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. Author manuscript; available in PMC: 2018 Dec 1.
Published in final edited form as: Drug Alcohol Depend. 2017 Oct 6;181:20–24. doi: 10.1016/j.drugalcdep.2017.09.011

Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

Joseph J Palamar 1,2, Pia M Mauro 3, Benjamin H Han 2,4, Silvia S Martins 3
PMCID: PMC5683908  NIHMSID: NIHMS912507  PMID: 29028555

Abstract

Background

Ecstasy/MDMA has been one of the most prevalent party drugs for decades, and powder ecstasy recently increased in popularity. We examined trends in use to determine who to best target for prevention and harm reduction.

Methods

Secondary analysis of the 2007–2014 National Survey on Drug Use and Health, a repeated cross-sectional, nationally representative probability sample, was conducted. Linear trends in past-year ecstasy use and trends in demographic and other past-year substance use characteristics among ecstasy users were examined among participants ages 12–34 (N=332,560).

Results

Past-year prevalence of ecstasy use was stable across years at 2% (P=0.693). Over time, the proportion of ecstasy users with a college degree increased from 11.5% in 2007/08 to 24.5% in 2013/14 (P<0.001). The proportion of users who were age 12–17 decreased, as did proportions of users who are non-Hispanic black, and reported income <$20,000/year (Ps<0.001). Prevalence of past-year use of marijuana, LSD, ketamine, and DMT/AMT/Foxy increased among ecstasy users (Ps<0.05); DMT/AMT/Foxy use increased more than four-fold from 2.1% in 2007/08 to 8.7% in 2013/14. Perception of great risk associated with LSD use decreased among users and ease of obtaining LSD increased (Ps<0.05). Past-year use of 5 or more other substances also increased over time (P<0.05).

Conclusions

Ecstasy use in the US appears to be increasing among those with college degrees and use of other substances among ecstasy users is growing—particularly use of otherwise rare substances such as tryptamines. Results inform prevention and harm reduction strategies in this increasingly shifting group of ecstasy users.

Keywords: MDMA, socioeconomic status, club drugs, DMT, tryptamines

1. Introduction

Ecstasy has been one of the most popular party drugs for decades (Johnston et al., 2017; Parrott, 2013). Ecstasy is a common street name for MDMA (3,4-methylenedioxy-methamphetamine) although it can contain similar MDx drugs (Parrott, 2004; Tanner-Smith, 2006) and commonly contains adulterants such as synthetic cathinones (Brunt et al., 2011; Palamar et al., 2016a; Palamar et al., 2017a). Ecstasy use has been associated with acute adverse effects including hyperthermia, nausea/vomiting, bruxism, and muscle aches/headache, and can have adverse after-effects on mood, sleep, and memory (Baylen, 2006; McCann and Ricaurte, 2007; Parrott, 2013; Taurah et al., 2013). Its use can also have longer-term memory and neurocognitive effects (Parrott, 2013). Recent evidence suggests, however, that MDMA may serve as an effective adjunct to psychotherapy in the treatment of post-traumatic stress disorder (White, 2014). Ecstasy traditionally comes in pill form, but it has increasingly been marketed in the United States (US) in powder/crystalline form as “Molly” (Palamar, 2017).

Various nationally representative surveys of individuals in the US have found that self-reported lifetime and past-year ecstasy use has decreased substantially since 2001 (Center for Behavioral Health Statistics and Quality [CBHSQ], 2015; Johnston et al., 2017). For example, a nationally representative study of high school seniors found that past-year prevalence decreased from 9.2% in 2011 to 2.7% in 2016 (Johnston et al., 2017). However, ecstasy has become more popular in recent years (e.g., mainstream music lyrics, media coverage, use at large dance festivals) despite decreased prevalence of use (Palamar, 2017). According to Drug Abuse Warning Network (DAWN) hospitalization data, ecstasy-related emergency department visits among people age 21 or younger increased from 4,460 in 2005 to 10,176 in 2011 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). Likewise, between 2007 and 2014, the number of major adverse outcomes or deaths reported to Poison Control Centers (PCC) involving hallucinogenic amphetamines (primarily ecstasy) nearly quadrupled from 26 to 101 (Bronstein et al., 2008; Mowry et al., 2015). The Global Drug Survey (GDS), an annual international self-selected sample of drug-using nightlife attendees also reported an increase in self-reported emergency medical treatment following ecstasy use, which tripled from 0.3% in 2013 to 0.9% in 2015 (Global Drug Survey, 2016).

In addition, ecstasy users are commonly polydrug users (Sanudo et al., 2015), that is, using ecstasy as well as various drugs (especially “club drugs” such as ketamine or gamma-hydroxybutyrate [GHB])— within the same period of time or interval (Bruno et al., 2012; Halkitis et al., 2007). Since concurrent drug use may place users at additional health risks, focus is needed on self-reported use of multiple substances.

While ecstasy use appears to be most prevalent in the electronic dance music scene (Hughes et al., 2017; Palamar et al., 2017b), examining recent shifts in demographic characteristics of users can inform potential needed changes to strategies for prevention efforts, public health messages, and harm reduction. User demographics may have shifted over time as the form of the drug has largely changed from pills to powder; individuals who continue to use ecstasy despite decreased prevalence could need focused efforts to reduce related harms. Thus, we examined trends in demographic and other substance use characteristics of ecstasy users in a nationally representative sample of individuals ages 12–34 in the US.

2. Methods

2.1. Procedure

The National Survey on Drug Use and Health (NSDUH) is a nationally representative repeated cross-sectional survey of non-institutionalized individuals ages 12 and older in the 50 US states and the District of Columbia (CBHSQ, 2015). The sampling frame is obtained via four stages within each state. Surveys are administered via computer-assisted interviewing conducted by an interviewer and audio computer-assisted self-interviewing to increase honest reporting of sensitive information. Sampling weights were provided by NSDUH to address unit- and individual-level non-response and to derive nationally-representative estimates. Additional NSDUH methodology can be found elsewhere (SAMHSA, 2014).

Ketamine, GHB, and DMT/AMT/Foxy were not queried until 2006, and the definition of ecstasy changed as investigators added “Molly” to the definition in 2015, so for consistency, analyses focused on years 2007–2014 (weighted interview response rates ranging from 71.2–73.9%). We focused on individuals age 12–34 (N=332,560); we excluded ages >35 as self-reported use was rare among older individuals (0.1%).

2.2. Measures

Participants were asked about substance use in the past 12 months including ecstasy (MDMA), marijuana, LSD, cocaine, nonmedical use of opioids, heroin, ketamine, GHB, and a single item including three tryptamines (i.e., DMT [N,N-dimethyltryptamine], AMT [α-methyltryptamine], and Foxy [Foxy methoxy; 5-MeO-DiPT; 5-methoxy-diisopropyltryptamine]). A categorical variable was also created to indicate how many of these substances participants reported using (i.e., 0–1, 2–4, 5–8). Participants were also asked how much people risk harming themselves physically and in other ways when using marijuana, heroin, or LSD. They were also asked how difficult it is to obtain these drugs. Variables were dichotomized to indicate “great risk” and “fairly or very easy to obtain” for each of the three drugs.

Participants reported their age (i.e., 12–17, 18–25, and 26–34), gender, race/ethnicity, educational attainment, household annual total income, and marital status.

2.3. Analyses

We first estimated the prevalence of self-reported past-year ecstasy use over time. Similar to previous analyses (Han et al., 2016, 2017; Jones et al., 2015) we collapsed years into pairs—2007/08, 2009/10, 2011/12, and 2013/14—to increase power to detect linear trends.

We then examined demographic and other substance use characteristics among the subsample of ecstasy users ages 12–34 over time. We calculated both the absolute and relative change (i.e., percentage) from 2007/08 to 2013/14 for all covariates. We then estimated whether there was a linear time trend within each level of each covariate in the subsample of ecstasy users.

Analyses were weighted to account for the complex survey design. Since we used data from 8 survey years, we divided survey weights by 8 to obtain nationally representative estimates. Data were analyzed using Stata 13 SE (StatCorp, 2013), utilizing Taylor series estimation methods to provide accurate standard errors (Heeringa et al., 2010). This secondary analysis was exempt for review by the New York University Langone Medical Center Institutional Review Board.

3. Results

Prevalence of self-reported past-year ecstasy use was 2.2% in 2007/08, 2.6% in 2009/10, 2.4% in 2011/12, and 2.3% in 2013/14 with no statistically significant absolute or relative change over time (P=0.693). Table 1 describes demographic characteristics and other substance use characteristics among ecstasy users (N=7,979), reporting absolute and relative difference over time in the proportion of people in each subgroup. The majority of ecstasy users were ages 18–25 (i.e., 60%); this remained consistent across time. The proportion of users age 12–17 decreased by 42.9% between 2007/08 and 2013/14 (P<0.001) and increased among those age 26–34 by 31.5% (P=0.027). Nearly 7 out of 10 ecstasy users were non-Hispanic White and this remained consistent over time; the proportion of non-Hispanic Black participants decreased by 40.3% across years (P<0.001). The proportion of users earning <$20,000 decreased and the proportion of those earning $20,000–$49,999 increased significantly. The proportion of ecstasy users ages 18–34 with a high school diploma or less decreased, while the proportion of ecstasy users ages 18–34 with a college degree or more increased by 113.0% from 11.5% in 2007/08 to 24.5% in 2013/14 (Ps<0.001). Also among ages 18–34, the proportion of users who were never married increased over time (P<0.05).

Table 1.

Demographic and substance use characteristics of past-year ecstasy users among those age 12–34 in the US, 2007–2014

2007–2008 Column % (n=1,937) 2009–2010 Column % (n=2,304) 2011–2012 Column % (n=2,138) 2013–2014 Column % (n=1,600) % Absolute Change from 2007–2008 to 2013–2014 Change from 2007–2008 to 2013–2014 P (trend)
Age Group
 Age 12–17 16.8 17.5 16.1 9.6 −7.2 −42.9 <0.001
 Age 18–25 60.0 60.1 62.5 60.0 +0.0 +0.0 0.798
 Age 26–34 23.2 22.4 21.4 30.5 +7.3 +31.5 0.027
Sex
 Male 59.0 57.6 56.9 60.0 +1.0 +1.7 0.769
 Female 41.0 42.4 43.1 40.0 −1.0 −2.4 0.769
Race/Ethnicity
 Non-Hispanic White 66.8 64.3 61.4 69.2 +2.4 +3.6 0.635
 Non-Hispanic African American 14.4 11.3 9.3 8.6 −5.8 −40.3 <0.001
 Hispanic 14.6 18.9 21.7 14.9 +0.3 +2.1 0.719
 Other 4.2 5.5 7.6 7.4 +3.2 +76.2 0.002
Education (ages 18–34 only)
 <High School 18.9 19.0 15.5 9.7 −9.2 −48.7 <0.001
 High School 35.4 32.3 33.6 24.4 −11.0 −31.1 <0.001
 Some College 34.1 33.7 36.6 41.4 +7.3 +21.4 0.008
 College or More 11.5 15.0 14.3 24.5 +10.0 +113.0 <0.001
Household Income
 <$20,000 77.0 79.6 79.6 65.8 −11.2 −14.5 <0.001
 $20,000–$49,999 18.8 15.6 17.8 26.4 +7.6 +40.4 0.001
 $50,000–$74,999 2.7 3.7 1.5 4.6 +1.9 +70.4 0.378
 ≥ $75,000 1.5 1.0 1.1 3.3 +1.8 +120.0 0.081
Marital status (ages 18–34 only)
 Married 8.0 4.7 3.1 4.9 −3.1 −38.8 0.044
 Divorced or Separated 3.9 3.5 4.3 2.7 −1.2 −30.8 0.404
 Never Married 88.1 91.8 92.6 92.5 +4.4 +5.0 0.023
Past-Year Drug Use
 Marijuana 86.9 90.6 88.9 91.6 +4.7 +5.4 0.018
 Opioids (Nonmedical) 54.9 48.6 47.3 39.8 −15.1 −27.5 <0.001
 Cocaine 48.5 38.9 40.0 47.3 −1.2 −2.5 0.933
 LSD 20.3 16.7 21.5 27.8 +7.5 +36.9 <0.001
 Heroin 5.0 5.3 5.8 5.3 +0.3 +6.0 0.669
 Ketamine 3.6 4.8 5.9 6.5 +2.9 +80.6 0.010
 DMT/AMT/Foxy Methoxy 2.1 4.3 7.1 8.7 +6.6 +314.3 <0.001
 GHB 1.7 1.7 0.8 1.7 +0.0 +0.0 0.555
Past-Year Use Multiple Drug Use
 0–1 Other Drugs 29.6 34.6 34.5 30.0 +0.4 +1.4 0.986
 2–4 Other Drugs 66.8 61.7 61.0 64.6 −2.2 −3.3 0.379
 5–8 Other Drugs 3.6 3.7 4.5 5.4 +1.8 +50.0 0.047
Perceived Great Risk
 Marijuana (once a month) 5.0 3.2 2.2 1.7 −3.3 −66.0 <0.001
 Marijuana (1–2 times per week) 6.6 4.2 3.1 2.5 −4.1 −62.1 <0.001
 Heroin (trying once or twice) 70.9 69.0 70.4 72.1 1.2 1.7 0.482
 Heroin (1–2 times per week) 90.8 92.3 90.2 94.0 3.2 3.5 0.072
 LSD (trying once or twice) 38.6 33.8 29.5 21.2 −17.4 −45.1 <0.001
 LSD (1–2 times per week) 70.0 63.2 61.2 55.2 −14.8 −21.1 <0.001
Perceived Easiness to Obtain
 Marijuana 94.2 95.4 94.8 96.3 2.1 2.2 0.081
 Heroin 25.1 25.0 25.0 24.2 −0.9 −3.6 0.727
 LSD 27.6 30.0 31.6 33.8 6.2 22.5 0.011
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Note. Respondents age 12–17 were not asked about education or marital status.

Trends in past-year use of other substances among ecstasy users were substance-specific (Table 1); 94.6% of ecstasy users reported using at least one other substance in the last year. The proportion of users also reporting marijuana, LSD, ketamine, or DMT/AMT/Foxy use increased significantly across years. The proportion of ecstasy users reporting use of DMT/AMT/Foxy increased from 2.1% in 2007/08 to 8.7% in 2013/14 (P<0.001). In contrast, nonmedical opioid use decreased significantly from 54.9% to 39.8% over this same time period (P<0.001). Roughly two-thirds of the sample reported use of 2–4 substances other than ecstasy, and this remained stable, while use of 5–8 other substances increased by 50% over time (P=0.047). Perceived great risk associated with marijuana and LSD use decreased (Ps<0.001) and perceived ease to obtain LSD increased over time (P=.011).

4. Discussion

This study of a nationally representative and non-institutionalized US population ages 12–34 found that while prevalence of past-year ecstasy use remained stable at 2.2–2.6% from 2007/08 to 2013/14, user characteristics shifted toward young adults with a higher education. Six out of ten users were young adults ages 18–25; the proportion of users ages 26–34 increased over time. Decreases in use among younger participants are consistent with decreases in use of other substances (Johnston et al., 2017). The majority of ecstasy users identified as non-Hispanic White; however, the proportion of non-Hispanic black users decreased and the proportion of those identifying as “other” race increased. While these results corroborate older NSDUH studies examining ecstasy use (Martins et al., 2005, 2007; Wu et al., 2006), they also suggest a recent shift in trends. For example, an analysis of ecstasy users in NSDUH from 1995–2001 found that while White participants and those age 18–25 were at higher risk for use, use increased among all age categories (age 12–34), races and ethnicities (Martins et al., 2005).

The proportion of ecstasy users ages 18–34 with a college degree more than doubled from 2007–08 to 2013–14. Interestingly, a recent longitudinal study of first-year college students found that reported opportunity to use ecstasy substantially increased over time—particularly among those age 18–21 with nearly half reporting opportunity to use the substance (Allen et al., 2017). Thus, availability of ecstasy may be increasing among college students; however, the NSDUH does not assess perceived availability of ecstasy. Ecstasy users were also less likely to report an annual income of <$20,000 over time; therefore, there might have been somewhat of a socioeconomic shift in users.

Adding to the literature on polydrug use among ecstasy users (Halkitis et al., 2007; Martins et al., 2007; Palamar et al., 2017b; Wu et al., 2006), 70% of ecstasy users in this sample reported using at least 2 other substances in the past year, and reporting use of 5–8 substances increased across time. The proportion of past-year use of marijuana, LSD, ketamine, and/or DMT/AMT/Foxy increased, with greatest relative increases in DMT/AMT/Foxy use (i.e., 314%) from 2007/08 to 2013/14. Another study found that eight out of ten individuals who reported DMT/AMT/Foxy use or other tryptamines in the NSDUH also reported lifetime ecstasy use (Palamar et al., 2015). This increase in use of tryptamines may be due to a recent increase in popularity of DMT (Winstock et al., 2014). Ecstasy users in particular may be more drawn to these substances for their psychedelic effects. In contrast, the proportion of ecstasy users reporting nonmedical opioid use decreased over time, and may be related to the recent decrease in self-reported nonmedical opioid use in the adolescent general population (Allen et al., 2017; McCabe et al., 2017). Decreases in perceived great risk associated with marijuana and LSD, and increases in perceived ease to obtain LSD, could be contributing to increased use of these substances among ecstasy users. Thus, ecstasy users in particular should be targeted regarding risk awareness not only for ecstasy use, but also for use of other drugs.

4.1. Limitations

NSDUH questionnaires did not include “Molly” in the definition of ecstasy until 2015, which could have led to under-reporting of ecstasy use (Palamar et al., 2016b). In addition, ecstasy can be adulterated with other drugs such as synthetic cathinones (Brunt et al., 2011; Palamar et al., 2016a; 2017a), so some individuals reporting use in these samples might have also been ingesting drugs other than MDMA. In restricting our sample to past-year ecstasy users (i.e., approximately 2%), we were limited in the power to examine non-linear trends within further stratified subgroups. Ad hoc analyses suggest that significant changes in trends among those age 12–17, age 26–34, and those with a high school diploma, some college, and/or college or more, did not significantly shift until 2013/14. While future studies with more available time points may be better able to examine inflection points in trends, the current study uses the most up-to-date trend data available through the NSDUH. Sensitivity analyses stratifying by age (not shown) suggested many significant trends were similar to our combined 12–34 age group; however, subsample sizes were often too small to estimate trends with precision, therefore limiting our reporting to the combined 12–34 age group. Finally, past-year substance use did not differentiate which substance was used first or most recently, limiting our ability to make temporal associations across substances in this sample.

5.0 Conclusions

While prevalence of past-year ecstasy use has remained stable in the US over the past decade, ecstasy users are increasingly young adults with higher education, and thus may require different prevention methods commonly geared to ecstasy-using populations a decade ago. Past-year use of many (>5) other illegal substances is increasing among ecstasy users, particularly LSD, ketamine, and tryptamine use. The current generation of ecstasy users may require further prevention and harm reduction as polydrug use may place ecstasy users at greater risk for experiencing adverse outcomes.

Highlights.

  • Past-year prevalence of ecstasy use was stable at 2% from 2007/2008 to 2014/2015

  • Over time, users tended to be older (age 26–34), more educated, and not married

  • Over time, users were less likely to be younger (age 12–17) or black

  • Over time, users were less likely to report lower income or be less educated

  • Past-year other drug use increased over time, particularly tryptamine (DMT/AMT/Foxy) use

Acknowledgments

Role of funding source

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers K01DA038800 (PI: Palamar), R01DA037866 (PI: Martins), and T32DA031099 (PI: Hasin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp).

The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp).

Footnotes

Contributors

All authors are responsible for this reported research. J. Palamar conceptualized and designed the study, and conducted the statistical analyses. J. Palamar, P. Mauro, B. Han, and S. Martins drafted the initial manuscript, interpreted results, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

Conflict of Interest

No conflict declared.

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