Risk communication about high-dose MDMA: Impact of a hypothetical drug alert on future MDMA use.
Joel Keygan, Breanna Willoughby, Raimondo Bruno, Monica J Barratt, Amy Peacock
Drug and Alcohol Review May 1, 2025 DOI: 10.1111/dar.14037 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 625 |
| Population | Australians who used MDMA pills or capsules in the past year |
| Interventions | effects and actions to reduce harm |
| Topics | MDMA |
| Keywords | Drug safety alerts MDMA/Ecstasy/Molly Public health interventions Behaviour change Drug alerts Harm reduction Risk communication |
| Citations | 1 |
| Key findings | Receipt of a high-dose MDMA drug alert was associated with greater intention to not use the drug or to reduce the initial dose, compared to no alert, but variations in alert phrasing did not significantly affect intended behavior. |
Abstract
Despite high-dose 3,4-methylenedioxymethamphetamine (MDMA) drug alerts being distributed, no research has been conducted as to changes in use in response. This study aimed to determine if: (i) high-dose MDMA drug alerts, and (ii) varied descriptions of dose, effects and actions to reduce harm were associated with intentions to reduce the initial MDMA dose in a hypothetical scenario. Australians who used MDMA pills/capsules in the past year completed an online survey. Respondents were randomised into alert (n = 441) or control (n = 184) conditions, with the former receiving a high-dose MDMA alert with systematically varied descriptions of dose, effects and actions to reduce harm. Multinomial logistic regressions determined the association between receipt of drug alert (and varying alert content) and hypothetical MDMA dosing. Almost half (45.4%) of those in any alert condition reported intention to not use (20.7% of control participants) and 46.7% stated they would use and reduce their initial dose (69.0% of control group). Compared to the control group, those who received an alert were significantly more likely to report intention to not use the drug, as compared to taking a smaller initial dose (adjusted relative risk ratio [aRRR] = 3.28, 95% confidence interval [CI] 2.13, 5.07) or taking the same/higher initial dose (aRRR = 2.62, 95% CI 1.31, 5.22). There was no significant association between different alert phrasing and intended behaviour. While there was no significant effect of variation in phrasing, receipt of an alert promoted intended harm reduction behaviours. Future research assessing actual behaviour and different substances (e.g., heroin, methamphetamine) is important to further understand the utility of this public health communication.
Comparable studies
Other randomized controlled trials on MDMA, most cited first.
Citations in the library
Cites 21
- Constructing drug effects: A history of set and setting Drug Science, Policy and Law 2017
- Human Pharmacology of MDMA Therapeutic Drug Monitoring March 19, 2004
- Multiple MDMA (Ecstasy) Overdoses at a Rave Event Journal of Intensive Care Medicine May 28, 2012
- MDMA and MDMA-Assisted Therapy. American Journal of Psychiatry 2025
- MDMA-related deaths in Australia 2000 to 2018. International Journal of Drug Policy December 19, 2019
and 16 more in the library