several significant issues relevant for the

design of future prevention and harm reduction

programs. These are the key strengths of the

study. The use of qualitative data, specifically focus

group methodology, has well-known advantages

and disadvantages. Specifically, with the study

of a sensitive issue such as illicit drug use, it is

reasonable to assume that the use of focus groups

may discourage some people from participating,

with issues of confidentiality perhaps being at the

forefront. Furthermore, the localised nature of the

study (one college participated), small sample size

and the fact that participants self selected, mean

that the findings should not be used to generalise to

the broader population of college students. Future

quantitative study is needed.

Patterns of use and characteristics of

ecstasy users

Pape H & Rossow I 2004 “’Ordinary’ people with

‘normal’ lives A longitudinal study of ecstasy and

other drug use among Norwegian youth”, Journal of

Drug Issues 34:2, pp. 389–418

Key findings Using three waves of data collection

over a period of 7 years and among 63 Norwegian

schools (participant mean age at the time,

21.6 years), this longitudinal study examined

characteristics of drug users. The findings of this

study contradicted the common “mainstream”

assumption that ecstasy users are ordinary, welladjusted,

educated young people who are not

linked to crime. The findings indicated that young

ecstasy users are characterised by excessive use of

other substances, unfavourable family background,

high prevalence of psychological problems and are

involved in anti-social and criminal activity. The

analysis compared ecstasy users to non-users,

cannabis users and users of traditional “hard drugs”

(for example, cocaine, amphetamine, LSD and

heroin).

Study quality was high. The longitudinal design,

multiple waves of measurement and large sample

were excellent. Moreover, the results achieved

highlighted the overall unique contribution of the

research to the current body of knowledge, and

stressed the importance of further well-designed

research. The decrease in response rate from time

one to three may have impacted the results. The

authors found non-response at time three was

predicted by engagement in criminal and anti-social

behaviour. Thus, it might be that an important group

of deviant drug users was not assessed. Further

replication of this study in different nations is

needed.

Winstock AR, Griffiths P & Stewart D 2001

Drugs and the dance music scene: A survey of

current drug use patterns among a sample of dance

music enthusiasts in the UK”, Drug and Alcohol

Dependence 64, pp. 9–17

Key findings This self-report study of 1151 dance

drug users in the United Kingdom aimed to assess

patterns of use. In addition, this study also examined

the utility of recruiting through advertisement in

a popular young people’s journal. The majority of

participants reported development of tolerance

to ecstasy with 55 per cent of users declaring

continuation of ecstasy consumption despite

experiencing medical and psychosocial problems.

In addition, a quarter of the participants reported

difficulty in controlling the amount of ecstasy tablets

they consumed, and significant proportions stated

loss of interest in non-ecstasy related activities.

Finally, the results indicated that polydrug use is a

common pattern among United Kingdom ravers and

clubbers.

25


Prevention, ecstasy and related drugs

Study quality was moderate. This cross sectional

study further adds to the understanding of patterns

of use, and the consequent difficulties associated

with Ecstasy consumption. Furthermore, given the

difficulties in collecting data and recruitment of

drug users, the authors of this study applied a low

cost, practical and timely recruitment technique to

overcome such problems. On the other hand, the

fact that the sample was self-nominating, may have

led to subject bias and thus cannot be said to be

representative of drug users associated with the

dance scene.

Çorapçıo A & Ögel K 2004 “Factors associated

with ecstasy use in Turkish students”, Addiction 99,

pp. 67–76

Key findings Grade 10 students from across Turkey

were enrolled into a study that aimed to reveal

the factors associated with ecstasy use among

secondary school students. Data were collected in

a total of two waves (18 599 and 11 991 in 1998

and 2001, respectively). The researchers identified

an increase of 25 per cent in ecstasy use between

time one and two, with older students reporting

higher rates of life-time ecstasy use. It was found

that ecstasy use was more common among users

from higher socioeconomic backgrounds. However,

a significant increase in ecstasy consumption

among students from lower-income groups was

also observed. Furthermore, students at high risk

for ecstasy intake were those who lived alone and

those attending private schools. Increase in ecstasy

use was predicted by communication difficulties

with parents, being male, older age, use of other

substances and attending informative meetings on

the potential effects of substance use. The study

provided a constructive insight into ecstasy patterns

within Muslim cultures. Future research is needed to

assess the prevalence of ecstasy use within Muslim

groups in Western countries (for example, Germany,

Australia and the United Kingdom).

Study quality was high. By using representative

samples of Grade 10 Turkish students, coupled with

the dual waves of measurement, the findings of this

carefully designed study can be generalised to all

secondary schools across Turkey. One of the major

findings of this study is the relationship between

educational program attendance and increase in

ecstasy use. This may have related to inappropriate

content in prevention programs. However, the fact

that approximately 55 per cent of Turkish children

attend secondary school means that the study

conclusions cannot be generalised to the young

Turkish population.

A note on the limitation of ecstasy related

studies

Studies investigating the adverse effects of ecstasy

use generally fall into two main categories: 1) animal

research and 2) human research. Each has is own

limitations, which the reader should bear in mind.

Obviously, animals cannot “talk” and reveal

subjective effects such as headache or psychological

effects. In addition, animal studies have limitations

in their ability to predict human toxicity, and no

matter how well performed, they are not necessarily

predictive of human pathology (Wallender 1993).

Ecstasy research with humans produces a different

set of limitations. Firstly, most of the information

is derived from case studies, is student-based and

participants are usually recruited through a “snow

balling” technique. Thus, it is not clear whether

the results can be generalised to the population of

ecstasy users (Gouwing et al. 2001; Hammersley

et al. 1999). Secondly, as most of the studies

are retrospective, they rely on participants’ self

report. It is therefore difficult to ascertain the

amount and type of drug used by the participants,

and consequently the reliability of the findings

are reduced (Cole & Sumnall 2003). Moreover,

retrospective studies cannot determine whether

differences between control and user groups

existed prior to ecstasy use (Cole & Sumnall 2003).

Furthermore, as epidemiological studies indicate,

most ecstasy users are polydrug users, and thus

it is difficult to confirm whether the effects are

ecstasy specific or are the cumulative effects of

other factors, such as cannabis or alcohol use (Cole

& Sumnall 2003). Finally, studies that employed selfreport

questionnaires within drug-related research

usually suffered from low response rates due to

the sensitivity of the information. In such studies,

a response rate of 30 per cent is considered “good

enough”. Consequently, the information regarding

the other 70 per cent remains unknown.

26


Reading and resource list

Number 16 December 2005

Reading and resource list

This list of selected resources does not aim to be comprehensive; rather it is intended to be a

starting point in your research. The list is sorted chronologically and by author within each section.

These selected resources are all available in the DrugInfo Clearinghouse. For more information

please check the library catalogue (www.druginfo.adf.org.au/libsearch/asp), or contact us on email

library@adf.org.au.

Books and reports

Cherney A, O’Reilly J & Grabosky P 2005 The

governance of illicit synthetic drugs, Canberra:

Commonwealth of Australia

Report on a project focusing on amphetamines,

methamphetamines and ecstasy, aiming to identify

instances of law enforcement agencies harnessing

external institutions to further illicit synthetic

drug control, analyse strengths and weaknesses

and disseminate the findings to law enforcement

agencies in Australasia.

DrugInfo Clearinghouse no. MM32 NDLERF

Stoové M, Laslett A-M & Barratt M 2005

Victorian trends in ecstasy and related drug markets

2004. Findings from the Party Drugs Initiative (PDI),

Sydney: National Drug and Alcohol Research Centre

Trends in ecstasy and related drug markets are

also available for the other states and territories

of Australia, and for Australia as a whole. Party

drug trends are also available for the states and

territories of Australia.

DrugInfo Clearinghouse no. RA NDARC T226

Degenhardt L, Dillon P, Duff C & Ross J 2004

Driving and clubbing in Victoria. A study of drug

use and risk among nightclub attendees, Sydney:

National Drug and Alcohol Research Centre

This is the report of a study conducted from April to

July 2004 to investigate illicit drug use, transport

methods, history of drug use and driving among

nightclub attendees in Melbourne, in anticipation

of the introduction of roadside saliva testing in

Victoria. The study aimed to establish a baseline

that could be used as a comparison for further

research into behaviour following the introduction of

testing.

DrugInfo Clearinghouse no. RA NDARC T209

Degenhardt L, Howard J, White B & Duff C 2004

“Managing the risks and harms of party drug use”

in 15th International Conference on the Reduction

of Drug Related Harm, 20–24 April 2004, Melbourne

Convention Centre, Doncaster: Conference Media

Services Australia

This roundtable session included “Examining trends

in party drug use and harms in Australia”, “When

the ‘party’ is over: a profile of, and challenges

presented by young people in residential

treatment”, “Risk perception of party drug users”,

“Party drugs and party people: are we witnessing

the normalisation of party drug use in night-clubs”

DrugInfo Clearinghouse no. CD JB22 IHRA 1

Drugs and Crime Prevention Committee 2004

Inquiry into amphetamines and party drug use in

Victoria. Final report, Melbourne: Victorian Drugs

and Crime Prevention Committee

This research discusses the nature and extent of

amphetamine and party drug use, and the culture

of amphetamines and party drugs in Victoria. It

examines the short and long-term consequences

and examines the law, law enforcement, education

and treatment issues.

DrugInfo Clearinghouse no. BJ2 INQ

European Monitoring Centre for Drugs and Drug

Addiction 2004 Report on the risk assessment

of 2C-1, 2C-T-2 and 2C-T-7 in the framework of the

joint action on new synthetic drugs. EMCDDA Risk

Assessments no. 6, Luxembourg: EUR-OP

27


Prevention, ecstasy and related drugs

This report is the sixth in a series of formal risk

assessments on synthetic drugs, including MBDB,

4-MTA, GHB, Ketamine, PMMA, 2C-I, 2C-T-2, 2C-T-7

and TMA-2. Reports include guidelines for future

risk-assessment procedures.

DrugInfo Clearinghouse no. JA62 EMC

The full series of risk assessment reports are

available online at www.emcdda.eu.int/nnodeid=431

Gascoigne M, Copeland J & Dillon P 2004 Ecstasy

and the concomitant use of pharmaceuticals,

Sydney: National Drug and Alcohol Research Centre

This document discusses the incidence and effects of

using ecstasy in conjunction with pharmaceuticals

such as Viagra and benzodiazepines.

DrugInfo Clearinghouse no. RA NDARC T201

Gascoigne M, Dillon P & Copeland J 2004

Sources of ecstasy information: their use and

credibility, Sydney: National Drug and Alcohol

Research Centre

This survey examined the types of drug information

accessed by young people, which sources they

trusted and which sources they did not.

DrugInfo Clearinghouse no. RA NDARC T202

Johnston J, Laslett A-M, Miller P, Jenkinson R,

Fry C & Dietze P 2004 Victorian Psychostimulant

Monitoring project. Trialling enhanced drug trend

monitoring of Melbourne psychostimulant markets.

Final report, Fitzroy: Turning Point

The findings in this report provide a summary of

patterns and characteristics of use as detected in

Melbourne, Victoria, collected through the conduct

of the PMP. The nature and characteristics of supply

and demand are discussed together with emergent

issues.

DrugInfo Clearinghouse no. AD10 JOH

Victoria, Department of Human Services,

Drugs Policy and Services Branch 2004 Code of

practice for running safer dance parties, Melbourne:

Department of Human Services

This document aims to assist organisers of festivals

and dance parties to plan, manage and run events,

while meeting legal requirements, government

standards and safety obligations.

DrugInfo Clearinghouse no. JP73 DHS

Whiteaker B 2004 The new youth drug culture:

friends, parties and drug cocktails. A survey

of university students about “party drug” use,

Melbourne: Victorian Alcohol and Drug Association

This documents reports on the findings of a survey

of 137 Melbourne University students, undertaken

in March 2004. The survey found that the students

often mixed their drugs, perceived the drugs as

being safe to use, were greatly influenced by their

friends and had experienced varying degrees of

harm as a result of their use of these drugs.

Journal articles

Culture and trends

DrugInfo Clearinghouse no. BA6 WHI

Degenhardt L, Copeland J & Dillon P 2005

“Recent trends in the use of ‘club drugs’, an

Australian review”, Substance Use and Misuse.

Special Issue on Club Drug Epidemiology, 40:9,

pp. 1241–56

The harms that require further investigation are the

association between ketamine and unsafe sex and

injecting behaviours, the neurotoxic effects, and

use in situations where there is a heightened risk

of accidental death when the user’s cognition is

grossly impaired. In contrast, while least is known

of the epidemiology of GHB use, there is mounting

evidence suggesting significant acute and long-term

risks associated with the use of this drug. (Taylor &

Francis)

Duff C 2005 “Party drugs and party people.

Examining the ‘normalization’ of recreational drug

use in Melbourne, Australia”, International Journal of

Drug Policy, 16: 3, Jun, pp. 161–70

Findings of a survey of 379 bar and nightclub patrons

that examines the “normalisation” of young people’s

drug use and the links between this drug use and

young people’s “time out”. The author suggests that

drug use is becoming increasingly normalised within

youth populations in Australia.

Krebs CP & Steffey DM 2005 “Club drug use

among delinquent youth”, Substance Use and

Misuse. Special Issue on Club Drug Epidemiology,

40:9, pp. 1363–79

28


Reading and resource list

Number 16 December 2005

This study is an analysis of factors associated with

several measures of club drug use among a sample

of delinquent young people in Oregon. Descriptive,

bivariate, and multivariate analyses are used to

identify factors associated with club drug use and

determine whether the current grouping of club

drugs is appropriate. Findings indicate that users of

club drugs are significantly different from delinquent

young people who have not used club drugs on a

number of dimensions, including age, engagement

in risk behaviours, victimisation, home environment

and rave attendance. (Taylor & Francis)

Measham F 2004 “The decline of ecstasy, the rise

of ‘binge’ drinking and the persistence of pleasure”,

Probation Journal. The Journal of Community and

Criminal Justice, 51:4, pp. 309–26

This article explores the changes in recreational

drug use over the previous 15 years in the United

Kingdom. In particular, the author traces the decline

in use of cocaine powder and ecstasy, and the rise

of binge drinking.

Moore K & Miles S 2004 “Young people, dance and

the sub-cultural consumption of drugs”, Addiction

Research and Theory, 12: 6, pp. 507–23

This article discusses the role of drug consumption

in the lives of young “clubbers”. Arguing that

debates over the consumption of drugs and youth

transitions both serve to “problematise” young

people, the suggestion is made that the role of

drug consumption in dance-related settings remains

largely misunderstood.

Risk taking

Kelly BC 2005 “Conceptions of risk in the lives

of club drug-using youth” in Substance Use and

Misuse. Special Issue on Club Drug Epidemiology,

40:9, pp. 1443–59

The author explores how club drug-using young

people conceive of risks related to club drug use,

specifically ecstasy, and how such conceptions

compare and contrast with current professional

models of risk. These conceptions of risk are crucial

to understand, as they form an informal logic by

which club drug practices are guided. Ultimately, the

author examines how the relationship between folk

models and professional models might inform health

promotion efforts targeting youth. (Taylor & Francis)

Travers KR & Lyvers M 2005 “Mood and

impulsivity of recreational ecstasy users in the week

following a ‘rave’”, Addiction Research and Theory,

13:1, Feb., pp. 43–52

Two days following widely attended “rave” or dance

party events, questionnaires assessing mood were

administered. Participants who had taken ecstasy

at the events were significantly more depressed

two days later than controls. Results are considered

in terms of the hypothetical mood effect of shortterm

depletion of serotonin induced by MDMA, as

well as several alternative non-pharmacological

explanations.

Pharmacology

Britt G & McCance-Katz E 2005 “A brief overview

of the clinical pharmacology of ‘club drugs’”,

Substance Use and Misuse. Special Issue on Club

Drug Epidemiology 40:9, pp. 1189–203

Four different “club drugs” are reviewed: MDMA

, ecstasy, GHB, ketamine, and Rohypnol®. The

neurobiology, clinical pharmacology, and treatment

issues for each are discussed. (Taylor & Frances)

Maxwell JC 2005 “Party drugs, properties,

prevalence, patterns, and problems” in Substance

Use and Misuse. Special Issue on Club Drug

Epidemiology, 40:9, pp. 1203–40

This review summarises the latest literature on

“party” or “club” drugs, defined as MDMA, GHB,

ketamine and Rohypnol, as published from 2002

to early 2005. Club drugs have been categorised

as being used at raves and dance parties. The

literature shows that each drug has different

properties, users and settings. (Taylor & Francis)

Parrott AC 2004 “Is ecstasy MDMA A review of

the proportion of ecstasy tablets containing MDMA,

their dosage levels, and the changing perceptions of

purity”, Psychopharmacology, 173:3–4, pp. 234–41

Surveys the pharmacological constituents of ecstasy

tablets, dosage levels, and empirical reports of their

perceived purity. Dosage levels of tablets are shown

to be highly variable, with low-dose tablets often

encountered during the mid-1990s, and high-dose

tablets now seen more frequently. The theoretical

29


Prevention, ecstasy and related drugs

and practical implications of these findings are

debated.

Green AR 2004 “MDMA: fact and fallacy, and the

need to increase knowledge in both the scientific

and popular press”, Psychopharmacology 173:3–4,

pp. 231–33

The author suggests that media and science interest

in this drug causes a belief that this is a dangerous

drug, when the statistics indicate the opposite.

Discusses acute responses to taking the drug and

the variables that contribute to these responses.

Gateway drugs

Zimmermann P, Wittchen HU, Waszak F,

Nocon A, Hofler M & Lieb R 2005 “Pathways into

ecstasy use. The role of prior cannabis use and

ecstasy availability”, Drug and Alcohol Dependence,

79:3, Sept., pp. 331–41

Results of this study suggest that cannabis use is

a powerful risk factor for subsequent first onset

of ecstasy use and this relationship cannot be

sufficiently explained by availability of ecstasy in

the observation period.

Morbidity and mortality

Gouzoulis-Mayfrank, E & Fischermann T 2005

“Memory performance in polyvalent MDMA (ecstasy)

users who continue or discontinue MDMA use”, Drug

and Alcohol Dependence, 78:3, June, pp. 317–23

This data does not support or rule out memory

decline following use of the serotonergic neurotoxin

MDMA. In light of the popularity of ecstasy among

young people, further investigations are needed.

Research strategies should now move to prospective

designs in order to shed more light on the course of

possible adverse cognitive effects of ecstasy use

Caldicott DGE, Chow FY, Burns BJ, Felgate PD

& Byard RW 2004 “Fatalities associated with the

use of gamma-hydroxybutyrate and its analogues

in Australasia”, Medical Journal of Australia, 181:6,

pp. 310–13

This study supports the existing evidence that GHB

overdose is associated with fatalities, and that fatal

overdoses occur in the context of isolated use.

(MJA)

www.mja.com.au/public/issues/181_06_200904/

cal10128_fm.html

Moore K & Miles S 2004 “Young people, dance and

the sub-cultural consumption of drugs” in Addiction

Research and Theory, 12: 6, pp. 507–523

This article discusses the role of drug consumption

in the lives of young “clubbers”. Arguing that

debates over the consumption of drugs and youth

transitions both serve to “problematise” young

people, the suggestion is made that the role of

drug consumption in dance-related settings remains

largely misunderstood.

Schifano F 2004 “A bitter pill. Overview of

ecstasy (MDMA, MDA) related fatalities”, Psychopharmacology,

173: 3–4, pp. 242–48

This review focuses on the epidemiological, clinical

and pharmacological issues related to ecstasy

fatalities and finds that due to a number of different

reasons, the rates of ecstasy related deaths

seem to have peaked in recent years. A number

of methodological problems can contribute to

making difficult the interpretation of the role played

by ecstasy in so-called ecstasy related deaths,

especially so if accurate information is not available.

Audiovisual

2005 National Drugs Campaign, Canberra: Australian

Commonwealth Government Department of Health

and Ageing

This CD ROM includes a variety of resources aimed

at parents and young people. Parent resources

include a booklet, “Talking with your kids about

drugs”, a mini-brochure, print advertisements and

radio advertisements. There are also non-English

language parent resources in Arabic, Bosnian,

Chinese, Croatian, Farsi, Greek, Indonesian, Italian,

Khmer, Korean, Macedonian, Russian, Serbian,

Spanish, Turkish and Vietnamese.

Resources for young people include print ads,

television commercials on the topics of ecstasy,

marijuana and speed, a booklet and a wallet card,

“Places to turn to when you need a helping hand”.

DrugInfo Clearinghouse no. av JE60 AUS

30


Reading and resource list

Number 16 December 2005

2004 Weekend junkies. Body hits, series 1,

episode 4, North Sydney: BBC Learning

This documentary video discusses recreational use

and effects of drugs such as ecstasy, cocaine and

cannabis.

DrugInfo Clearinghouse no. VID MC54 BBC

2003 Club drugs: nothing to rave about, Northcote:

Avenue Education

Aimed at junior to middle secondary students, this

United States-produced video discusses the dangers

of club drugs, including death from overdose, and

gives a strong “no-use” message.

DrugInfo Clearinghouse no. VID BJ2 AVE

2002 Club drugs: the real deal, Northcote: Avenue

Education

Aimed at middle to senior secondary students, this

United States-produced video discusses ecstasy,

GHB, methamphetamines and Rohypnol. The video

encourages young people to evaluate their choices

at parties.

DrugInfo Clearinghouse no. VID BJ2 AVE

2002 Club drugs: what you should know, Bendigo:

Video Education Australasia

This hard-hitting program will open teenagers’ eyes

to the facts, the effects and the consequences

of using club drugs. A drug prevention specialist

speaks to a group of teenagers about the most

popular of these drugs: Rohypnol (the date rape

drug), ecstasy, GHB, ketamine, methamphetamine,

party balls (the combining of various drugs), LSD

and the effect that alcohol has when used in

conjunction with these drugs.

DrugInfo Clearinghouse no. VID BJ2 CLU

2002 Ecstasy: the facts, Northcote: Avenue

Education

This United States video, aimed at middle to senior

secondary school students, looks at the dangers of

ecstasy and the look-alike drug DMA.

DrugInfo Clearinghouse no. VID BJ2 AVE

1997 What’s your poison Ecstasy, Canberra:

Australian Broadcasting Corporation

Episode 5 of the ABC Quantum series, looks at the

physical, psychological, historical, social effects and

research findings of the popular drug ecstasy.

DrugInfo Clearinghouse no. VID BJ28 WHA

1996 Ecstasy: the agony, Bendigo: Video Education

Australasia

In this program viewers learn of the side effects of

ecstasy, including the anxiety and depression, and

of its potential to cause long-term physical and

psychological effects.

DrugInfo Clearinghouse no. VID BJ28 ECS

Other resources available at DrugInfo

Clearinghouse

Fact sheets

Club drugs (ADF 2003)

“Ice” (crystal methamphetamine hydrochloride) (ADF

2003)

Pamphlets & booklets

Chemical reaction (MDECC 2001)

Club drugs (NDARC 2000)

Dealing with party drug use: a guide for parents

(ADF 2003)

Ecstasy: facts and fiction (NDARC 1998)

How drugs affect you. Amphetamines (ADF 2002)

How drugs affect you. Ecstasy (ADF 2002)

Users’ guide to speed (NDARC 2001)

Postcard

What drug is that Party drugs (ADF 2003)

31


Notes

32


Need to find more information on

our catalogue

Try using the following keywords:

ecstasy

party drugs

club drugs

designer drugs

rave culture

raves

polydrug use

Need help with your research

Contact our friendly staff in the DrugInfo

Clearinghouse Resource Centre and library:

Telephone

1300 85 85 84 (Monday to Friday, 9am to 5pm)

Fax

(03) 9328 3008

Email

druginfo@adf.org.au

Website

www.druginfo.adf.org.au

drug trends

MDMA


www.druginfo.adf.org.au

DrugInfo Clearinghouse

409 King Street West Melbourne

Victoria 3003

Email: druginfo@adf.org.au

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