Human behavior is thought to be the biggest factor in causing ecstasy-related harm, according to the latest findings from the Global Drug Survey. The annual survey asked 150,000 users around the world about their drug habits and found that the number of people who sought emergency medical attention after taking MDMA has gone up.
In the last 12 months 1.2% of people who took ecstasy reported that they sought medical attention, compared to 0.8% last year, and 0.6% in 2014. However while the overall number of people ending up in the emergency rooms around the world has risen, the figures for the UK dropped from 1.2% last year to 0.8% this year.
"Just knowing what is in your drug is not enough," Dr. Adam Winstock, director of the Global Drug Survey, said. "It's what you do once you know that matters. In our opinion the biggest variable in drug-related deaths is human behavior."
The survey's author said that findings of this year's study highlight that the risks of MDMA use vary widely across different regions and demographics. The country with the highest rate of users seeking emergency attention was Denmark with 2.5% of users, while the lowest rate was 0.3% in Italy.
In the US, the rates were below the global average at 0.7%, but showed a slight increase from 0.5% in 2016, and 0.4% in 2015.
Winstock attributed the downward trend of people in the UK reporting to need emergency treatment to better drug education. "The downward trend in the UK is good news," he said. "I like to think it might be down to people in the UK starting to use more safely and sensibly."
The survey found that on average 60% of users around the world reported that they take a test dose from new batches of pills or powder. This keeps with harm reduction advice to start with a low dose and wait for effects to kick in. However age and sex appeared to influence the risk behavior of ecstasy users. Women over the age of 25 were 1.3 times more likely to test dose than men under 25.
Winstock said that these differences emphasize the fact that most drug-related harm is linked to individual behavior rather than the drug itself. This was further supported by the findings relating to the behavior of people who had taken MDMA and sought emergency medical help. Over 50% of people who sought medical attention after taking MDMA were drunk, only 20% had test dosed their batch, and 42% took a bigger dose than their usual amount that night.
"While the determinants of MDMA risk are many it pretty much come down to the interaction between the person, the amount and types of drugs they take and what they do when they use," Winstock said. He added that the findings point to the need of people taking proactive harm reduction steps if they choose to take MDMA.
Winstock said: "Test dose any new batch by using a small amount of a new powder or a quarter or a half of new pill and waiting at least two hours before redosing—three hours is even better. Don't get drunk before you start dosing (or afterward for that matter), and if you don't feel well don't take anything, save it for another day."
Among the findings, young women were significantly more likely to report having sought emergency medical treatment following the use of MDMA. While the average rate of all people seeking medical attention was 1.2%, that figure was 2.2% for women under the age of 25.
This may support previous research by the Global Drug Survey that came out in November which suggested that MDMA may pose a greater risk to women than men. Last year's study found that women are two to three times more likely to end up in emergency rooms having taken ecstasy, compared to men, possibly because of the way the drug interacts with the body's hormones.
This year's survey also found that MDMA is most likely to be used in a nightlife setting, with the highest percentage of users (35%) taking it in a club, and 27% taking it at a festival. Only 2% of users reported using MDMA on their own.
"We believe that people who use drugs should have access to timely, accurate information about the composition of their drugs," Winstock said. "Greater emphasis should be given to promoting honest harm reduction information to users with a revision of club licensing laws that prevent dance venues and other hubs for young people to receive credible live-saving information."
Anna Codrea-Rado is THUMP's News Editor. Follow her on Twitter.