May 2021 Update on MDMA

MDMA strength/ potency is increasing

MDMA is the shortened chemical name for the synthetic psychoactive drug 3,4-methylenedioxymethamphetamine, also known as ecstasy.

It is one of the most commonly used substances in Ireland and is associated with the night time economy and new user groups among young people.

Drug markets can change quickly and both high-dose MDMA and adulterated products have been a concern for some time. Recently there have been rising numbers of MDMA-related hospital admissions, and even deaths in some countries (EMCDDA, 2016).The latest drug-related death data for Ireland shows that 14 deaths occurred as a result of MDMA use in 2017 with a total of 89 deaths occurring between the period of 2008 -2017.

For a number of years we have raised awareness of the changing MDMA market, increasing levels of use and have provided harm reduction advice through national campaigns in collaboration with Student Unions to respnd to the issue. As part of this work we have expressed concern regarding the strenght of products identified throughout Europe.

What do we know about this trend?

European drug checking organisations provide valuable insight into this market and can rapidly identify the latest MDMA trends regarding contents and potency. From these results we are aware that on average, MDMA tablets now contain higher levels of the drug than at any time in the past (EMCDDA, 2020).
Ten years ago pills contained roughly 60 - 90 mg of MDMA, whereas services are now finding that pills can contain 2-3 times (over 200 + mg) the average adult dose of MDMA which can greatly increase the risks.
As a rough guide, some drug checking services state that 125 mg is considered a high and riskier dose of MDMA, but a persons reaction to any drug will be based on a number of unique factors such as their physical and mental health, if they have existing health concerns, their gender and the setting they use in. It is always safer for people not to use at all.
In response to this trend, harm reduction agencies have provided information reminding people who use to divide pills into thirds or quarters to reduce the risks to their health.
Interestingly, the Dutch Drug Information and Monitoring System (DIMS) reported an increasing number of lower dosage MDMA tablets available on the Dutch market in 2020.This may be as a result of the adaptation of use in domestic settings throughout lock down periods as a result of COVID-19 (EMCDDA, 2021).
The latest report published in May 2021 by DIMS found that there can be large differences in MDMA doses in ecstasy tablets submitted for testing. Of the pills submitted, the average contained 166 mg of MDMA (Trimbos Institute, 2021).

While being mindful of the risks posed by high strength pills, people should also consider high strenght powder/crystal products and the risk of over consumption.

Follow the same harm reduction steps to avoid overdose such as taking a test dose, leaving time to see the effects, avoiding re-dosing, limiting the amount consumed and not mixing with alcohol, other drugs and prescription medication.

Adulteration and unknown contents in MDMA products

PMA/PMMA

Although high strength products are one of the main concerns at present, the risk of adulterated MDMA pills, powders and crystal is an on-going concern. People may be familar with the substances PMA/PMMA which were linked with a number of deaths in Ireland and throughout Europe after appearing in pills sold as MDMA from around 2011 onwards. These substances are more dangerous as they are potent in lower doses than MDMA alone and can take longer to kick in which could lead a person to take more without being aware of the risks. It is always important to leave time and wait until the effects are felt.

While there is no recent evidence of these substances appearing, they may still appear from time to time. A recent example of their emergence was documented by the Loop drug checking organisation who issued an alert at Boom Festival in 2019 upon finding PMMA in orange Superman tablets being sold at the event.

Pentylone (N-Ethylpentylone)

Other substances may also appear in MDMA products which can cause negative health effects such as Pentylone (N-Ethylpentylone) which is a cathinone type substance which may provide stimulation so a person feels like they have consumed MDMA. This substance was identified in a number of samples at UK festivals in 2019 by the drug checking service the Loop. It was found in crystal form and also in powders and pills. It looks and smalls similar to MDMA and therefore is difficult for a person to detect. Pentylone has been linked with prolonged effects as it is a long lasting drug. People have experienced prolonged effects on their mental health such as insomnia, paranoia and anxiety. People were advised as part of alerts issued by the Loop to rest, stay hydrated, be with others for support and get medical help if experiencing long lasting and severe mental health concerns as a result of use. It has also been linked with deaths internationally.

Eutylone (Bk-EBDP)

Other examples of substances missold as MDMA include Eutylone (Bk-EBDP), which was identified in grey crystal by Energy Control in Spain and in multiple pills, powders and crystals by Know Your Stuff New Zeland earlier this year. Similar to Pentylone, Eutylone is also a cathinone type substance which can lead people to think they have purchased weak MDMA and consume more. The effects will include anxiety, insomnia, head aches, paranoia and an upset stomach. Know Your Stuff Newzeland are aware of seizures linked with use and stated that there is also a risk of convulsons and death.

1. Information about MDMA

2. EMCDDA 2016 'Recent changes in Europe’s MDMA/ecstasy market'

3. Harm Reduction for people who use MDMA

4. Electric Picnic festival goers warned of high strength drugs

5. Media 'Experts issue warning for a deadly "MDMA like" substance at festivals.