Danger on the dance floor: ecstasy impurity

In 2013, Miley Cyrus released a song called We Can’t Stop, which was controversial because of the words, “We like to party, dancing with Molly.” The controversy comes from the name Molly, which is a reference to a synthetic stimulant also known as MDMA or ecstasy. This drug has been popular for decades, commonly used at raves, clubs, and music festivals, and renowned for its effects that include increased energy and feelings of closeness and empathy towards others.

Ecstasy has been in the news a lot lately. Not just because of its references in popular culture, but because of its impurity and the resulting harms. While pure ecstasy should contain MDMA only, it sometimes contains other chemicals, such as PMA or PMMA, which is nicknamed Death because of its toxic effects. For example, 27 people in Western Canada died between July 2011 and April 2012 after they ingested ecstasy that contained PMMA. More recently, last year, two young adults died at the Veld Music Festival in Toronto after they consumed drugs that they probably thought were MDMA. Similarly, this year there have been multiple incidents at North American music festivals where attendees have suffered negative effects due to drug use, including ecstasy use, including the Chasing Summer Festival in Calgary.

Drugs sold as ecstasy are sometimes adulterated with other chemicals or contain no MDMA at all. To make matters worse, individuals cannot know the exact contents of tablets or powder sold as ecstasy based on their appearance. So what can people do to avoid “bad ecstasy”?

Here are two options:

1) Laboratory testing. People can send ecstasy to a laboratory pill testing program called the Ecstasy Data Program. Individuals can anonymously mail samples to the laboratory at the cost of $40 to test tablets or $100 to test powder, and in two to three weeks the organization will post the results of the analysis online. It is important to note that the laboratory can only detect active chemicals and chemicals that their instruments are capable of detecting, and the laboratory is only allowed to post the ratio of active chemicals, not the quantity.

2) Testing kits. Although laboratory testing is fairly accurate, ecstasy users may not want to pay the fee or they may not want to wait a few weeks to find out what is in their ecstasy. So do-it-yourself reagent testing kits, are a more convenient option since they produce results within minutes. To use the kit, you apply reagents to an ecstasy sample, and chemical reactions will produce colours, which can be compared to a chart that shows colours produced by different drugs. Test kits cost about $20 to $65 online, depending on the type of kit. Harm-reduction organizations often promote the use of testing kits because they are helpful in showing if an ecstasy sample contains no MDMA; however, they cannot reveal if a sample is pure MDMA nor the quantity of MDMA it contains. While testing kits are imperfect, they can provide a significant level of protection to users as long as they are aware of the limitations of the kits.

It is important to understand that even if a drug is pure MDMA it can still have adverse effects. Firstly, consuming a high dose of MDMA is dangerous, which is why groups in the United Kingdom recently started the Crush-Dab-Wait Campaign to help protect people when they are taking MDMA crystals. Secondly, an individual might have a bad, possibly deadly, reaction to even a small, pure dose of MDMA.

Ecstasy users should inform themselves of the harms and risks associated with ecstasy use, especially in regard to impurity, so they can help protect themselves if they choose to “dance with Molly.”

 

Callas-Melanie
Author: Melanie Callas, MA Candidate, Department of Anthropology, University of Victoria

Let’s talk about pleasure: harm reduction by any other name

As a doctor who works with people whose lives have been severely affected by drugs, I realize that changing behavior, even when it is devastating to the individual, is very difficult. Part of the problem, as far as I see it, is that as a society we pay relatively little attention to people who use drugs until they either break the law or develop health problems.

The only form of prevention most governments consider is prevention of initiation of use. Such an approach, although valid and useful, means that the part of the community who are most at risk of developing problems (people who already use drugs) are devoid of any assistance in helping them monitor and self-regulate their consumption to reduce the risk of crossing that blurred boundary that divides problematic from non-problematic drug use. While a more honest discourse addressing harm-reduction strategies for users of all drugs is becoming more acceptable and available through the web-based user forums and drug information sites such as erowid, drugs-forum and blue-light, there is still a long way to go.

Pleasure drives drug use, not the avoidance of harm

I founded the Global Drug Survey (GDS) in 2011; in 2015, more than 100,000 people filled out our survey in 10 different languages. Our mission is to help people who choose to use drugs do so more safely and to provide independent, objective and credible information to individuals and their communities. Through our research and apps, GDS aims to help communities craft the most effective public health responses to the use of drugs, including alcohol and prescription medications.

The notion of engaging people in a conversation about harm reduction and discussing strategies that ‘allow’ them to continue to get pleasure from their drug use is still rather uncommon among drug-treatment services. I believe that if you can encourage behavior change that reduces risk but does not diminish pleasure, you are more likely to see your advice adopted.

The GDS has started that dialogue with the development of the GDS Highway Code, the world’s first harm-reduction guide voted for by people who use drugs (the people who are most trusted by other people who use drugs). It not only ranks different harm-reduction strategies by the proportion of users who normally adopt it and how important they perceive each one is in reducing risk of harm, but uniquely rates different strategies on the impact they have on drug-related pleasure. The headline conclusion is that safer drug use appears to be more enjoyable drug use. It has been downloaded over 80,000 times and translated into French and Portuguese.

The Highway Code shows how many respondents use this particular harm-reduction strategy as well as how much it reduces risk and enhances pleasure. Staying well hydrated was the #1 strategy used by MDMA users.
The Highway Code shows how many respondents use this particular harm-reduction strategy as well as how much it reduces risk and enhances pleasure. Staying well hydrated was the #1 strategy used by MDMA users.

Consequences not consumption

Another approach is to focus on possible social consequences of substance use. When it comes to alcohol, many interventions look at things like calories, units and health risks, which might not be as meaningful for younger people. Supported by findings from GDS2015 that social humiliation is in the top four motivators for changing drinking patterns, GDS has developed a microsite quiz for young drinkers.

After a brief survey, the "One too Many" app gives you an ARSE score.
After a brief survey, the “One too Many” app gives you an ARSE score.

The one too many app free at onetoomany.co is a novel way of getting young people to think about their drinking. While most digital interventions focus on how much you drink, one too many asks about behaviors that matter to young people. In just 20 questions covering things like losing your phone, passing out, or ending up in bed with someone you wish you hadn’t due to your drinking, one too many gives people a unique ARSE (Alcohol Related Social Embarrassment). And because we don’t always know what we are like when we are drinking, one too many allows you to send a link on Facebook and Twitter so your friends can anonymously give you an ARSE score (only you ever see the scores others give you). Over 200,000 people have got their ARSE score so far, and it’s about to be trailed and evaluated by a team at Oxford Brookes University.

GDS hopes that by compiling the world’s biggest database of drug use and by assessing both levels and patterns of use, our apps can provide critical, evidence-based feedback on health risks adjusted for a person’s unique medical, behavioral and familial history. We hope all of our work helps people use drugs more safely, so they remain a source of pleasure not pain to them, those they care for or their communities.

adam-winstock

Author: Dr. Adam R Winstock MBBS, BSc, MSc, MRCP, MRCPsych, FAChAM, MD
Founder and Director, Global Drug Survey; Consultant Psychiatrist and Addiction Medicine Specialist, SLAM NHS Trust; Senior Lecturer, Kings College London

Twitter:
@globaldrugsurvy
@drugsmeter

(Author’s note: Want to help contribute to this research? We will be launching GDS2016 in November, 2015 with focuses on psychedelics, safer MDMA dosing, drug vaping and drug tourism. We are hoping to increase our Canadian participation this year, so don’t hesitate to contact me if you would like to help us spread the word.)

 **Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC