In 2013, 44% of a sample of 654 regular ecstasy users in Australia had used a new psychoactive substance (NPS) in the past six months. The most common NPS were the hallucinogens 2C-I (14%) and 2C-B (8%). Users of NPS were younger, used a wider variety of drugs more frequently, and were more likely to rate ecstasy purity as low compared to those who did not use NPS. NPS have become a regular part of Australia's recreational drug scene, and monitoring systems need to adapt to track this rapidly changing market.
Between 2011 and 2017, MDMA-related death rates increased in Australia, Finland, Portugal, and Turkey, coinciding with higher MDMA purity and availability. Across 1,400 deaths in Turkey, 507 in Australia, 100 in Finland, and 45 in Portugal, most decedents were young males (81–94% male; median age 24–27.5 years). Drug toxicity was the primary cause in Australia (61%), Finland (70%), and Turkey (60%), while other causes dominated in Portugal (56%). Only 13–25% of deaths were due to MDMA alone; these had significantly higher blood MDMA concentrations than multiple-drug toxicity deaths. Other drugs commonly detected included stimulants and alcohol in Australia and Finland, benzodiazepines and opioids in Finland, and synthetic cannabinoids and cannabis in Turkey.
Tablets sold as MDMA frequently contain psychoactive adulterants that vary by region and year, potentially increasing central nervous system harm. A review of studies from 2020 to 2025 covering Continental Europe, the UK, the USA, and Australia found that co-administration of MDMA with common adulterants can exacerbate noxious neurological and psychiatric effects. The composition of tablets differs across these regions, and interactions between MDMA and adulterants may explain some adverse effects seen in users. Expanding drug checking and public health efforts is essential to inform users, first responders, and healthcare professionals about these risks.