Louisa Degenhardt and Wayne Hall (editors) The health and psychological effects of “ecstasy” (MDMA) use NDARC Monograph No. 62 i ii THE HEALTH AND PSYCHOLOGICAL EFFECTS OF “ECSTASY (MDMA) USE” Louisa Degenhardt and Wayne Hall (editors) Monograph No. 62 ISBN: 978 0 7334 2862-3 ©NDARC 2010 Funded by the Australian National Government Department of Health Ageing, and by the Australian National Health and Medical Research Council iii For further information about this publication please contact: Louisa Degenhardt National Drug and Alcohol Research Centre University of New South Wales Sydney NSW 2052 AUSTRALIA Telephone: +61 (0)2 9385 0230 Facsimile: +61 (0)2 9382 0222 Email: [email protected] The citation for this report is as follows: Degenhardt, L., & Hall, W. (eds) (2010). The health and psychological effects of “ecstasy” (MDMA) use. National Drug and Alcohol Research Centre. University of New South Wales, Sydney. NDARC Monograph No. 62. iv Author affiliations Ross Beck National Drug and Alcohol Research Centre University of NSW Stuart Kinner Sydney NSW 2052 AUSTRALIA Senior Research Fellow & Deputy Director (Research) Raimondo Bruno Queensland Alcohol and Drug Research Lecturer and Education Centre (QADREC) School of Psychology School of Population Health University of Tasmania The University of Queensland GPO Box 252-30 Brisbane QLD 4072 Australia Hobart TAS 7001 AUSTRALIA Iain S. McGregor Paul Callaghan Professor of Psychopharmacology Radiopharmaceutical Research Institute ARC Australian Professorial Fellow Australian Nuclear Science and School of Psychology (A18) Technology Organisation University of Sydney PMB 1 Sydney NSW 2006 Australia Menai NSW 2234 AUSTRALIA Edmund Silins Louisa Degenhardt Doctoral Candidate/Senior Research Professor of Epidemiology Officer National Drug and Alcohol Research Centre National Drug and Alcohol Research Centre University of NSW University of NSW Sydney NSW 2052 AUSTRALIA Sydney NSW 2052 AUSTRALIA Jessica George Natasha Sindicich Research Officer Research Officer Queensland Alcohol and Drug Research National Drug and Alcohol Research Centre and Education Centre (QADREC) University of NSW School of Population Health Sydney NSW 2052 AUSTRALIA The University of Queensland Brisbane QLD 4072 Australia Libby Topp Senior Research Officer Wayne Hall Centre for Health Research in Criminal Professor of Public Health Policy Justice School of Population Health Suite 302, Level 2, Westfield Tower University of Queensland 152 Bunnerong Road Level 2 Public Health Building Pagewood NSW 2035 AUSTRALIA Herston Rd Herston, Queensland, 4006 v vi Table of contents UListU of tablesU................................................................................................................................................. viii UListU of figuresU ............................................................................................................................................... viii UAcknowledgementsU U ....................................................................................................................................... ix UGlossaryU U .......................................................................................................................................................... xi U1.U U UIntroductionU U ........................................................................................................................................... 1 ULouisaU Degenhardt and Wayne HallU .................................................................................................................... U2.U U UAssessingU the adverse health and psychological effects of MDMA (“ecstasy”) useU .................. 5 UWayneU HallU ......................................................................................................................................................... U3.U U UWhatU is “ecstasy”?U ............................................................................................................................... 16 ULouisaU Degenhardt and Natasha SindicichU ........................................................................................................... U4.U U UTheU epidemiology of ecstasy useU ...................................................................................................... 31 ULouisaU Degenhardt and Natasha SindicichU ........................................................................................................... U5.U U UTheU Psychopharmacology of MDMAU ............................................................................................. 48 UMurrayU R. Thompson, Paul D. Callaghan and Iain S. McGregorU ....................................................................... U6.U U UTheU acute effects of ecstasy (MDMA) useU ...................................................................................... 81 UEdmundU SilinsU ..................................................................................................................................................... U7.U U UDoesU MDMA use affect the immune and reproductive systems?U .............................................. 99 URossU BeckU ............................................................................................................................................................. U8.U U UIsU there an ecstasy (MDMA) dependence syndrome?U ................................................................ 115 ULouisaU Degenhardt, Raimondo Bruno and Libby ToppU ........................................................................................ U9.U U URelationshipsU between ecstasy use, the use of other drugs and mental disordersU .................. 134 ULouisaU Degenhardt, Wayne Hall, Jessica George and Stuart A. KinnerU ............................................................... U10.U U UTheU effects of ecstasy use upon cognitive functioningU ............................................................... 157 UEdmundU SilinsU ..................................................................................................................................................... U11.U U UMortalityU related to ecstasy (MDMA) useU ..................................................................................... 191 UEdmundU SilinsU ..................................................................................................................................................... U12.U U UTheU use of MDMA for therapeutic purposesU .............................................................................. 207 UNatashaU Sindicich, Louisa Degenhardt and Wayne HallU ..................................................................................... U13.U U USummaryU and implicationsU .............................................................................................................. 215 UWayneU Hall and Louisa DegenhardtU .................................................................................................................... vii List of tables UTableU 4.1: Prevalence of ecstasy use across countriesU .......................................................................... 39 UTableU 4.2: Prevalence of ecstasy use among young people across countriesU ................................... 40 UTableU 4.3: Patterns of use in regular ecstasy users in Australia, 2007U ................................................ 42 UTableU 8.1: DSM-IV dependence criteriaU ............................................................................................... 128 UTableU 8.2: Criteria for past year ICD-10 drug dependenceU ............................................................... 128 List of figures UFigureU 3.1: Usual locations of ecstasy use among regular ecstasy users in Australia, 2007U ............ 24 UFigureU 3.2: Tablets sold as “ecstasy”U ....................................................................................................... 26 UFigureU 3.3: Median number of pills typically taken in “average” and “heavy” use episodes by frequency of ecstasy use in the past six months among regular ecstasy users in Australia, 2007U . 28 UFigureU 4.1: Prevalence of ecstasy use in Australia, 1988-2004U ............................................................ 36 UFigureU 4.2: Prevalence of ecstasy use relative to other illicit drugs, Australia, 2004U........................ 37 UFigureU 4.3: Prevalence of lifetime and past year ecstasy use by age, Australia, 2004U ...................... 38 UFigureU 4.4: Prevalence of past year ecstasy use among high school students, United States, 1996- 2006U .............................................................................................................................................................. 40 UFigureU 4.5: Frequency of ecstasy use among past year users in Australia, 2004U .............................. 41 UFigureU 11.1: Number of ecstasy-related deaths nationally by level* of contribution to death, 2001 - 2004U .......................................................................................................................................................... 222 UFigureU 11.2: Ecstasy-related deaths by cause of death, 2001-4, AustraliaU ....................................... 222 viii Acknowledgements This work arose out of the increasing perception that there needed to be a summary of existing research on the epidemiology and possible effects of “ecstasy” (MDMA) use, given its increasing prevalence among young adults, and understandable