Ecstasy use in Australia: patterns of use and associated harm
Introduction
The use of ecstasy1 appears to be spreading in many parts of the world. Many European countries report increasingly high prevalence of use among young people, notably the UK, Germany, the Netherlands, Spain and some Central and Eastern European countries (Korf and Wurth, 1995; Griffiths et al., 1997; Pompidou Group, 1997). Australian surveys indicate that between 1990 and 1995, 1–3% of the general population used ecstasy (Commonwealth Department of Human Services and Health, 1994; Commonwealth Department of Health and Family Services, 1996). Use was most prevalent among younger users and females, with 9% of females aged 14–24 reporting use of ecstasy. In the US, there have been reports of marked increases in use in association with the ‘rave’ scene in San Francisco, Dallas, Houston, Miami and Denver (Miller, 1997). Between 1994 and 1995, the US Monitoring the Future Study recorded a significant increase in the prevalence of people aged between 19 and 28, who had used ecstasy in the last 12 months, from 0.7 to 1.6% (Johnston et al., 1997).
Early studies of ecstasy users found generally self-limiting patterns of use, low levels of injecting and few negative health effects (Solowij et al., 1992; Moore, 1993; Beck and Rosenbaum, 1994). The euphoric effects experienced during the first few use episodes soon diminished, perhaps due to rapid development of tolerance. As a result, many subjects discontinued use after several doses, or used intermittently to allow tolerance to dissipate. Relatively few associated problems were reported. For example, an Australian survey of 100 ecstasy users found that most adverse effects were unpleasant side-effects of acute use, such as loss of appetite, dry mouth, palpitations and bruxism (Solowij et al., 1992). Only two subjects reported feeling dependent on the drug. This study confirmed the results of studies conducted in the US (Peroutka et al., 1988; Beck, 1990; Peroutka, 1990; Beck and Rosenbaum, 1994). It provided support for suggestions that, while the pattern of ecstasy use remained one of intermittent oral administration, there was little cause for concern because use was usually self-limited and there were few extreme reactions or severe problems among users (Chesher, 1990; Solowij, 1993; Beck and Rosenbaum, 1994).
Such results thus seemed to confirm the prevailing view that ecstasy was a relatively benign substance with few associated problems (Nichols and Glennon, 1984; Downing, 1986; Fromberg, 1990). More recent research suggests that patterns of ecstasy use may be changing, with injecting becoming more prevalent, a wider range of drug use occurring in dance environments and a broader range of users using in a variety of settings (Green et al., 1995; Forsyth, 1996; Boys et al., 1997; Peters et al., 1997). Recently in the UK, Merrill (1996) described a group of ecstasy users who administered the drug repeatedly in increasing doses to overcome short-term tolerance. There have also been a growing number of deaths, in which ecstasy has been implicated (Henry et al., 1992; Solowij, 1993; White et al., 1997), although the reasons for extreme reactions are yet to be clearly delineated. Deaths have most often been attributed to heat stroke resulting from the circumstances in which ecstasy is used, such as dance venues (White et al., 1997). Some other deaths have been attributed to excessive water consumption (Cook, 1996; Matthai et al., 1996). Other research has noted significant psychological morbidity associated with the use of ecstasy (Cassidy and Ballard, 1994; McGuire et al., 1994; Series et al., 1994; Williamson et al., 1997).
Little systematic research on patterns of ecstasy use and perceptions of ecstasy-related harm has been conducted in Australia since the early 1990s. The present study aimed to:
- 1.
examine the patterns of ecstasy and other drug use among a sample of current ecstasy users; and
- 2.
examine subjects’ perceptions of the incidence and nature of ecstasy-related harm.
Section snippets
Recruitment
A total of 329 ecstasy users were interviewed in Australia’s three largest cities: Sydney (64.7%); Brisbane (17.9%) and Melbourne (17.3%). Subjects were recruited through a purposive sampling strategy (Kerlinger, 1986), which included snowball procedures (61.3%), advertisements in local and entertainment newspapers (12.2%), interviewer contacts (11.3%), radio (7.9%), flyers (4.9%) and others (2.4%). ‘Snowballing’ (Biernacki and Waldorf, 1981) is a means of sampling ‘hidden’ populations which
Sample characteristics
Half (51%) of the sample were female. The majority (92%) spoke English at home and the remainder represented 16 language backgrounds. A minority (2%) were of indigenous Australian descent. The mean age of the sample was 23.1 years (S.D. 5.6; range 15–46). Females were significantly younger than males (21.3 vs. 24.9 years, t306=6.1; P<0.001). Few subjects had dependent children (5%).
Mean number of school years completed was 12.2 (S.D. 1.0; range 8–13). Half (49%) of the sample had completed
Discussion
This study involved in-depth interviews with a wide cross section of 329 users from three Australian cities and revealed their perceptions of a diverse range of ecstasy-related harm. Young, female polydrug users and those that binged on ecstasy for 48 h or more appeared particularly at risk of experiencing harm that they attributed to their ecstasy use. The limitations of ‘snowball’ sampling, however, dictate that the generalising of these findings to the wider population of ecstasy users be
Conclusion
Contrary to predictions that ecstasy use was a ‘fad’ which would quickly be superseded by some other substance (Solowij et al., 1992) and the common belief that oral, intermittent use was the predominant pattern and of little concern (Chesher, 1990; Solowij, 1993; Beck and Rosenbaum, 1994), the present results have demonstrated that there are significant hazards associated with some patterns of ecstasy use. In particular, young, female, polydrug users and those who binged on ecstasy were most
Acknowledgements
This study was funded by a research grant from the National Initiatives in Drug Education, Commonwealth Department of Health and Family Services and by Queensland Health. The authors would like to thank Steven Crocker and Mary Shire from the CDHFS, Wayne Hall for overseeing the project to its fruition, Michael Lynskey for statistical advice and Louisa Degenhardt and anonymous reviewers for helpful comments on this paper. Clinton Kempnich, Suzanne Miller, Nicole Lee and John Fitzgerald assisted
References (60)
- et al.
Relationships between frequency and quantity of marijuana use and last year proxy dependence among adolescents and adults in the United States
Drug Alcohol Depend.
(1997) Subjective reports on the effects of the MDMA (‘ecstasy’) experience in humans
Prog. Neuropsychopharmacol. Biol. Psychiat.
(1995)- et al.
Amphetamine-related harms and treatment preferences of regular amphetamine users in Sydney, Australia
Drug Alcohol Depend.
(1997) - et al.
Toxicity and deaths from 3,4-methylenedioxymethamphetamine (‘Ecstasy’)
Lancet
(1992) - et al.
MDMA (‘ecstasy’) consumption in the context of polydrug abuse: A report on 150 patients
Drug Alcohol Depend.
(1998) - et al.
Adverse effects of stimulant drugs in a community sample of drug users
Drug Alcohol Depend.
(1997) The public health implications of MDMA use
- et al.
Pursuit of ecstasy: the MDMA experience
(1994) - et al.
Snowball sampling: Problems, techniques and chain referral sampling
Soc. Methods Res.
(1981) - et al.
Polydrug use at raves by a Western Australian sample
Drug Alcohol Rev.
(1997)