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Multiple Drug Ingestion by Ecstasy Abusers in the United States (April 2009)

Multiple Drug Ingestion by Ecstasy Abusers in the United States (April 2009)

    Journal of Analytical Toxicology, Vol. 33, April 2009

    David L. Black 1, Beverly Cawthon 1, Tim Robert 1, Frank Moser 1, Yale H. Caplan 2, and Edward J. Cone 3,*
    1 Aegis Sciences Corporation, 515 Great Circle Road, Nashville, Tennessee 37228; 2 National Scientific Services, 3411 Phillips Drive, Baltimore, Maryland 21208; and 3 Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland 21224


    The abuse of ecstasy-type drugs such as 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyamphetamine (MDA) is generally associated with young adults attending “Rave” parties. Little toxicological information has been reported regarding ecstasy usage by individuals undergoing monitoring in other settings in the United
    States. The goal of this study was to determine the prevalence and patterns of licit and illicit drugs in urine specimens of ecstasy users.

    A survey of laboratory data over the years 2005–2007 revealed that 198 urine specimens were confirmed positive (cutoff concentration 100 ng/mL) for MDMA and/or MDA from the following types of donors (# positive specimens): Correctional (159); Sports (19); Workplace (9); Pain Patients (8); and Special Test Requests (3). Of these, 122 (61.6%) were positive for MDMA and MDA, 70 (35.4%) were positive for MDMA, and 6 (3.0%) were positive for MDA.
    A majority (84.3%) of the specimens contained multiple drugs and/or metabolites in addition to MDMA and MDA. The median number of drugs/metabolites reported for these ecstasy users was 5 (range, 1–9). In addition to MDMA/MDA, the most commonly identified drug groups (%) were cannabis (THCCOOH) (61.6%); amphetamine/ methamphetamine (38.4%); benzoylecgonine (30.8%); diazepam-related (9.6%); opiates (7.1%); alprazolam (5.6%); and others (5.6%).

    Although multidrug ingestion appears to be common amongst ecstasy users, caution is recommended in interpretation. Illicit ecstasy in the United States and Canada frequently contains methamphetamine and other active substances, and multidrug use may not have been intentional.