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
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Instability of the American Ecstasy Market,
1999 - 2013
Hunter Dayton; Dr. Eric L. Sevigny
What Does the Literature Say about Ecstasy Purity?
How has the United States ecstasy market evolved
Purity as % of
What types of drugs are used in adulterated ecstasy
What do fluctuations in the frequency of adulterants
over time tell us about the larger population of
*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
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.
Mimic or compliment desired drug
Poor manufacturing techniques
Common Adulterants in Tablets Sold as Ecstasy
Popular Due to Availability (Cole et al. 2011)
Psychoactive at Low Production Cost (Cole et al. 2010)
Piperazines (BZP, TFMPP, mCPP)
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
Ecstasy Pill Content
# of Submissions
Number of Substances Detected in Tablets Sold as Ecstasy
(n = 2,268)
% 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
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 + Other Drugs
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
MLS + Other Drugs
Drug % in Tablets Sold as Ecstasy Over Time
Relevance: Public Health
Physical Side Effects
Bruxism (teeth grinding)
Increased body temperature
Psychological Side Effects
Acute renal failure
Disseminated intravascular coagulation
Cognitive Side Effects
Disrupted sleep patterns
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
Limitations, Proceedings &
operated by Erowid Center, performs tablet analyses and reports the
results online. Purity information is made public, compliant with national drug laws. Due
% of Drug in Tablet
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).
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.
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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.