September 2021 update on MDMA contents in Europe
Get the facts and reduce the harms
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 of young people. MDMA is commly known as coming in bright coloured and branded pills but new trends have led to a shift towards the use of MDMA powder and crystals .
For a number of years we have raised awareness about the changing MDMA market and increasing levels of use among young people in Ireland.We are committed to providing harm reduction advice in collaboration with relevant stakeholders, including the Union of Students in Ireland. As part of this work we have expressed concern regarding the strength of products identified throughout Europe as well as the changing nature of this market increasing overdose risks for young people.
We have complied some of the latest EU trends to help inform people who use MDMA.
MDMA strength/ potency is increasing throughout Europe
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 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.
What do we know about increased potency of products?
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 compared 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 very rough guide, some 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 and people may not be aware of the dosage that a pill, powder or crystal contains. 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).
MDMA powders and crystals
Through our work with Student Unions, we have identified that some young people perceive MDMA powders and crystals as a more 'trusted' option compared to pills.
While being mindful of the risks posed by high strength pills, people should also consider that potency and contents of powder and crystal products and the risks they also pose. If you choose to use powders or MDMA crystals, follow the same harm reduction steps to avoid overdose such as:
- taking a test dose and leaving time to see the effects
- avoiding re-dosing
- limiting the amount consumed and not mixing with alcohol, other drugs and prescription medication
- hydrating but not consuming over a pint an hour, taking breaks from dancing to cool down
UK MDMA Alerts, August 2021
Although high strength MDMA products is one of the main concerns at present, the most recent UK drug checking data shows that unknown or new contents are emerging in MDMA powder, pill and crystal products.
A number of recent alerts have been issued in relation to MDMA containing 3-Methylmethcathinone (3-MMC), 4-Chloromethcathinone (4-CMC) and Eutylone.
This is substance is from the 'Cathinone' class of sub substances and is similar to mephedrone (4 -MMC) which was previously sold in head shops in Ireland. This substance produces strong effects and a strong urge to re-dose and consume extra doses. It can lead to adverse mental health reactions, prolonged stimulation and insomnia.
This substance has been identified in a number of UK products throughout summer 2021. It is a potent stimulant from the 'Cathinone' class of substances. It is reported to produce strong stimulant effects with less empathogenic effects compared to MDMA. It can lead to adverse mental health reactions, prolonged stimulation and insomnia.Learn more about this substance here.
Image source: The Loop and MANDRAKE, 2021
Eutylone has also recently been detected in UK samples. It can produce similar effects to MDMA that are short lived which could lead to risky re-dosing.
Eutylone is also a cathinone type substance and can lead people to think they have purchased weak MDMA and consume more. It is associated with a long period of negative after effects including difficult anxiety, paranoia and prolonged stimulation.
Other examples of this substance appearing in Europe include in a grey crystal product by Energy Control in Spain and in multiple pills, powders and crystals by Know Your Stuff New Zeland earlier this year. Similar to other mentioned substances, 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.
Other substances of concern
Other substances may also appear in MDMA products which can cause negative health effects such as Pentylone (N-Ethylpentylone) which is also 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.
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.