Ecstasy and the concomitant use of pharmaceuticals

Recent anecdotal evidence suggests that it is becoming increasingly popular among ecstasy users to attempt to negate certain side-effects or enhance the drug experience through the concomitant use of pharmaceutical drugs or supplements. This study was designed to explore the practice of deliberately using pharmaceuticals for any reason in association with ecstasy and related drug (ERD) use. A cross sectional survey was conducted with 216 adults who had used ecstasy at least once in the previous 6 months. Generally, this sample was young, well educated, and likely to be in some form of paid employment.

Males were slightly overrepresented within the sample. About one quarter of the sample had deliberately taken a pharmaceutical substance for its putative effects on the euphoric effects of, or recovery from, ecstasy use. Those who reported using pharmaceuticals were significantly more likely to be male, had more ‘apparent’ years of use, and were more likely to have injected ERDs.

As a result, there appears to be a need for harm reduction information for ecstasy users regarding the risks associated with the mixture of ERDs with pharmaceuticals and supplements. Particular attention should be paid to informing users of the potentially fatal serotonin syndrome that is likely to arise from combining serotonin-enhancing substances, such as ecstasy or SSRI and MAOI groups of antidepressants.

Introduction

In Australia, the 2001 National Drug Strategy Household Survey (NDSHS) found that of those aged over 14 years around 3% had used ecstasy within the last 12 months, with use most popular among the 20- to 29-year age group (22%) (AIHW, 2002).

Recent anecdotal evidence suggests that it is becoming increasingly popular among ecstasy users to attempt to negate certain side-effects through the concomitant use of pharmaceutical drugs or supplements (Breslau, 2002). This is of concern, as some of these ecstasy-pharmaceutical combinations can have potentially serious health consequences (Singh & Catalan, 2000 and Sternbach, 1991).

The aims of this study were to examine the practice of the deliberate use of pharmaceuticals for any reason related to ERD use. Specifically, this paper aimed to examine the range of pharmaceutical substances used by ERD users concomitantly, the reasons for, and expected effects of, these combinations, and the health consequences of potentially dangerous combinations.

2. Method

The sample consisted of 216 adults who had used ecstasy at least once in the previous 6 months. The interview was comprised of quantitative and qualitative questions relating to the user’s experiences of ecstasy and pharmaceuticals. Ethics approval was received from the University of New South Wales Human Ethics Committee for all aspects of the study. All participants were reimbursed with AU$25 at the completion of the interview for travel and related expenses.

3. Results

The mean age of the 216 participants was approximately 26 years (S.D. 5.2) with a range of 19 to 39 years. Over half of the sample (63%) was male. The mean age at which participants had first tried ecstasy was approximately 20 years (19.8 years, S.D. 3.9) and an average period of about 7 years had elapsed since their first use occasion (6.7, S.D. 3.8). Participants reported an average of 11 days of ecstasy use (S.D. 11.5) in the last 6 months and an average of about two ecstasy pills per use occasion (2.1, S.D. 1.3).

Over a quarter of the sample (28%) had used a pharmaceutical substance in order to achieve an effect that was somehow related to the use of ERDS. Benzodiazepines and Viagra were the most common pharmaceuticals taken in conjunction with ERDs. When participants were asked to mention which ERD/pharmaceutical combinations they had taken, these pharmaceuticals were both mentioned 34 times each. SSRI and MAOI antidepressants were reported 19 times, while 5-HTP, the most popular supplement, was reported on nine occasions. Most of these pharmaceutical substances (83%) were combined with ecstasy, although the remaining combinations involved the use of amphetamines, ketamine, crystal meth or GHB. Of the 27 people who had taken ecstasy and Viagra, nine of these indicated that this would be the only context in which they would take Viagra. In addition to providing information on the sequence of pharmaceuticals used when taking ERDs, participants were also asked to give their reasons for combining these drugs. Viagra was most likely to be used in order to gain or maintain an erection (by 77% of those that had taken this combination), although smaller proportions used the pharmaceutical for its perceived aphrodisiac qualities. Almost equal proportions of participants reported using the supplement 5-HTP to either prevent potential neurotoxic ecstasy effects (36%), to avoid the negative effects associated with the ecstasy ‘comedown’ period (36%), or to increase the strength of the ecstasy ‘high’. Antidepressant medication was also used in a similar fashion to 5-HTP, although some participants also used them to extend the duration of the ecstasy ‘high’ (13%) or as a sleeping aid (4%). The use of medication for Attention Deficit Hyperactivity Disorder (ADHD) seemed to be restricted to the improvement of the ecstasy ‘high’ period, whereas benzodiazepines were primarily taken to assist with the after effects of ecstasy, although a minority used them during the ‘high’ period. With the exception of ADHD drugs, pharmaceuticals were most likely to be taken after ecstasy use. ADHD drugs were more likely to be taken before ecstasy consumption and unlikely to be used during the ecstasy high.

References

Sternbach, 1991 H. Sternbach, The serotonin syndrome [comment], American Journal of Psychiatry 148 (1991) (6), pp. 705–713. View Record in Scopus | Cited By in Scopus (592)

Source: Addictive Behaviors
Volume 31, Issue 2, February 2006, Pages 367-370
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