March 24, 2011

Emergency Department Visits Involving Ecstasy

The drug 3,4-methylenedioxy-methamphetamine (MDMA) more commonly is referred to by its party or street names, such as "Ecstasy" (as it will be referred to hereafter), "X," or "XTC." Trend data show that Ecstasy use appears to be increasing among younger populations. Specifically, data from the National Survey on Drug Use and Health (NSDUH) show that, between 2005 and 2008, past year use of Ecstasy increased among adolescents (from 1.0 to 1.4 percent) and young adults (from 3.1 to 3.9 percent).¹ Because it provides psychedelic and stimulant side effects, Ecstasy is associated with dynamic social environments, such as parties or raves, where there is loud music and dancing.² Yet the benign nicknames and the lively social environments in which the drug often is used belie the serious health and mental consequences that can result from casual to heavy Ecstasy use.

Aside from addiction, Ecstasy use can cause anxiety, agitation, recklessness, increased blood pressure, dehydration, heat stroke, muscle cramping, blurred vision, hyperthermia, heart failure, and kidney failure.² The social and environmental contexts in which Ecstasy often is used—prolonged vigorous activity in warm environments, such as dancing at crowded parties—can amplify associated cardiovascular health risks.³ Because it also compromises metabolic functioning, Ecstasy taken in combination with other drugs may place users at increased risk for additional and life-threatening drug interactions.³

Medical emergencies associated with Ecstasy use may be tracked through the Drug Abuse Warning Network (DAWN). DAWN is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States. To be a DAWN case, an ED visit must involve a drug, either as the direct cause of the visit or as a contributing factor. This issue of The DAWN Report provides data on trends in ED visits involving Ecstasy from 2004 through 2008 and highlights the demographic characteristics of such visits in 2008.

The number of Ecstasy-related ED visits increased by 74.8 percent from 2004 to 2008. Specifically, the number of drug-related ED visits involving Ecstasy increased significantly from 10,220 visits in 2004 to 17,865 visits in 2008 (Figure 1).

Figure 1. Number of Drug-Related Emergency Department (ED) Visits Involving Ecstasy: 2004 to 2008*

In 2008, Ecstasy-related ED visits represented 1.8 percent of all visits involving illicit drugs. Ecstasy was the seventh most commonly involved illicit drug in ED visits, behind cocaine (48.5 percent), marijuana (37.7 percent), heroin (20.2 percent), methamphetamine (6.7 percent), phencyclidine (PCP; 3.8 percent), and amphetamines (3.2 percent).

Most ED visits involving Ecstasy in 2008 (69.3 percent) were made by patients aged 18 to 29. Smaller proportions of visits were made by adolescents aged 12 to 17 (17.9 percent) and adults aged 30 or older (12.8 percent). Males accounted for slightly more than half (52.8 percent) of the ED visits involving Ecstasy.

More than one third of Ecstasy-related visits were made in the South (34.0 percent), nearly one third were made in the West (31.4 percent), nearly one fifth were made in the Midwest (18.5 percent), and nearly one sixth were made in the Northeast (16.1 percent) (Figure 2).

Figure 2. Drug-Related Emergency Department (ED) Visits Involving Ecstasy, by Region*: 2008

On average, there were 2.8 drugs involved per Ecstasy-related ED visit in 2008. An estimated 77.8 percent of Ecstasy-related ED visits also involved alcohol or other drugs (including pharmaceuticals or illicit drugs, hereafter referred to as "other drugs"); in fact, 31.3 percent involved one other drug, 15.0 percent involved two other drugs, 14.0 percent involved three other drugs, and 17.5 percent involved four or more other drugs (Table 1).

Marijuana, alcohol, and cocaine were the drugs most commonly used in combination with Ecstasy. Each of these drugs in combination with Ecstasy was involved at a similar level: marijuana was involved in 38.2 percent of Ecstasy-related ED visits, alcohol in 38.1 percent, and cocaine in 31.8 percent.

There were no significant differences by gender for ED visits involving Ecstasy in combination with other drugs. When examined by age group, Ecstasy-related ED visits made by patients aged 20 or younger were more than twice as likely as visits made by patients aged 21 or older to involve only Ecstasy (35.0 vs. 13.6 percent) (Figure 3).

Figure 3. Other Drugs Involved in Emergency Department (ED) Visits Involving Ecstasy, by Age Group: 2008

In terms of specific drugs, Ecstasy-related ED visits among patients aged 21 or older were more likely than visits made by patients aged 20 or younger also to involve alcohol (50.1 vs. 20.4 percent) or cocaine (43.4 vs. 14.7 percent) (Figure 4). There was no significant difference between the two age groups for visits involving Ecstasy in combination with marijuana.

Figure 4. Emergency Department (ED) Visits Involving Alcohol, Marijuana, and Cocaine among ED Visits Involving Ecstasy, by Age Group: 2008

Ecstasy continues to be a public health concern because it is addictive, produces adverse health consequences, and often is used in combination with alcohol or other drugs. With the number of Ecstasy-related ED visits increasing since 2004, these data highlight the importance of prevention efforts that target adolescents and young adults who make up the majority of Ecstasy users.⁴ Although the use of Ecstasy alone can result in serious medical complications, its use in combination with other drugs may exacerbate these dangers. In this report, almost 8 in 10 Ecstasy-related visits to the ED involved Ecstasy in combination with alcohol or other drugs, suggesting that Ecstasy users need to be educated about the dangers of not only Ecstasy but also these drug combinations.

Prevention efforts targeted at the two age groups noted above may need to be tailored in both the messages and the medium presented. First, the high rate of Ecstasy used in combination with other drugs suggests that a focus on the potentially dangerous consequences not only of Ecstasy alone but also of Ecstasy in combination with other drugs may be most compelling. Second, for the age cohorts most affected, the medium of the message, particularly the use of social networking sites, may be the most effective mechanism for both reaching and persuading potential users to abstain from use of Ecstasy and other illicit drugs. Illicit drug prevention activities also can promote the recognition and reporting of the signs of drug overdose. If partygoers are made aware of the negative symptoms associated with Ecstasy use in particular, they may be less inclined to use the drug itself and may also better be able to recognize overdoses so that they can help those individuals gain access to on-site medical personnel or to call 911. Moreover, a heightened awareness of Ecstasy overdose symptoms (e.g., anxiety, tachycardia, hypertension, and hyperthermia) among health care providers—especially those on the front lines of emergency care on weekends—can help to ensure that patients who come into medical facilities receive immediate and appropriate care.