PDF Archive

Easily share your PDF documents with your contacts, on the Web and Social Networks.

Share a file Manage my documents Convert Recover PDF Search Help Contact



Instability of the American Ecstasy Market, 1999 2013 .pdf


Original filename: Instability of the American Ecstasy Market, 1999 - 2013.pdf
Title: Instability of the American Ecstasy Market, 1999 - 2013
Author: Hunter Dayton

This PDF 1.5 document has been generated by Microsoft® PowerPoint® 2016, and has been sent on pdf-archive.com on 29/05/2017 at 08:15, from IP address 68.131.x.x. The current document download page has been viewed 99 times.
File size: 1.3 MB (1 page).
Privacy: public file




Download original PDF file









Document preview


Instability of the American Ecstasy Market,
1999 - 2013
Hunter Dayton; Dr. Eric L. Sevigny
Research Questions

What Does the Literature Say about Ecstasy Purity?

How has the United States ecstasy market evolved
over time?

Purity as % of
All Tablets
Analyzed*

What types of drugs are used in adulterated ecstasy
tablets?
What do fluctuations in the frequency of adulterants
over time tell us about the larger population of
ecstasy tablets?

*Purity is defined as containing some form of MDMA-Like Substance (MLS)

Characterization of the American Ecstasy Market,
1999 - 2013

What is Ecstasy?

Data are analyzed from EcstasyData.org, a laboratory testing service operated by Erowid Center. Ecstasy tablet content is published online in reply to user submission.
Number of Submissions Versus Percentage of 12th Grade
Users Within Last Year
400

10

350

9

Ecstasy pill content deserves in depth analyses because tablets sold as Ecstasy are often adulterated with substances
other than MDMA. Despite its desirability, MDMA may not be present at all (Duterte et al. 2009; Heifets et al. 2000;
Johnston et al. 2006) A group of chemicals known as MDMA-like substance (MLS) include MDMA and its structural
analogues. 3,4-methylene-dioxyamphetamine (MDA), 3,4-methylene-dioxyethylamphetamine (MDEA) and N-methyla-(1,3-benzodixol-5-yl)-2-butamine (MBDB). This family of phenthylamines generally produce desirable effects
among users, with the exception of MDA alone (Brunt et al. 2011). Therefore, pills containing MLS may be considered
relatively pure. Adulterants vary by intentionality.

300

7

250

6

200

5

150

4
3

100

2

50

1

0

0

Adulterants
Intentionally Added
Increase bulk
Mimic or compliment desired drug
Facilitate transportation

Tablets Submitted

Unintentionally Added
Poor manufacturing techniques
Improper production
Inadequate supplying

Common Adulterants in Tablets Sold as Ecstasy
Popular Due to Availability (Cole et al. 2011)
Psychoactive at Low Production Cost (Cole et al. 2010)
Caffeine
Dextromethorphan (DXM)
Procaine
Amphetamines
Paracetamol
Piperazines (BZP, TFMPP, mCPP)
Sugars
Mephedrone
Adverse public health effects are a major concern. In the 2013 World Drug Report, the United Nations Office on Drugs
and Crime stated that a “large proportion of seized drugs marketed on the street as ‘ecstasy’ continue to contain
substances other than MDMA.” Thus users may be unaware of the substances – both licit and illicit – they are ingesting
(Kalasinsky, Hugel & Kish 2004). Exact tablet content is not easily discernable without advanced equipment (Hayner
2002).

10.53%

24.99%

59.01%

1

2

3

4

5

6

1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013

Ecstasy Pill Content

# of Submissions

8

Number of Substances Detected in Tablets Sold as Ecstasy
(n = 2,268)
3.75%
1.41%
0.31%

% of 12th grade last year users

MDMA (3,4-Methylenedioxymethamphetamine), commonly referred to as “Ecstasy,” “E,” “X,” or “XTC” is a
psychoactive, sympathomimetic drug derived from amphetamines. Its chemical structure strongly resembles that of
amphetamine and mescaline (Karch 2011). It is often taken orally in tablet form, containing 60 to 120 milligrams of
MDMA (Bialer 2002). Users describe euphoric, stimulant, and minor hallucinogenic effects, resulting in mood
enhancement. Terms such as “enatogenesis” – the feeling of contentment with the world– and “empathogenesis” – an
emotional rapport with others – are used to describe MDMA’s effects (Bialer 2002). Ultimately, the subjective user
experience is resultant from the pharmacological content of the ecstasy tablet (Brunt et al. 2011).

Annual Prevalence (MTF-12th)
Purity of Tablets Sold as Ecstasy Over Time

Purity Across United States Census Divisions
100%

100%

90%

90%

80%
80%

70%
60%

70%

50%

60%

40%

50%

30%
40%

20%
10%

30%

0%

20%
10%

Tablet Branding

0%
Ecstasy pills are often branded – stamped with an insignia in order to differentiate between batches. This practice likely
began in European clandestine laboratories (Karch 2011). Despite aesthetic similarities, pills among the same brand
name have been found to vary in amounts of active ingredients (Sherlock et al. 1999). Therefore, it is difficult to issue
warnings to drug users based on tablet appearance as individual pill content may vary.

MLS Only

MLS + Other Drugs

No MLS

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
MLS Only
MLS + Other Drugs
No MLS

Drug % in Tablets Sold as Ecstasy Over Time
Freq.

Percent
37
30
24
22
22
22

1.63
1.32
1.06
0.97
0.97
0.97

Relevance: Public Health
Physical Side Effects
Jaw clenching
Bruxism (teeth grinding)
Blurred vision
Palpitation
Headache
Nausea
Increased body temperature

Psychological Side Effects
Anxiety
Depression
Paranoia

Toxic Effects
Delirium
Tachycardia
Tachypnea
Profuse sweating
Hyperthermia
Acute renal failure
Cardiovascular collapse
Disseminated intravascular coagulation
Hepatic failure
Hyponatremia
Cerbral infarct/hemorrhage
Death
Cognitive Side Effects
Disrupted sleep patterns
Heightened impulsivity
Depression

While the “incidence of serious acute
adverse events related to ecstasy is low,”
the potential and unpredictability of
physical and psychological harm, as
well as mortality, cannot be overlooked
(Gowing et al. 2002). Additional
substances in tablets sold as Ecstasy
may combine with MDMA to increase
toxicity and augment negative health
effects (Baggott et al. 2000; Kalasinsky,
Hugel & Kish 2004; Kaye, Darke &
Duflou 2009). Given Ecstasy users’ high
rate of polydrug use (Indig et al. 2010;
Johnson et al. 2006; Kaye, Darke &
Duflou 2009; Morefield et al. 2011;
Schifano 2004) in addition to
widespread adulteration, it is difficult to
attribute exact causality of adverse
health effects (Karch 2011; Kelleher et
al. 2011).

Limitations, Proceedings &
EcstasyData.org,
operated by Erowid Center, performs tablet analyses and reports the
Conclusion
results online. Purity information is made public, compliant with national drug laws. Due

60
50

% of Drug in Tablet

Brand
Dolphin
Mitsubishi
Smiley
Star
Superman
Yin Yang

To the left is the most prevalent
brands in the EcstasyData.org data.
Note the low percentages relative to
the total sample. Brands vary
greatly across tablets. To the right is
a Mitsubishi tablet – a relatively
common brand, particularly on the
West Coast (Duterte et al. 2009).

40

to DEA regulation, certain variables are intentionally left vague. Drug amounts, for
example, are presented in ratios rather than milligrams. Two tablets may be listed as
containing 2/3 MDMA yet the milligram content may be vastly different. Furthermore,
the data possess statistical limitations such as self-selection bias due to user submission.
Individuals submitting tablets to the testing service likely represent wealthier users, given
the $40 submission cost, and those who have reason to suspect the purity of their tablet.
Thus the data may indicate lower quality ecstasy trends than the true population.
Nevertheless, laboratory analyses give considerable notion to the larger population of
ecstasy tablets, particularly when examining adulterants.

30
20
10
0

DXM

BZP

MDA

TFMPP

Methamphetamine

Methylone

Sources
Baggott, M., Heifets, B., Jones, R. T., Mendelson, J., Sferios, E., & Zehnder, J. (2000). Chemical analysis of ecstasy pills. JAMA: The Journal of the American Medical Association, 284(17), 2190-2190.
Bossong, M., Brunt, T., Van Dijk, J., Rigter, S., Hoek, J., Goldschmidt, H., et al. (2010). mCPP: an undesired addition to the ecstasy market.Journal of Psychopharmacology, 24(9), 1395-1401.
Boyer, E. W., Quang, L., Woolf, A., Shannon, M., Magnani, B., & Mendelson, J. (2001). Dextromethorphan and ecstasy pills [3] (multiple letters). Journal of the American Medical Association, 285(4), 409-410.
Brunt, T. M., Koeter, M. W., Niesink, R. J., & van den Brink, W. (2012). Linking the pharmacological content of ecstasy tablets to the subjective experiences of drug users. Psychopharmacology, 220(4), 751-762.
Brunt, T. M., & Niesink, R. J. (2011). The Drug Information and Monitoring System (DIMS) in the Netherlands: implementation, results, and international comparison. Drug Testing and Analysis, 3(9), 621-634.
Brunt, T. M., Niesink, R. J., & van den Brink, W. (2012). Impact of a transient instability of the ecstasy market on health concerns and drug use patterns in The Netherlands. International Journal of Drug Policy, 23(2), 134-140.
Brunt, T. M., Poortman, A., Niesink, R. J., & van den Brink, W. (2011). Instability of the ecstasy market and a new kid on the block: mephedrone. Journal of Psychopharmacology, 25(11), 1543-1547.
Cheng, J. Y. K., Chan, M. F., Chan, T. W., & Hung, M. Y. (2006). Impurity profiling of ecstasy tablets seized in Hong Kong by gas chromatography–mass spectrometry. Forensic Science International, 162(1–3), 87-94.
Cole, C. (2010). CUT: a guide to adulterants, bulking agents and other contaminants found in illicit drugs. Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University.
Cole, J. C., Bailey, M., Sumnall, H. R., Wagstaff, G. F., & King, L. A. (2002). The content of ecstasy tablets: implications for the study of their long‐term effects. Addiction, 97(12), 1531-1536.
Connell, D., & Heffron, J. J. A. (2000). Rapid analysis of illicit drugs by mass spectrometry: Results from seizures in Ireland. The Analyst 125, no. 1 (2000): 119.
de Almeida, S. P., Garcia-Mijares, M., & Silva, M. T. A. (2009). Patterns of Ecstasy Use and Associated Harm: Results of a Brazilian Online Survey. Substance Use & Misuse, 44(14), 2014-2027.
Duterte, M., Jacinto, C., Sales, P., & Murphy, S. (2009). What's in a Label? Ecstasy Sellers' Perceptions of Pill Brands. Journal of Psychoactive Drugs, 41(1), 27-37.
Gibbons, S. (2012). 'Legal Highs'-novel and emerging psychoactive drugs: a chemical overview for the toxicologist. Clinical Toxicology, 50(1), 15-24.
Giraudon, I., & Bello, P.-Y. (2007). Monitoring ecstasy content in France: results from the National Surveillance System 1999-2004.Substance Use & Misuse, 42(10), 1567-1578.
Halpern, P., Moskovich, J., Avrahami, B., Bentur, Y., Soffer, D., & Peleg, K. (2011). Morbidity associated with MDMA (ecstasy) abuse: A survey of emergency department admissions. Human & Experimental Toxicology, 30(4), 259-266.
Hayner, G. N. (2002). Mdma Misrepresentation: an Unresolved Problem for Ecstasy Users. Journal of Psychoactive Drugs, 34(2), 195-198.
Horyniak, D., Degenhardt, L., Munir, V., Johnston, J., Fry, C., & Dietze, P. (2013). Pattern and characteristics of ecstasy and related drug (ERD) presentations at two hospital emergency departments, Melbourne, Australia, 2008–2010. Emergency
Medicine Journal.
Indig, D., Copeland, J., Conigrave, K. M., & Arcuri, A. (2010). Characteristics and comorbidity of drug and alcohol-related emergency department presentations detected by nursing triage text. Addiction, 105(5), 897-906.
Johnston, J., Barratt, M. J., Fry, C. L., Kinner, S., Stoove, M., Degenhardt, L., et al. (2006). A survey of regular ecstasy users' knowledge and practices around determining pill content and purity: Implications for policy and practice. International Journal
of Drug Policy, 17(6), 464-472.
Kalasinsky, K. S., Hugel, J., & Kish, S. J. (2004). Use of MDA (the" love drug") and methamphetamine in Toronto by unsuspecting users of ecstasy (MDMA). Journal of Forensic Sciences, 49(5), 1106-1112.
Karch, S. B. (2011). A Historical Review of MDMA. Open Forensic Science Journal, 4.
Kaye, S., Darke, S., & Duflou, J. (2009). Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: Demographics, circumstances, toxicology and major organ pathology. Drug and Alcohol Dependence, 104(3), 254-261.
Kelleher, C., Christie, R., Lalor, K., Fox, J., Bowden, M., & O'Donnell, C. (2011). An overview of new psychoactive substances and the outlets supplying them.
Miller, P. G., Johnston, J., Dunn, M., Fry, C. L., & Degenhardt, L. (2010). Comparing probability and non-probability sampling methods in ecstasy research: implications for the internet as a research tool. Substance Use & Misuse, 45(3), 437-450.
Milliet, Q., Weyermann, C., & Esseiva, P. (2009). The profiling of MDMA tablets: a study of the combination of physical characteristics and organic impurities as sources of information. Forensic Science International, 187(1), 58-65.
Moore, K., Dargan, P. I., Wood, D. M., & Measham, F. (2013). Do Novel Psychoactive Substances Displace Established Club Drugs, Supplement Them or Act as Drugs of Initiation? The relationship between Mephedrone, Ecstasy and
Cocaine. European Addiction Research, 19(5), 276-282.
Morefield, K. M., Keane, M., Felgate, P., White, J. M., & Irvine, R. J. (2011). Pill content, dose and resulting plasma concentrations of 3, 4‐methylendioxymethamphetamine (MDMA) in recreational ‘ecstasy’users. Addiction, 106(7), 1293-1300.
Parrott, A. C. (2004). Is ecstasy MDMA? A review of the proportion of ecstasy tablets containing MDMA, their dosage levels, and the changing perceptions of purity. Psychopharmacology.
Renfroe, C. L. (1986). MDMA on the street: Analysis Anonymous®. Journal of Psychoactive Drugs, 18(4), 363-369.
Schifano, F. (2004). A bitter pill. Overview of ecstasy (MDMA, MDA) related fatalities. Psychopharmacology.
Schroers, A. (2002). Drug Checking: Monitoring the Contents of New Synthetic Drugs. Journal of Drug Issues, 32(2), 635-646.
Sherlock, K., Wolff, K., Hay, A. W. M., & Conner, M. (1999). Analysis of illicit ecstasy tablets: implications for clinical management in the accident and emergency department. Journal of Accident and Emergency Medicine 16, no. 9903 (1999): 194.
Spruit, I. P. (2001). Monitoring Synthetic Drug Markets, Trends, and Public Health. Substance Use & Misuse, 36(1-2), 23-47.
Tanner-Smith, E. E. (2006). Pharmacological content of tablets sold as "ecstasy": Results from an online testing service. Drug and Alcohol Dependence, 83(3), 247-254.

Further research will examine trends in ecstasy purity relative to ecstasy-related hospital
admissions in 13 designated Metropolitan Statistical Areas (MSAs). Rates of ecstasy use
are generally higher among young people in urban nightlife settings such as clubs and
raves (UNODC 2013). Therefore, the MSAs, defined by the Drug Abuse Warning
Network (DAWN), represent locations with significant ecstasy prevalence. We
hypothesize purity and hospitalizations to be inversely correlated; that is, as purity
decreases in the area, hospitalizations increase. Due to medical record constraints, small
amounts of literature compare ecstasy toxicology to mortality and morbidity. Future
investigations will likely contribute valuable insight to the public health realm of ecstasy.
According to morbidity reports, deaths due to MDMA appear to be increasing (Kaye,
Darke & Duflou 2009). As the drug is most popular with young people, proper harm
minimization practices must target this demographic. Youth often obtain information on
ecstasy via the Internet (Duterte 2009; Miller et al. 2010). Therefore, harm reduction
messages should be geared towards this medium. Forum postings, particularly about new
psychoactive substances appearing in tablets sold as ecstasy, are a limited yet valuable
source of information (Kelleher et al. 2011). Public health warnings are essential as many
ecstasy-related deaths are preventable (Bellis 2002). As demonstrated in the data, tablet
adulterants appear in high frequency. Users should always approach ecstasy cautiously,
utilizing laboratory analyses services or, at the very least, reagent testing kits.


Document preview Instability of the American Ecstasy Market, 1999 - 2013.pdf - page 1/1

Related documents


PDF Document ecstasyliteraturereview dayton
PDF Document instability of the american ecstasy market 1999 2013
PDF Document 67467760
PDF Document vitamin supplements 3
PDF Document microcrystalline cellulose powder for tableting1719
PDF Document 5 most obnoxious substances people abuse


Related keywords