Palliative & End-of-Life DistressSafety & Risk ManagementPublic Health, Prevention & Behaviour ChangeDepressive DisordersAnxiety DisordersMDMA

A rapid scoping review of harm reduction strategies for ecstasy (MDMA) users in recreational settings

This rapid scoping review maps a wide range of drug-specific, behavioural and peer-related harm-reduction strategies used by ecstasy (MDMA) users in recreational settings and shows users obtain guidance from diverse sources including friends, clubs and user-oriented websites. It also finds many user-facing websites lack evidence citations and that adherence to strategies varies with users' goals and experience, indicating a need for more effective, evidence-informed communication.

Authors

  • Edwards, D.
  • Csontos, J.
  • Pascoe, M. J.

Published

Research Square
meta Study

Abstract

Background

Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies.

Methods

A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches.

Results

Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content.

Conclusions

While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed.

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Research Summary of 'A rapid scoping review of harm reduction strategies for ecstasy (MDMA) users in recreational settings'

Introduction

Edwards and colleagues frame MDMA (ecstasy) as a commonly used recreational stimulant whose sought effects include euphoria, increased energy, musical appreciation and emotional closeness. The introduction emphasises that illicitly produced MDMA varies in form and purity and is often used in hot, prolonged-dancing settings such as nightclubs and festivals, which raises the risk of adverse drug reactions (ADRs) including hyperthermia and hyponatraemia. The authors note a wide spectrum of other reported harms from mild (e.g. bruxism, nausea) to severe outcomes (e.g. hepatotoxicity, acute renal failure, seizure, coma, death), and describe increasing MDMA-related deaths in England and Wales over the past decade. They position harm reduction—ranging from simple behaviours (drinking water, taking breaks) to service-level interventions (free water, chill-out spaces, drug checking/pill testing)—as potentially mitigative but under-reviewed in the ecstasy-specific context. This rapid scoping review aimed to map the range and prevalence of harm reduction strategies used by people who consume ecstasy in recreational settings, and to identify where users obtain harm-reduction information. The study also sought to catalogue MDMA-specific harm-reduction content on user-oriented drug information websites, motivated by the practical need to target effective education and to assess the credibility of commonly cited online sources.

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Study Details

References (1)

Papers cited by this study that are also in Blossom

Using the Theory of Planned Behavior to predict implementation of harm reduction strategies among MDMA/ecstasy users

Davis, A. K., Rosenberg, H. · Psychology of Addictive Behaviors (2016)

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A rapid scoping review of harm reduction... — Research Summary & Context | Blossom