British ffournal of Addiction (1992) 87, 1161-1172

:, J. (1986) Substance usen Barcelona (Spain). Aurveys, Drug and Alcohol8.

;. · v_co, A. (1988) RESEARCH REPORT; university students intdiction, 83, pp. 91-98.D., DEL RIO, M. C. &

ems of drug use by young Recreational MDMA use in Sydney:nunity of Spain, British

p. 647-652. a profile of 'Ecstasy' users and their1981) La poblaci6n Espa-

Spaniards in the face of n experiences with the drugia/, 42, pp. 25-114.85) SAS User's Guide:2, SAS Institute lac).9) Los Andalumes ante las

_.f_e ofa.,w (S_viU,. NADIA SOLOWIJ, WAYNE HALL & NICOLE LEEefta de Salud y Servicios

la Dwga).

encias (Drug AadictionO e National Drug and Alcohol Research Centre, University of New South Wales, PO Box I,

:s de la Uni6n General de Kensington,NSW 2033, AustraliaHo_so_, R. (1981)

tion of drag- and alcohol-fthe World Health Organ-

AbstractCONSUMO (1988) Actuar_nci6n prmaria de sa/ud 'Ecstasy' (3,4-methylenedioxymethamphetamine or MDMd) iv a recreational drug that is gaining popularity(The general practitioner world wide. There is a paucity of research regarding the ways in which Ecstasy is used and the nature of its

id, Ministerio de Sanidad effects. ,4 'snowball' peer network technique was used to recruit 100 users who completed anonymous

I Gobiemo para el Plan questionnaires. The research revealed that Ecstasy is primarily used by infrequent recreational drug users for

a._tnN, M. (1989) The fun' at dance parties and social gatherings. The primary reported effects of Ecstasy were a _ositive mood state'lated to its abuse, Phar- and feelings of intimacy and closeness to others. The secondary effects of tJcstasy were the stimulant effects of· 3-52. energy and activation, and the psychedelic effects of insight and perceptual and sensual enhancement. Ecstasy

rets, I., At. VA.,_.z-L_, was reported to share the properties of both amphetamines and hallucinogens in the nature of its side effects and

& Faa_, M. (1987) residual effects which were no more severe than those of the latter two classes of drug. It appeared Ecstasy wasics in Barcelona, Lancet,

not conducive to regular and frequent use, because tolerance was reported to develop to the positive effects of

ucci6a de la oferta y la l_cstasy, while negative effects increased with use. Hlthough ferz' problems associated with the recreational use of

ae droga (Decreasing the Ecstasy have surfaced to date, animal research has shown it to be neurotoxic to serotonerg_c nerve terminals.

drugs), Pohiica Exterior, Caution must be observed until further research can determine the level of hazard in humans.

.ilo sobre conocimiento ySvenes (Knowledge andong the young adults),rud (Monogrdfico:Juven- Introduction streets just prior to its illegalization. 3 Although use

83. 'Ecstasy' is the common name for 3,4-methylene- diminished subsequent to its scheduling, Ecstasy's

dioxymethamphetamine, otherwise known as high media profile continued for a number of years

MDMA. This relatively new street drug was first with widespread recreational used The drug first

synthesised in 1914 but only gained popularity as reached Australia in the mid eighties, with reports of

both a therapeutic and recreational drug in the it being used as an adjunct to psychotherapy) A

United States in the seventies. L: In 1985 it was survey conducted by the National Campaign

made illegal under emergency action by the US Against Drug Abuse in April 1988 found that of

Drug Enforcement Administration's placement in 1830 Australians questioned about their drug use,

Schedule One of its regulations, banning the manu- 3% claimed to have been offered Ecstasy. s Anecdo-

facture, sale, possession or use of the substance, tal evidence of increasing use continued to accumu-

This was accompanied by wide media coverage of late, with much media coverage in association with

the debate over its potential for abuse versus its dance parties, peaking in 1989-1990. However,

utility as a psychotherapeutic agent, with resultant research into the precise nature of Ecstasy use and

popularisation and a boom of Ecstasy use on the characteristics of users in Australia has been greatly

1161

1162 Nadia Solowij et al.

lacking. Moreover, internationally there is a paucity sociological exploration of MDMA users in the questionnaires and instructe,

of research regarding the nature of the effects United States have only recently become avail- many people as were known

produced by this drug. able,_$and represent the only other comprehensive ,, users, with instructions to tIt is precisely because of its alleged effects that work performed to date describing MDMA use in si again. With each questionn

Ecstasy has been used in psychotherapy. It has been the community, instruction sheet and return treported to facilitate interpersonal relations, eh- The primary aims of this study were: (1) to Anonymity was assured.hance communication and intimacy, increase self- investigate Ecstasy use in Sydney with a view to The criterion for inclusiesteem and elevate mood. 2,7 These attributes, its ascertain who uses, why, when, where and how, that 'anyone who had ever tried Fearly widespread therapeutic use and its popularisa- is, the context and mode of use; (2) to further against setting a criterion suction as the 'hug drug' (together with the name investigate and quantify the subjective effects of three times, for fear of fail'Ecstasy' which sells itself)_ have helped to convey Ecstasy, including primary psychological and phy- extreme reactions to first

the general impression that this substance is psycho- siological effects, side effects and residual effects Further, based upon informlogically beneficial and harmless. This impression and explore the issues of tolerance and problematic pilot study, it was felt that

was facilitated by the fact that the effects of Ecstasy use; and (3) to compare the effects and side effects could be obtained not only frdid not fit neatly into any of the traditional of Ecstasy to those of amphetamines and hallucino- Ecstasy and have thus usec

categories of drugs of abuse. It was found to be gens. While analysis of street samples would have from those who perhaps 'donchemically related to and to possess both hal- provided a useful corollary, unfortunately this was a conscious decision not to u

lucinogenic and stimulant properties, however, not possible. Moreover, analyses of police seizures few uses. In the pilot study iits psychoactive effects seemed to be quite unique of the drug are qualitative only, not quantitative, certain questions, such as tho

and distanct from other known classes of com- Previously reported analyses have detected high effects, were dependent upor:pounds. Further, since MDMA was found to differ levels of purity in Sydney, _6 in other Australian substance. Therefore, the quein its pharmacological properties from the known states _7 and internationally. _3''x When accounts into three segments: one to

derivatives called 'hallucinogenic amphetamine have been reported to the contrary, what stands out entire sample, one specifica

analogues', it was suggested that it may' indeed is that MDMA differs from other street stimulants times users' and another sperepresent a completely new pharmacologic class in that when adulterated, it appears to contain only time users', defined as those 'named 'entactogens? Shulgin _ provides a review of its _close relative MDA' rather than a whole consort more than three times.the background, chemistry, pharmacology and toxi- of other substances? Given the known pharmacol~cology of MDMA. ogy of the drug and the consistency of reported '

There is little systematic information on the effects in this study with those of previous research,

effects of Ecstasy on humans and existing accounts it would appear that it is a reasonable assumption to The Sampleare varied. Some suggest a benign drug, whose make that the Ecstasy being sold on the streets in The sample consisted of 100.

effects include feelings of insightfulness and inner Sydney was primarily MDMA. females, ranging in age fromcontentment, euphoria and enjoyable changes in age of 27.13 (SD-_ 6.69).

perception without significant distortions of consci- collection, 63% of the sampl,ousness or disorientation. _.2._°.'' Others emphasise time and 23% were students.distressing subjective and physical effects associated Method had completed or were current

with its use. For example, involuntary jaw move- An initial pilot study was carried out to determine education. Seventy-five perce:ments, motor restlessness, tremors, ataxia, nystag- the areas worthy of investigation. Interviews were residing in the city or inner simus, tachycardia, increased sweating, blurred conducted with a sample of 12 users known to the ethnic group predominated.vision, nausea, and feelings of panic and paranoia investigators, encompassing a wide range of experi-have all been reported to varying degrees3 ,_.':._3 ence with Ecstasy and a reasonable cross section of

These negative effects appear to be partially, but society. The interviews were based on a draftnot wholly, dose-related23 However, reports of version of a questionnaire and yet were informal Ecstasy and other drug useproblems arising from Ecstasy use appear to be enough to allow users to report new and pertinent The overall level of experie

relatively rare given its widespread use. Given the information regarding their use and the effects of portrayed in Fig. 1. Sixty-elack of quality control in manufacture which is an Ecstasy. There was no evidence of lack of under- sample had used Ecstasy moreinevitable characteristic of this type of illicit sub- standing or misinterpretation of any of the ques- will be termed 'Multiple timestance, many of the acute adverse reactions may tions, The information provided by this initial 46 males, 22 females, agedresult from ingestion of substances other than sample was incorporated into the final refined (SD = 7.29). Thirty-two peroMDMA. Reports of the effects of Ecstasy have version of the questionnaire (available from the used Ecstasy three times or le:primarily been obtained from uncontrolled clinical authors on request:°). These initial subjects formed 'one to three times users', constrials _a° and from descriptive reports from select the starting points in a peer network 'snowball' females, aged 16-36, mean 24.,samples of users. 13.'4 The results of an extensive sampling technique. :_ They were given bundles of average reported age at which

Recreational MDMA use in Sydney 1163

m of MDMA users in the questionnaires and instructed to pass them on to as the first time was 25.1 (SD = 6.24, range 14-43),

rely recently become avail- many people as were known to them to be Ecstasy and the longest duration of use was more than 5he only other comprehensive users, with instructions to pass them on to others years._te describing MDMA use in again. With each questionnaire was provided an

instruction sheet and return postage paid enve!opes. 30of this study were: (1) to Anonymity was assured.

;e in Sydney with a view to The criterion for inclusion in the study was ___y,when, where and how, that 'anyone who had ever tried Ecstasy'. It was decided _ 20node of use; (2) to further against setting a criterion such as use of more thanify the subjective effects of three times, for fear of failing to detect possible _0mary psychological and phy- extreme reactions to first time use of Ecstasy. 5: effects and residual effects Further, based upon information gathered in the

of tolerance and problematic pilot study, it was felt that valuable information ore the effects and side effects could be obtained not only from subjects who 'like' L : _ _ m-_5 _e-_o , _o

amphetamines and haUucino- Ecstasy and have thus used repeatedly, but also Numbcrofllxpcncnce_ withEcstasyff street samples would have from those who perhaps 'don't like' Ecstasy or made Figure 1. The overall levelof experienceofthesamplewtth_llary, unfortunately this was a conscious decision not to use again after the first Ecstasy, expressedas the number of occasions on which·r, analyses of police seizures few uses. In the pilot study it became obvious that Ecstasy was used.mtive only, not quantitative, certain questions, such as those regarding long term

malyses have detected high effects, were dependent upon significant use of the The average alcohol consumption of respondentsydney, t6 in other Australian substance. Therefore, the questionnaire was divided was 3-4 drinks per occasion, on 2-3 days per week.ionally. _3a8 When accounts into three segments: one to be answered by the Other drug use by the sample is presented in Tablethe contrary, what stands out entire sample, one specifically for 'one to three I. Current use was primarily defined as social or

from other street stimulants times users' and another specifically for 'multiple occasional use rather than regular or frequent use.ed, it appears to contain only time users', defined as those who had used Ecstasy While 40% of the sample reported regular use of_,'rather than a whole consort more than three times, marijuana, only 9% claimed to useamphetamines onGiventhe knownpharmacol- a regularbasis,6%reportedregularuseof LSDandthe consistencyof reported 7%claimedto be frequentusersof amylnitrate.A

:ththoseof previousresearch, surprisinglylarge proportion(28%) of the sampleis a reasonableassumption to The Sample reported current use of amylnitrate in general.This

being sold on the streets in The sample consisted of 100 subjects: 61 males, 39 inhalant is popular within the homosexual commu-MDMA. females, ranging in age from 16 to 48 with a mean nity '2 and may reflect a large number of homosexual

age of 27.13 (SD = 6.69). At the time of data respondents within this sample. Other inhalantscollection, 63% of the sample were employed t_tll such as glue, petrol, paint, were the least popular intime and 23% were students. Seventy-two percent this sample, tollowed by heroin, other opiates,had completed or were currently completing tertiary, tranquilisers and barbiturates. These data portray a

was carried out to determine education. Seventy-five percent of the sample were group of primarily recreational drug users.lvestigation. Interviews were residing in the city or inner suburbs. No particularpie of 12 users known to the ethnic group predominated.lssing a wide range of experi-a reasonable cross section of Resultsws werebasedon a draft Generalfindings

naire and yet were informal Ecstasy and other drug use Image and perceived risks. The most frequentlyto report new and pertinent The overall level of experience with Ecstasy is reported reasons for trying Ecstasy were 'out oftheir use and the effects of portrayed in Fig. 1. Sixty-eight percent of the curiosity', for experimental reasons, for 'fun' and

o evidence of lack of under- sample had used Ecstasy more than three times and recreational purposes. The most common method of

retation of any of the ques- will be termed 'Multiple time users', consisting of introduction was being offered it by a friend. It wasm provided by this initial 46 males, 22 females, aged 17-48, mean 28.33 reported as most often initally taken fora particularated into the final refined (SD = 7.29). Thirty-two percent of the sample had occasion, such as a party, a dance party or some

onnaire (available from the used Ecstasy three times or less and will be termed other celebration. Peer use was high. Subjects wereThese initial subjects formed 'one to three times users', consisting of 15 males, 17 asked to describe the types of people who use: a peer network 'snowball' females, aged 16-36, mean 24.63 (SD = 4.32). The Ecstasy. The most frequently reported types wereThey were given bundles of average reported age at which Ecstasy was tried for 'dance party people' and 'socially active types'

1164 Nadia Solowij et al.

Table 1. Otherdruguse by the sample relationships, communication or social interactions, use Ecstasy. The reasonsSixteen percent claimed that having used Ecstasy anymore by the remaining 2

Have Currently had actually improved their relationships, and many 'boring' or 'overrated' and hatried use subjects alluded to the gaining of insight and Ecstasy reasons or having decided no(%) (%)

having enriched their psychological growth in some as well as the high price of:Marijuana 99 77 way. Only seven subjects mentioned having experi, as reasons for not taking iAmphetamines 83 47 enced depression acutely as a result of having used within this group ranged fi

Hallucinogens 84 38 Ecstasy. Although 45% of the sample reported months ago, median 4 montlAmyl Nitrate 75 28Cocaine 77 26 Ecstasy as having no effect on their general healthBarbiturates 52 11 personally, many believed that regular use of large Frequency of use.The freqTranquilizers 51 5 quantities of Ecstasy would affect general health in the sample is presented graHeroin 16 5 the following ways: more fatigue, generally 'run third of the sampleuse Ecst_Otheropiates 31 3Inhalents 4 -- down', more colds and lowered immune response to once a month to once every !

infection. Twenty-five percent reported experienc- more frequently, 18% use

lng these effects to some degree, sions. Three subjects reportedays. Fifteen percent report.

(54%).Twenty-eightpercent reportedusers to be usedEcstasycontinuouslyf'normal people', qualified by 'all types' and empha- One to three times users primarily because it was frsising the notion that Ecstasy is accessible to and The one to three times users of this study present as fun'. Forty-three percent olused by people of any age, from all walks of life. primarily a group of expermaental and infrequent _' their pattern of use since thcThe third typolog3' proferred (26%) was that of recreational drug users who tried Ecstasy and found _ not changed over time, 2

'experimenters', 'sensation seekers' and 'emotion that either, it didn't live up to their expectations, or decreased (often followingenhancers', referring to both spiritual and personal they haven't had an opportunity on which to take 15% go through cyclical p:insight, and to experimental dabblers in pure drug Ecstasy again. Seventy-five percent of this group with availability, personal p:experiences--a further 16% clearly stated 'recrea- described their experience on Ecstasy as pleasant the social climate (e.g. freqt

tional drug users'. There was also an association and enjoyable, and 63% said they would use it again 2o[with the 'yuppie' scene (14%) and use by the if offered to them. Reasons for not having used

homosexual community (11%). Most respondents again were either due to wariness regarding the _claimed that they themselves belong to one of the effects of Ecstasy, having had no opportunity or _,

typologies they had nominated. When asked directly special occasion on which to take it, or financial _ _0what sort of image Ecstasy has for people, or what reasons. Forty-one percent claimed they had foundsort of words they associate with Ecstasy or Ecstasy the experience 'boring', with Ecstasy not livingusers, responses clustered predominantly into the up to their expectations or not worth the money.following two types: (1) fun, good time, stimulating, Twenty-five percent described their experience as o _

dance parties, 'acid house', energy; and (2) corn- unpleasant, having experienced negative feelings or _,* y_ _ _'munication, relationships, loving, touching, en- indulged in undesirable behaviours. Several respon- _hancement of sex, lack of inhibitions. When asked to dents described their experience as both pleasant Fro

rate how 'hard' a drug Ecstasy is perceived to be on and unpleasant, either at different times within the Figure 2. Frequencyof Ecsa scale from 0 to 10, where marijuana was placed as duration of the drug, or in that Ecstasy produced

0 and heroin at 10, the mean response was 4.67 both pleasant and unpleasant effects. The last use of(SD = 2.19). Ecstasy ranged from 2 to 36 months ago, median 7.5

Subjects perceived the following risks to be months ago. Forty-one percent of this group volun- Social aspects. Most res[involved in using Ecstasy: (1) risks to mental health, teered no information in regard to problems of any Ecstasy with a small group

brain damage, depression, emotional problems, cog- kind related to the use of Ecst-sy. The remainder with a large group of 5 ornitive impairment, memory loss, psychosis; (2) risks nominated acute bad reactions such as anxiety, with one other person onlyto general physical health; and (3) concern about panic attacks and vomiting, together with a number were reported to be the munknown composition of substances purporting to of other side effects and after effects such as jaw taking Ecstasy (72%), follcbe Ecstasy, and the lack of research and facts tension and mild depression. None of these were (59%) and nightclubs (49 °,regarding long term effects, dangerous side effects rep6rted as major or prolonged episodes, reported venue for taking E,and possibledependenceor addiction.Despitethese one'spartnerfortheintimacconcerns, 50% of the sample actually reported Multiple time users and as an evening at home,

Ecstasy as having had no effect at all on their Seventy-five percent of this group (who had used than going out. These data rpsychological state of mind, well being, personal Ecstasy more than three times) still use or intend to the drug as both a stimula

Recreational MDMA use in Sydney 1165

mication or social interactions, use Ecstasy. The reasons given for not using enhancer as well as an introspective, emotional or

med that having used Ecstasy anymore by the remaining 25% were that Ecstasy is spiritual arouser. The most popularly reported timesd their relationships , and many 'boring' or 'overrated' and has lost its appeal. Health for taking Ecstasy were on weekends, usually in the

:e gaining of insight and Ecstasy reasons or having decided not to 'do drags' anymore, late evening, and preferably when one was notr psychological growth in some as well as the high price of Ecstasy were also. given working the following day. These data reinforce the,jects mentioned having experi- as reasons for not taking it any longer. Last use idea of Ecstasy as a social drug, but also one which_tely as a result of having used within this group ranged from 2 days ago to 42 requires time for recuperation. Nevertheless, 40% of45% of the sample reported months ago, median 4 months ago. respondents claimed that there are no after effects,

effecton theirgeneralhealth or that it is possibleto minimisethem by various

lieved that regular use of large Frequency of use. The frequency of Ecstasy use by preventative methods such as not drinking alcoholwould affect general health in the sample is presented graphically in Fig 2. One while on Ecstasy, eating well both before and aftermore fatigue, generally 'run third of the sample use Ecstasy somewhere between the experience, or being physically and mentally

_dlowered immune response to once a month to once every 3 months, 24% are using prepared and well rested prior to taking Ecstasy.ye percent reported experienc- more frequently, 18% use mainly on special occa-omc degree, sions. Three subjects reported using every couple of Dosage and mode of use. Tablets were by far the

days. Fifteen percent reported having at some time most frequently reported form of Ecstasy available,used Ecstasy continuously for a few days in a row, followed by capsules. It was also reported as being

ers primarily because it was freely available and 'it's available in powdered form. Ninety-eight percent of

:s users of this study present as fun'. Forty-three percent of the sample claim that the time, Ecstasy was swallowed, but 'snorting',experimental and infrequent their pattern of use since they first tried Ecstasy has injecting and suppositories were also reported as

rs who tried Ecstasy and found not changed over time, 26% claim that it has methods of taking it by small proportions of theive up to their expectations, or decreased (often following an initial increase), and sample. The fact that people do experiment Withopportunity on which to take 15% go through cyclical patterns of use, varying different ways of taking it is apparent in that 41% of

_ty-five percent of this group with availability, personal preferences to do so, and the sample claim to have noticed differences in therience on Ecstasy as pleasant the social climate (e.g. frequency of parties), effects of Ecstasy by taking it in different ways._%saidtheywoulduse it again Injectingwas reported as havingthe quickestonset

'(Reasonsfor not havingused and producinga more intensebut shorter lasting

ae to wariness regarding the _. experience. Snorting was reported as being quicker_avinghad no opportunityor _ to take effectbut shorterlasting,whilea suppositorywhich to take it, or financial _ _() had a slow onset but produceda more intenseand

prolonged experience..'rcent claimed they had foundng', with Ecstasy not living _- The effectsof onedoseor tabletwerereportedtoons or not worththe money, last anywherebetweenI and 12 hours(median5

described their experienceas _' _ _ _ _ :4 _ _ _ _ hours) with residual effects lasting up to 32 hours._ _ _ _ _ _ Although unverified in this study, most of the

:perienced negative feelings or _q _ _ _ _ _ _le behaviours. Several respon- -_ z - _ _ S literature reports a single tablet to contain 120 mg of- experience as both pleasant Frequency MDMA. Seventy-one percent of the sample re-r at differenttimeswithinthe ported takingonly onedoseor tabletper occasion,

, or in that Ecstasy produced Figure 2. Frequencyof Ecstasy use by the sample. 9% took less than one, 13% took two, 7% took more_leasanteffects.The lastuseof than two.The maximumnumberof tabletsreported

2 to 36 months ago, median 7.5 as the usual dose per occasion was 5. The least:e percent of this group volun- Social aspects. Most respondents prefer to take quantity tried by respondents was about a quarter of

in regard to problems of anY Ecstasy with a small group of 2-4 friends (69%), a tablet, reported to have a mild, shorter lastingse of Ecst'.sy. The remainder with a large group of 5 or more friends (57%) or effect. A number of subjects commented upont reactions such as anxiety, with one other person only (38%). Dance parties experiencing the strongest effects the first time they

aiting, together with a number were reported to be the most popular venues for ever tried Ecstasy, even on a small dose.and after effects such as jaw taking Ecstasy (72%), followed by private parties Fifty-nine percent of the sample have experi->ression. None of these were (59%) and nightclubs (49%). Another frequently merited with larger doses per occasion. Several

prolonged episodes, reported venue for taking Ecstasy was at home with respondents had tried between 5 and 9 tablets at aone's partner for the intimacy and emotional effects, time, with one person having taken 5 tablets over 50

and as an evening at home with close friends rather times. The maximum dose reported by any respon-of this group (who had used than going out. These data reflect the dual nature of dent was nine tablets in one night. The effect ofee times) still use or intend to the drug as both a stimulant energiser and social taking larger doses was reported as primarily more

1166 Nadia Solowij et al.

hallucinatory, with disorientation and increased side aspects of Ecstasy were its side effects and after drug, but who are less likely

effects. It was longer lasting, more intense, with a effects, 'the coming down' and the price. The drug. These two categories olonger and stronger rush and 'peak' period, pro- unpleasant side effects were reported as being with the perceived 'image' cduced more after effects and was described as experienced 86% of the time. Ten percent of the the nominated typologies otdisabling 'the feeling of being in control'. Most sample claimed that there was nothing they disliked Ecstasy: the dance party crovrespondents reported staggering the multiple doses about Ecstasy. and the 'sensation seekers' a_

they take by waiting until the effects of the first Subjects were then given an adjective checklist of (insight, enlightenment).have worn off before taking the second in order to effects. This checklist (and the side effects checklist

prolong the experience. Successive doses are most discussed below) was compiled by extracting des- Effects of Ecstasy comparedoften reported to be less intense and shorter lasting criptors of the effects of various classes of drugs hallucinogens. Analyses were

than the first dose taken on each occasion, often from the research literature, incorporating effects of who had tried all three drug,with reduced pleasurable effects and increased side Ecstasy nominated by subjects in the initial pilot simplified multivariate profileffects. This may reflect the development of tachy- study. One to three times users were asked to simply taken by firstly standardisingphylaxis, a rapid production of immunity, which is check Yes or No for each word, while multiple time subscales to equalise means ar,known to occur with hallucinogens, users were asked to indicate how often they Next, for each subject lin

experience each of the effects on a scale of Always, standard (z) scores were com_

Tolerance. Most subjects did report some kind of Sometimes or Never. One of the aims of this project of the drug types (e.g. the Etolerance to the effects of Ecstasy, but the definition was to investigate the perceived similarities and Activation subscale minus the

of tolerance varied. The sample was divided regard- differences between Ecstasy, amphetanUnes and for the Activation subscale)mg the need to take more to experience the same hallucinogens. Multiple time users only, because of that the mean difference = 0 ¢

effects. Those who have found this (49%) attributed their ability to make a better judgement based on a single sample t-test forit to either a gradual decrease in quality (24%) or to experience, were asked to also complete the check- comparison on each set of sul

tolerance/addiction (18%). Again, many respon- lists in regard to amphetamines and hallucinogens if results of this analysis havedents alluded to the first time having been the they had tried either or both of these drugs. Overall, where? ° Significantly morestrongest and each successive experience on Ecstasy the effects on the checklist were classified into 5 Intimacy effects were reportebeing in some way inferior. Some described this in subscales: Positive Mood, Negative Mood, Inti- either amphetamines or halterms of Ecstasy losing its novelty value. Others macy, Activation and Insight (for full details see difference between the latter

believed in a physical tolerance or adaptation to the Solowij & Lee2°). The most frequently reported produced the highest scores or.effects of Ecstasy. Seventy percent reported having effects of Ecstasy fell into the Positive Mood and by Ecstasy and then hallucimnoticed variations in the effects of Ecstasy over Intimacy categories, followed by Activation and subscale, there was no differc

time, such as worse side effects and reduced Insight effects. Negative Mood effects were the and hallucinogens but bothpleasurableeffects but attributed this to fluctuations least reported, duce significantly more effecin quality and purity. Respondents believed that the

amphetamines. Hallucinogensfollowing factors contribute to or affect the way in One to three times users compared to multiple time number of Negative Moodwhich Ecstasy is experienced: variations in quality/ users. The frequency of effects on each of the amphetamines, with Ecstasypurity (94%), the setting/environment (71%), subscales as reported by the multiple time users was The 10 most frequently reptmood (68%), using too often (65%), physical compared to that reported by the one to three times drug are presented in Tabladaptation to the effects (59%). Respondents also user group. There was no significant differencevolunteered the following factors as affecting the between the two groups on Positive Mood, Intimacyexperience: who one is with, whether any other and Negative Mood effects, indicating that Ecstasy Table 2. T,substances are consumed, and one's state of health, is consistent and reliable in producing the former Asterisks im

two types of effects and in eliciting few of the latter

type, regardless of level of experience with and EcstasyEffects of Ecstasy and drug comparisons frequency of use of the drug. However, multiple

Effects. Prior to completing adjective check- time users reported experiencing significantly more Talkativelists, subjects were asked to nominate what it is that frequently effects on the subscales of Activation Open min,Closenessthey like best about Ecstasy. Using a number of (F = 4.02, p < 0.05) and Insight (F = i1.06, Happinessadjectives already present in our checklists as p < 0.0013) than the one to three times users. It Easy gointdescriptors, what emerged could best be called a may be precisely these types of effects that people Accepting'

Sensual*'positive mood state'. This positive mood state is who are more likely to use drugs are seeking out.

Euphoria*perhaps the most consistent effect of Ecstasy and That is, it may be the desire to experience these Confidentwas reported as being experienced 94% of the times types of effects that will differentiate more frequent CarefreeEcstasy is taken. The least liked or most disliked recreational drug users from those curious to try a

Recreational MDMA use in Sydney 1167

'ere its side effects and after drug, but who are less likely to continue using that effects are those which differentiated each drug

down' and the price. The drug. These two categories of effects are in accord from the rest, i.e. those which were significantly

cts were reported as being with the perceived 'image' of Ecstasy reflected in more frequently reported for one particular drug:he time. Ten percent of the the nominated typologies of people likely to use than for each of the other two drugs. When asked tohere was nothing they disliked Ecstasy: the dance party crowd (activation, energy) nominate which other drug Ecstasy was most similar

and the 'sensation seekers' and 'emotion enhancers' to in terms of its effects, thirty-two percent

given an adjective checklist of (insight, enlightenment), nominated amphetamines, 28% nominated cocaine,(and the side effects checklist 24% nominated LSD, while a further 25% claimed

compiled by extracting des- Effects of Ecstasy compared to amphetamines and that it was unlike any other drug. Comparisons were__sof various classes of drugs hallucinogens. Analyses were confined to subjects also made to combinations of drugs, such as 'like arature, incorporating effects of had tried all three drugs (n = 46). A form of mixture of x + y', but with little consistency.

y subjects in the initial pilot simplified multivariate profile analysis was under-nes users were asked to simply taken by firstly standardising ratings on each set of Side effects and residual effects. Subjects wereach word, while multiple time to equalise means and standard deviations, given adjective checklists of side effects. All sub-

o indicate how often they Next, for each subject linear combinations of jectswere asked to indicate the severityofeachsidee effects on a scale of Always, standard (z) scores were computed to compare each effect experienced on a scale of NO, MILD or

Dne of the aims of this project of the drug types (e.g. the Ecstasy z score for the SEVERE. The side effects checklist was classifiedhe perceived similarities and Activation subscale minus the Amphetamine zscore into two subscales: Physical and Mental? TheEcstasy, amphetamines and for the Activation subscale). The null hypothesis Physical side effects of Ecstasy were reported more

,le time users only, because of that the mean difference = 0 could then be tested by often and as more severe than the Mental side

a better judgement based on a single sample t-test for each pairwise drug effects. There were no significant differences be-

:d to also complete the check- comparison on each set of subscales. The complete tween one to three times users and Multiple timehetamines and hallucinogens if results of this analysis have been published else- users in type or severity of side effects reported.)r both of these drugs. Overall, where,z° Significantly more Positive Mood and However, the severity of side effects reported was

_ecklist were classified into 5 Intimacy effects were reported for Ecstasy than for positively correlated with both the total number of_4ood, Negative Mood, Inti- either amphetamines or hallucinogens, with no doses consumed (r = 0.34, p < 0.05) and the fre-t Insight (for full details see difference between the latter two. Amphetamines quency of use (r = 0.50, p < 0.01).

'he most frequently reported produced the highest scores on Activation, followed Multiple time users were asked to complete thet into the Positive Mood and by Ecstasy and then hallucinogens. On the Insight same checklists for amphetamines and hallucinogensfollowed by Activation and subscale, there was no difference between Ecstasy if they had tried either of these drugs. The side

_tive Mood effects were the and hallucinogens but both were reported to pro- effects of Ecstasy were then compared to those of

duce significantly more effects on this scale than amphetamines and hallucinogens. There was noamphetamines. Hallucinogens produced the most significant difference between Ecstasy and am-

:sets compared to multiple time number of Negative Mood effects followed by phetamines in the reported severity of side effects: of effects on each of the amphetamines, with Ecstasy producing the least, overall, while hallucinogens were reported to pro-by the multiple time userswas The 10 most frequently reported effects of each duce significantly more severe side effects than)fred by the one to three times drug are presented in Table 2. The asterisked either of the other two drugs. There was noNas no significant differenceps on Positive Mood, Intimacyfffects, indicating that Ecstasy Table 2. The 10 most frequently reportedeffectsfor each drug category.

Asterisks indicate those individual effects which distinguished each drug:able in producing the former categoryfrom the rest,significantat 0.001nd in eliciting few of the latterevel of experience with and Ecstasy Amphetamines Hallucinogensthe drug. However, multiplexperiencing significantly more Talkative Energetic Strange thoughts*Openminded Talkative Openminded1 the subscales of Activation Closeness to others* Alert* Enlightened) and Insight (F = 11.06, Happiness* Confident Insightful.' one to three times users. It Easygoing* Clearthinking Restless

se types of effects that people Accepting* Attentive AcceptingSensual* Incr self-esteem Energeticto use drugs are seekingout. Euphoria* Openminded Easygoinghe desire to experiencethese Confident Easygoing Talkativerill differentiate more frequent Carefree Accepting Happinessrs from those curious to try a

i!65 Nadia Soiow_j et ai.

Table 3. The I0 mostfrequentlyreportedside effectsfor each drugcategory Twenty-eight percent ofhaving experienced problen

Ecstasy Amphetamines Hallucinogens Ecstasy. The problems de

Loss of appetite Loss of appetite Visual illusions predominantly acute bad reDry mouth Insomnia Visual hallucinations as paranoia, panic, loss ofRapid heartbeat Rapid heartbeat Loss of appetite anxiety, hallucinations. EigJaw tension Jaw tension Insomnia bad physical side effects sucInsomnia Grinding teeth Confusion respiration, grinding teeth,Grinding teeth Dry mouth Poor concentrationHot andcoldflushes . Palpitations Soundhallucinations clenching. Sixteen percentSweating/sweaty Irritability Anxiety vomiting. Nine percent p:

palms 'taking too much' as probleJPoor concentration Desire to urinate Mental Instability what extent this meant ta

Desireto urinate Tremors Rapidheartbeat experiencingan acute bad retoo often. When asked dire

two people claimed they ha

significant difference between Ecstasy and am- while on Ecstasy. Alcohol was reported as deadening 22% of the sample claimedphetamines on severity of Physical side effects, and or counteracting the effects of Ecstasy, and inducing who had been dependent oboth produced marginally more severe Physical side more side effects and vomiting. Forty-seven percent on Ecstasy was described aseffects than hallucinogens. Ecstasy produced more have used it with marijuana, reported as both 'picks to cope everyday, and the iMental side effects than amphetamines, while you up' and 'brings you down'. Many respondents out without it, having fu:

hallucinogens produced more severe Mental side smoke marijuana on the 'coming down' phase of the upon having taken Ecstasy.effects than either Ecstasy or amphetamines. These experience, either in an attempt to prolong the of taking increasingly lar;results tend to place Ecstasy in between the other 'high', or to try to counteract the stimulant proper- percent of the sample belietwo classes of drug in the types of side effects it ties and overcome insomnia. Forty-one percent have become 'addicted' to Ecstas'

produces: Ecstasy produced physical side effects had Ecstasy together with amphetamines, which sought help regarding their_akin to those of the amphetamines, but was more increased the stimulant properties of the drug.

like the hallucinogens in its propensity to produce Nineteen percent have had it together with LSD,mental side effects. The l0 most frequently re- increasing the hallucinogenic properties, although Discussion

ported side effects of each drug are presented in this combination would make exact attribution of This study provides a corn torder of severity in Table 3, where the predomi- effects difficult. Some had tried Ecstasy together of the ways in which Ecstanance of Mental side effects for hallucinogens is with cocaine, amyl nitrate and 'designer drug findings concerning the na

apparent, derivatives' but there was little consistency or Ecstasyas experiencedby itsThe descent from the 'high', termed 'the coming validity in the descriptions of these drug interac- the case in the present study:

down', and the 'hangover' effects of Ecstasy were tions. While it is clear that Ecstasy users at times the advantage of using socialmostly described as 'better than' or mild by consumed other substances together with Ecstasy, to substantial numbers of illcomparison to other drugs (34%) with descriptors these experiences were infrequent enough or suffici- ease of use carries disadva;such as 'tired, lethargic, spaced out, irritable, ently differentiated from the primary experience of over who answers the questemotional, depressed'. The residual effects of Ecstasy, to permit attribution of the effects reported respondents choose to interEcstasy were reported to last up to 24 hours (or 32 in this study to Ecstasy itself. It is also clear that arise about the possbility ofhours at the extreme) with a prolongation of the recreational drug users are likely to experiment with their answers, or providing ri

types of side effects included in our checklist, various 'cocktails' or mixture of substances, whether by myths and stereotypes ab(Twelve percent of the sample described the 'coming it be premeditated or opportunistic experimenta- the illicit drug using subculttdown' and after effects as severe, while a further tion. Further research is needed to explore the matters that demand circums12% claimed there were none. There was no specific various drug interactions, licit and illicit, before the tation of our data. For tw,

after effect reported as intrinsic to Ecstasy. consequences of these can be fully understood. For believe nonetheless, that texample, significant toxicity has been reported from invalidate our findings. Firs

Concurrent drug use. In order to determine to the interaction of MDMA and monoamine oxidase study in general are remarkakto the research of Beck et al.

what extent any reported effects were specific to inhibitor antidepressants. 23Ecstasyitself, subjectswerequestionedas to their the UnitedStates.Second,ti-useof othersubstancesincombinationwithEcstasy. users in our surveyare the s

Twenty-four percent of the sample have never Problematic use small number of studies ottaken any other drug together with Ecstasy. Thirty Subjects were questioned about problematic use and MDMA under laboratory co_

percent of the sample rarely or never drink alcohol any bad experiences related to the use of Ecstasy. While the study of Beck

Recreational MDMA use in Sydney 1169

_ugcategory Twenty-eight percent of the sample admitted to study approached the subject matter from differinghaving experienced problems related to their use of theoretical perspectives, a number of factors regard-

gens Ecstasy. The problems described, however, were lng the recreational use of Ecstasy have emerged

tsions predominantly acute bad reactions to the drug such consistently in both studies, and thus in bothlucinations as paranoia, panic, loss of reality, loss of control, cultures. These include the motivations for use,_petite anxiety, hallucinations. Eighteen percent reported patterns of use, mode and context of use, the nature

bad physical side effects such as fainting, decreased of the experience itself (including effects, side

:entration respiration, grinding teeth, chewing mouth and jaw effects and residual effects), abuse potential andlucinations clenching. Sixteen percent reported nausea and issues of tolerance. Perhaps the only area on which

vomiting. Nine percent proferred overdosing or the Australia and American samples differ is in the

'taking too much' as problems but it was unclear to hierarchies of user 'typologies'. This may in part bestability what extent this meant taking a large dose and due to this Australian sample being primarily anrtbeat experiencing an acute bad reaction, or using Ecstasy inner city one, while the American sample was

too often. When asked directly about dependence, somewhat broader. In this Sydney sample at least,two people claimed they had felt dependent, while the most predominant users of Ecstasy were the

,hol was reported as deadening 22% of the sample claimed they knew of someone dance party crowd and recreational drug users inffects of Ecstasy, and inducing who had been dependent on Ecstasy. Dependence general whose main reason for using Ecstasy is to_omiting. Forty-seven percent on Ecstasy was described as a need to take it in order have 'fun'. It appears that Ecstasy has not pene-ijuana, reported as both 'picks to cope everyday, and the idea that one cannot go trated the social world of the 'New Age' spiritualistsou down'. Many respondents out without it, having fun becoming dependent to the same extent in Australia as it has in the_e 'coming down' phase of the upon having taken Ecstasy. There was also mention United States. While Australian users do seek the

an attempt to prolong the of taking increasingly large doses. Forty-seven therapeutic effects of Ecstasy, it is in a way moreinteract the stimulant proper- percent of the sample believe that it is possible to akin to a 'fortuitous therapy' user group with,mnia. Forty-one percent have become 'addicted' to Ecstasy. Only one person had therapeutic effects being the secondary bonus rather· with amphetamines, which sought help regarding their use of Ecstasy. than the primary reason for taking the drug.

mt propertiesof the drug. The resultsof thisstudysupportpreviousreportse had it togetherwithLSD, of the effects of MDMA and serve to furthernogenic properties, although Discussion elucidate and clarify the complex nature of thoseId make exact attribution of This study provides a comprehensive examination effects. The primary effect of Ecstasy is to produce

e had tried Ecstasy together of the ways in which Ecstasy is used, with major a 'positive mood state' which encompasses feelingsnitrate and 'designer drug findings concerning the nature of the effects of of intimacy and closeness to other people. Thesee was little consistency or Ecstasy as experienced by its users. As proved to be effects distinguish Ecstasy from other classes of

_tions of these drug interac- the case in the present study, snowball sampling has drugs, particularly those which it has been mostr that Ecstasy users at times the advantage of using social networks to gain access olden likened to, the amphetamines and hallucino-ances together with Ecstasy, to substantial numbers of illicit drug users. But its gens. It appears that Ecstasy shares the properties ofinfrequent enough or suffici- ease of use carries disadvantages. Control is lost both classes of drug in regard to its secondary

)m the primary experience of over who answers the questionnaire, and how the effects and in terms of the frequency and severity ofibution of the effects reported respondents choose to interpret it. Concerns also its side effects. The amphetamine-like effects ofsy itself. It is also clear that arise about the possbility of respondents falsifying Ecstasy are its secondary stimulant effects of energy; are likely to experiment with their answers, or providing reports which are biased and activation. The hallucinogen=like effects offixture of substances, whether by myths and stereotypes about drug effects held in Ecstasy are its secondary psychedelic effects of· opportunistic experimenta- the illicit drug using subculture. These are certainly insight and enlightenment, heightened sensitivity_ is needed to explore the matters that demand circumspection in the interpre- and mild perceptual and sensual alterations. Sie-ms, licit and illicit, before the ration of our data. For two reasons the authors gal's 13 conclusion that the "perceptual effects ofcan be fully understood. For believe nonetheless, that these factors do not MDM. A intoxication are typical of intoxications

xicity has been reported from i invalidate our findings. First, the findings of this from the classic hallucinogens such as mescaline"MA and monoamine oxidase study in general are remarkably similar in all aspects appears to be pertinent to high doses only. Indeed,tts.23 to the research of Beck et al. 15on MDMA users in the clarity of the experience on moderate doses of

the United States. Second, the subjective reports of Ecstasy is a distinguishing factor from the dis-users in our survey are the same as those from the orientation, hallucinations and distortions of

small number of studies of the acute effects of reality typical of moderate doses of the classic

ed about problematic use and MDMA under laboratory conditions, u° hallucinogens.elated to the use of Ecstasy. While the study of Beck et al? and the present Ecstasy is an appealing drug to recreational drug

1170 Nadia SoIowij et al.

users in that it provides an 'added bonus'. That is, addictive ... The drug's possible physical side Another study 36 examineefor those seeking primarily stimulant effects it also effects ... are more likely to discourage frequent use influence MDMA's neurot

induces the positive mood, euphoric and intimacy or high dosage abuse". Only two subjects in this the concentration of serotoreffects; for those seeking an enlightened experience study reported having felt dependent on Ecstasy (in brain to return to baselinor perhaps emotional therapy and insight it provides a psychological sense) and this is consistent with the following administration offeelings of intimacy and closeness to others plus the proportion of dysfunctional users one might expect which these findings ofstimulant-like alertness, talkativeness and energy, to find in any sample of recreational drug users, extrapolated to MDMA's fi

Further, it is a drug experience in which one feels Whilst intensity of use increases the more severe remains to be determined. 'Ithat one can remain in control of one's thoughts and side effects, more intense users tend to keep using, to date, examining monoamactions rather than the drug being in control, as do dysfunctional users of any drug. brospinal fluid, found no n

Although this 'staying in control' element of the While the media has been rife with reports of toxicity resulting fromEcstasy experience has not been explored in the extreme adverse reactions to Ecstasy, in reality these MDMA. 37Although controlresearch literature, it was evident in the study of are quite rare. Ecstasy is the least frequently seen users have not been undert;Beck et al. is and it appeared in the first description drug of all clinical drug-related presentations. The the drug is being used on a 1of MDMA's action in humans. Shulgin & Nichols 24 cases being reported in the clinical literature present extrapolated estimate of scdescribed it as "an easily controlled altered state of extreme exacerbation of the physiological side Ecstasy having been consconsciousness, with emotional and sensual over- effects of Ecstasy, such as tachycardia, hyper- decades world wide, 12as evitones" and this was apparent in the responses of a thermia and ataxia, or with symptoms of toxic of'chronic' MDMA users hz

large proportion of this sample, often being given as psychosis. Often these are triggered by some pre- number of reports of distresa reason for preferring Ecstasy over the more 'mind- cipitatmg factor such as a pre-existing disease bad reactions are few indeebending' drugs. This effect may explain the puzzle syndrome 2s-3° or arise due to extremely high doses degree of caution must beof Buffum & Moser 25who conducted a survey of the · being consumed, sometimes with other concurrent tional use of Ecstasy unteffects of MDMA on sexual function. They found it drug use.3j It is possible that some users will determine whether this subs

"curious that a drug which can increase emotional experience idiosyncratic or allergic reactions to ous in humans. On the otl

closeness, enhance receptivity to being sexual and MDMA. 32It has been suggested that a combination prediction may be that Ecstawould be chosen as a sexual enhancer, does not of individual sensitivity or susceptibility and dosage soon die out, to be supersedincrease the desire to initiate sex". Perhaps this is may account for the cases of adverse reactions which

precisely because of the ability to remain in control are severe enough to come to light._2 Since Ecstasyof one's actions with awareness of consequences, is a sympathomimetic substance, it is not surprising

Overall, Ecstasy was described as 'sensual' rather that it produces untoward physical side effects. The Acknowledgementsthan 'sexual' by the respondents of this study, majority of this sample, however, described these This research was made pos.,Buffum & Moser 2s too concluded that due to the negative effects as mild, if they were experienced at Drug and Alcohol Director,and Alcohol Research Cenincreased feelings of emotional closeness, Ecstasy all. Ecstasy produced no more, and no more severe National Campaign Againstserves to enhance the sensual aspects of sex. side effects than other widely used drugs, such as

collected between June andGiven that Ecstasy has so many positive aspects, amphetamines and hallucinogens. In accord with authors wish to thank all sui

why isn't it being used more often? Consistent with previous studies (e.g. SiegeP3), the findings of thisother studies, _a1.14.15.26users from this sample study suggest that the negative effects of Ecstasy are completed lengthy and detailreport that the'positive' or pleasurable effects of the dose-related, in that their severity correlated with authors are also grateful to

drug decrease with frequent use. Further, while both the total number of doses ever consumed and her assistance in designinginitial recruitment of subjectpleasurable effects diminish, side effects tend to with frequency of use, further emphasizing the rolesincrease, both with frequent use, and with high of tachyphylaxis and tolerance.doses of the drug. Hayner & McKinney n too Even if the majority of users do not experiencereported that side effects are experienced more distressing side effects from use of Ecstasy, there Referencesreadily following repeated doses, particularly within still may be reason for caution in that the long term 1. G_ER, G. & TOLSeRT,R.a few days of each other. There seems to be a point consequences of even problem free use are as yet of the effects of MDMA in

of PsychoactiveDrugs, 18, tat which the unpleasant side effects increase to the unknown. There is a growing body of literature 2. GRINSPOON,L.& BAKALAR,extent where they outweigh the pleasurable effects suggesting a neurotoxic effect of MDMA on sero- used to enhance the ps;initially sought by ingesters of the drug. That is to tonerg, ic nerve terminals. 33a4 One study demon- American yournal of 1:say, Ecstasy appears to be subject to the develop- strated a single large dose of MDMA given orally to 393-404.ment of tolerance and tachyphylaxis and this monkeys to produce a depletion of serotonin in the 3. BEcJc,J. (1986) MDMA:obviously has some bearing upon its dependence thalamus and hypothalamus two weeks later? The resultant implications of achoactive substance, Cont,liability. As expressed by Riedlinger, 27"there is no authors claim that humans are generally more pp. 23-61.evidence, at any rate, that MDMA is physically sensitive than monkeys to the toxic effects of drugs. 4. PERotrrr_, S. J. (1987) Inc

Recreational MDMA use in Sydney 1171

g's possible physical side Another study 36 examined the parameters that of 3,4-methylenedioxymethamphetamine (MDMA,y to discourage frequent use influence MDMA's neurotoxicity and determined "Ecstasy") on aa undergraduate campus, NewEngland Journal of Medicine, 317, pp. 1542-1543.Only two subjects in this the concentration of serotonergic uptake sites in rat 5. HORvrrz, T. (1986) High and low on Ecstasy,

It dependent on Ecstasy (in brain to return to baseline levels at 12 months Sydney Morning Herald: Good Weekend,August 23,_d this is consistent with the following administration of MDMA. The extent to pp. 15-17.mai users one might expect which these findings of animal studies can be 6. Co_omvva_ana D_tmTSt_wrov CosoatmrrYS_-

of recreational drug users, extrapolated to MDMA's function in human brain wc_sm) HEALTH(1989)Statistics onDrugAbuseinAustralia (Canberra, Australian Government Pub-increases the more severe remains to be determined. The only human research lishing Service).

3e users tend to keep using, to date, examining monoamine metabolites in cere- 7. CI.iS_o, R. P., Ro_mca, H., SWEEWe,D. R. &

rs of any drug. brospinal fluid, found no manifestations of neuro- Ax.-Razl, J. (1986-87) Ecstasy: a review of MDMAbeen rife with reports of toxicity resulting from recreational use of and MDA, International Journal of Psychiatry inMedicine, 16, pp. 359-372.

is to Ecstasy, in reality these MDMA. 37Although controlled studies of long term 8. NICHOLS,D. E. (1986) Differences between theis the least frequently seen users have not been undertaken, it is doubtful that mechanism of action of MDMA, MBDB and the

;-related presentations. The the drug is being used on a long term basis. With an classic hallucinogens. Identification of a new then-:he clinical literature present extrapolated estimate of several million doses of peutic class: entactogens, Journal of Psychoactive

Drugs, 18, pp. 305-313.of the physiological side Ecstasy having been consumed in the last two 9. SmmGl_,A. T. (1986) Thebackgroundaadchemis-

ch as tachycardia, hyper- decades world wide, t2.38evidence for the existence try of MDMA, Journal of PsychoactiveDrugs,18,pp.: with symptoms of toxic of'chronic' MDMA users has yet to surface, and the 291-304.

are triggered by some pre- number of reports of distressing residual effects and 10. DOWNING,J. (1986) The psychological and physio-as a pre-existing disease bad reactions are few indeed. Nevertheless, a good logical effects of MDMA on normal volunteers,Journal of Psychoactive Drugs, 18, pp. 335-340.

due to extremely high doses degree of caution must be observed with recrea- 11. Gm_zR,G. & TOLBm_T,R. (1990) The therapeuuc:imes with other concurrent tional use of Ecstasy until further studies can use of MDMA, in: P_otrrg_, S. J. (Ed.) Ecstasy:Thesible that some users will determine whether this substance is indeed hazard- Clinical, Pharmacologicaland NeurotoxicologicalEr-

ic or allergic reactions to ous in humans. On the other hand, a reasonable fects of the Drug MDMA (Boston, Ktuwer).

;uggested that a combination prediction may be that Ecstasy use is a 'fad' that will 12. FlAkER, G. N. & MctrdN_c, H. E. (1986) MDMA:the dark side of Ecstasy, Journal of Psychoactiveor susceptibility and dosage soon die out, to be superseded by the next trend. Drugs, 18, pp. 341-347.es of adverse reactions which 13. SIEGAL,R. K. (1986) MDMA: nonmedical use and

intoxication, Journal of Psychoactive Drugs, 18, pp._me to light, t: Since Ecstasy 349-354.ubstance, it is not surprising Acknowledgements 14. PERotrrr,A, S. J., NEWMAN,H. &Haw.g_, FI. (1988)trd physical side effects. The This research was made possible by a grant from the Subjective effects of 3,4-methylenedioxymethamphe-

e, however, described these Drug and Alcohol Directorate. The National Drug tamine in recreational users, Neuropsychopharmacol-ogy, 1, pp. 273-277.

, if they were experienced at and Alcohol Research Centre is fundect by the 15. BEck, I., HAm.OW,D., McDom__a_, D., MoROta_,o more, and no more severe National Campaign Against Drug Abuse. Data was P.A., ROSENBAUM,M. & WATSON, L. (1989)widely used drugs, such as collected between June and December 1990. The Exploring Ecstasy: a desCnpn°n of MDMA users,lucinogens. In accord with authors wish to thank ail subjects who gratuitously report to the National Institute on Drug Abuse (San;iegeP3), the findings of this Francisco, Institute for Scientific Analysis).egative effects of Ecstasy are completed lengthy and detailed questionnaires. The_eir severity correlated with authors are also grateful to Justine Armstrong for 16. lianLmm_'Magazine,D'(1989)TheTheAustralian,ECstasyinvasiOn,pp.30-36.TheAustra-her assistance in designing the questionnaire and 17. FrrzGEgaI.D, J. (1991) MDMA and harm, Theof doses ever consumed and initial recruitment of subjects. International ]ournal on Drug Policy, 2, pp. 22-23.further emphasizing the roles 18. Nl_w_l'r_, J. A. (1986) Some considerations on the)lerance. prevalence of MDMA use, Journal of Psychoactive7 of users do not experience Drugs, 18, pp. 361-362., from use of Ecstasy, there References 19. RIiNFRO!t,C. L. (1986) MDMA on the street: analysiscaution in that the long term 1. GRF._R,G. & TOLB_T, R. (1986) Subjective reports anonymous, Journal of Psychoactive Drugs, 18, pp.

problem free use are as yet of the effects of MDMA in a clinical setting, Journal 363-369.of Psychoactive Drugs, 18,pp. 319-328. 20. SoLowrh N. & Lmm,N. (1991) A survey of Ecstasy

growing body of literature 2. Gv.n_svoo_, L. & Bsr,asa_,J. B. (1986) Can drugs be [MDMA] users in Sydney, research grant report seriesc effect of MDMA on sero- used to enhance the psychotherapeutic process? Bgl/1 (NSW Department of Health, Drug andtals? TM One study demon- American Journal of Psychotherapy, XL, pp. Alcohol Directorate).

_se of MDMA given orally to 393-404. 21. MUGFOIm,S. & Colmlq, P. (1989) Drug use, socialdepletion of serotonin in the 3. BECK, J. (1986) MDMA: the popularisation and relations and commodity consumption: a study ofresultant implications of a recently controlled psy- recreational cocaine users in Sydney, Canberraandamus two weeks later. 3sThe choactive substance, ContemporaryDrug Problems, Melbourne(a Report to the Research into Drug Abuseromans are generally more pp. 23-61. Advisory Committee. National Campaign Against

to the toxic effects of drugs. 4. PERotrrr,a, S. J. (1987) Incidence of recreational use Drug Abuse).

$

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PEROLrrKA,S. J. (Ed.) Ecstasy: The Clinical, Pharma- tamine (MDMA, 'Ecstasy'), Research in Communitycological and Neurotoxicol°gtcal Effects of the Drug Substance Abuse, 8, pp. 125-138.MDMA (Boston, Klnwer). 38. BECK, J. (1990) The public health implications of Abstract

30. SuM_, R. V. & RIEMlmSMa, R. (1988) "Ecstasy" MDMA use, in: PEROLrI'Kn, S. J. (Ed.) Ecstasy: The The relationship between 15

and sudden cardiac death, Amercian Journal of Clinical, Pharmacological and Neurotnxicological El- lO0°A ethanol per day or mo7Forensic Medicine and Pathology, 9, pp. 339-341. fects of the Drug MDMA (Boston, Kluwer). from a general population s:

Stockholm in 1984. In a Ion,

related diagnosis was assesse

unemployment and high alcot

were positive and some were t

variation by sex and social cl

employees. Among males, the

risk of severe medical alcohol-cases. The odds ratio was 6.1.

(95% confidence interval 1.6_

risk for high alcohol consurnpl

unemployed more than once,

during the previous 5 years.

diagnosis at inpatient care du

conclusive. The strong, but i_problems, are however challe

repeated measurements of bott

Introduction

In a review Fillmore & Ca

fruits of epidemiologic studi

between occupation and alco