EMCDDA MDMA
Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

MDMA use is more risky than we thought

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New research reveals full risks of MDMA use - higher strength tablets, idiosyncratic toxicity, different strength within the same batch and varying rates of release.

We have known for some years that MDMa (Ecstasy) has regained its popularity and that the much higher strength of modern tablets creates health risks. MDMA use tends to go up in the summer with many people attending music festivals seeing Ecstasy use as an integral part of the experience. So new research from ASI (Analytic Services International), TICTAC (the drug identification and information service which has been based at St George’s Hospital London for many years) and Queen Mary University of London based on detailed testing of  650 MDMA tablets seized by the police is particularly timely.

The research has identified that not only does the amount of MDMA significantly vary in ecstasy tablets from the same batch, but there is also a large variance in the length of time it takes ecstasy tablets to release MDMA into the body (bioavailability). Add these to MDMA’s idiosyncratic toxicity (people react differently to the same dose of MDMA) and a trend of higher dose ecstasy tablets, and it really can be a game of Russian roulette for both experienced and new users. Yes, the vast majority of people taking MDMA do not come to harm, but there is at present no way to predict, determine or prevent who will.

In research findings just published in the journal Drug Testing and Analysis, ASI, TICTAC and QMUL analysed over 650 seized ecstasy tablets and established that tablets from the same batch can contain concentrations of MDMA which vary by more than 250%. [Full reference for those who are interested to read more: Couchman L et al. (2019) Variability in content and dissolution profiles of MDMA tablets collected in the UK between 2001 and 2018 – a potential risk to users? Drug Test Anal. DOI:10.1002/dta.2605 https://www.ncbi.nlm.nih.gov/pubmed/31009168]

For the first time, these experiments also revealed that ecstasy tablets disintegrate at different rates. ‘Fast releasing’ tablets released 95% of their MDMA into the body within 30 minutes while for ‘slow releasing’ tablets, this took 100 minutes. This effect increases the likelihood of double dosing (taking a second dose before the effects of the first dose are fully experienced because users think the tablet is of low strength). The research also confirmed the general trend of increasingly higher dosage illicit drugs in circulation, with older tablets containing less MDMA than more recent tablets.

Conclusions

These combined risks – higher strength MDMA tablets, idiosyncratic toxicity, within batch strength variance and varying rates of release, need to be considered by those intending to use MDMA and by those providing drug advice. Potency and toxicity cannot be predicted, even when drug testing for users is employed.

Dr Lewis Couchman, ASI’s Research Director, summarised the importance of the research:

Our research clearly demonstrates that taking MDMA is a far more risky activity than perhaps thought. It is prone to unpredictable dosing with toxic effects and potentially lethal consequences, of which users and drug workers need to be aware and should be warned.

It seems that drug testing services such as the Loop will be particularly important at festivals this summer, although it seems that the test results of one tablet cannot predict the strength of others in the same batch.

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