Do consumers of ecstasy-type pills take preventative measures to avoid bad

effects from ecstasy-type pills?

Dr Fairlie McIlwraithAssociate Professor Rosa Alati

Acknowledgements

National Drug and Alcohol Research CentreUniversity of New South Wales

Ecstasy and related Drug Reporting System– survey participants and key experts– research teams from each jurisdiction

Precautionary strategiesin 2012

Previous research findings

• Regular ecstasy users generally had a perception of risk, reasonably well informed, using harm reduction strategies

• Normalisation of ecstasy use• Pleasure a compelling reason for use• Mostly taken in a social environment. Friends

may provide a sense of security• Group decision making

Previous research findings

• Ecstasy the second most commonly used illicit drug in Australia

• Highest use in 20-29 age group, with recent use by 1 in 10

• Decrease from 2007

2010 National Drug Strategy Household Survey

Ecstasy and related drug reporting system

National monitoring system of people who regularly use ecstasy • Annual survey in all states and territories• Key expert interviews• Existing data

Method

A national sample of 606 people who regularly use ecstasy recruited through purposive sampling for confidential, face-to-face interviews of approximately one hour.

Criteria for participation were being at least 16 years old, having used ecstasy-type stimulants at least six times in the previous six months, and having lived for the past year in the capital city where the interview took place.

Participants gave informed consent.

Ethical clearance was obtained nationally and in each state and territory.

Demographic characteristicsof survey participants

• Mean age 25 years• Two thirds male• 87% heterosexual• Half had tertiary qualifications• 84% employed or studying (full-time, part-

time or in combination)

Ecstasy purity rated as low, 2003-12

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

10

20

30

40

50

60

70

80

90

100

1112 9

1317

14

24

5648

27

% o

f par

ticip

ants

2012

What precautions did you generally take to avoid bad

effects from ecstasy-type pills in the last six months?

Precautions taken

drug testing kit

observed effect on others

other

checked website

good reputation

initially one pill or less

trusted source

0 10 20 30 40 50 60 70

10

12

17

34

35

37

63

% of those who took precautions, n = 496

Nearly one in five (19%) responded ‘none’

Should we worry?!

Rating of ecstasy purity

Low Medium High Fluctuates0

5

10

15

20

25

30

35

40

25

36

2018

31 31

13

26

Precautions (n = 477) No precautions (n = 111)

% o

f ED

RS p

artic

ipan

ts

Lab testing results confirm that quality mixed

Number of people purchased from, by whether took precautions

Precautions

0 1 2 3 ≥4

Yes (%)n = 462 1 15 21 25 39

No (%)n = 108 3 9 23 22 43

Who is not taking precautions?

• Similar demographic characteristics• Similar proportion had experienced problems

caused by drugs (social, legal, risky behaviour, responsibilities)

• Similar level of mental health (self reported problems and K10)

In the last six months about what proportion of your friends and acquaintances have used ecstasy?

Proportion of friends who use ecstasy by whether precautions taken

All Most About half A few0

5

10

15

20

25

30

35

40

45

50

6

43

31

20

14

45

29

12

Precautions (n = 477) No precautions (n = 111 )

% E

DRS

par

ticip

ants

No significant differences

Ecstasy use• Age first used ecstasy and when use became

regular• Length of time using ecstasy• Frequency and amountEcstasy market• Perceptions of purity and availability• Who they purchased from & frequency of

purchases

Other risky behaviour by those who reported not taking precautions

Significantly less likely to have • Recently used an emerging psychoactive

substance, 23% compared with 35%Significantly more likely• Unprotected sex with a casual partner while

using drugs, 57% compared with 43%

Those who reported not taking precautions differed significantly around

alcohol use

• Drank alcohol more often in the previous six months, a mean of 68 days compared with 57 days

• More likely to have had more than 5 standard drinks the last time they had ecstasy, 72% compared with 62%

• More likely to have driven under the influence of alcohol, 68% compared with 54%

• Higher mean score on Alcohol Use Disorder Identification Test (AUDIT)

Alcohol Use Disorders Identification Test (AUDIT)

Low-risk Mod-risk High-risk Possible dependency0

5

10

15

20

25

30

35

40

45

19

39

18

25

11

2624

39

Precautions (n = 470) No precautions (n = 106)

% E

DRS

par

ticip

ants

Important differences

Those who said they did not take precautions were more likely to have

• higher use of alcohol• unprotected sex with a casual partner when

using drugs• a larger proportion of their friends using

ecstasy

Conclusions

• Combination of ecstasy use with high alcohol use associated with less precautionary behaviour

• Friendship networks amongst ecstasy users can work for or against harm reduction