A rapid scoping review of harm reduction strategies for ecstasy (MDMA) users in recreational settings

Abstract

Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies.

Methods: A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches.

Results: Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content.

Conclusions: While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed.