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| Journal of the New Zealand Medical Association,
04-April-2003, Vol 116 No 1171
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Ecstasy use in New Zealand: findings from the 1998 and 2001
National Drug Surveys
Chris Wilkins, Krishna Bhatta, Megan Pledger and Sally
Casswell
The use of ecstasy became a global phenomenon in the late
1990s with use spreading to Eastern Europe, the Americas, southern Africa, the
Middle East and South-East Asia.1 Although
global consumption remains concentrated in Western Europe and North America,
both Australia and New Zealand have reported high prevalence levels by
international standards.1 Ecstasy is widely
associated with dance music youth culture and use at ‘raves’ and
dance clubs.2,3 It is used in these contexts to
provide the energy to dance for long periods of time and to enhance
sociability.4
Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) combines
traditional amphetamine qualities and hallucinogenic characteristics, like
LSD.4 Immediate effects include increase in
heart rate, blood pressure and body temperature, increased energy and alertness,
and a warm state of empathy for others.4 High
doses cause teeth clenching, paranoia, anxiety, hallucinations and
confusion.4 Tolerance to ecstasy develops
rapidly, characterised by a reduction in the positive effects and increase in
the negative effects of the drug, and this has been associated with
self-limiting patterns of use (ie, periods of voluntary abstinence to regain
initial positive effects). However, a recent study of ecstasy use in Australia
found evidence of more-frequent use of larger doses to overcome short-term
tolerance, intravenous administration of the drug, and extensive poly-drug use
in combination with ecstasy use.5,6
Ecstasy can cause two types of acute side effect that often
have lethal consequences: hyperthermia and
hyponatraemia.7,8 These outcomes appear to
result from the compounding of ecstasy’s natural pharmacological effects
(on the body’s thermoregulatory mechanisms and ability to excrete fluid)
with specific individual behaviours (such as dancing without a break and
excessive intake of fluids) in specific settings (hot dance
clubs).7,8 Although instances of serious acute
effects are low relative to the extent of use, it is the unpredictability of
such events (dose is not clearly predictive of adverse effects) and the risk of
mortality that makes them significant.7,8 Three
people have died as a result of taking ecstasy in New Zealand since 1998
(personal communication, National Drug Intelligence Bureau, 2002). Ecstasy has
controversially been linked to damage to serotonin terminals in the brain with
possible implications for short-term memory, cognitive function and mood
regulation, particularly in later life.7,8
Confirmation of these effects awaits large-scale epidemiological
studies.4,7,8
Predicting the consequences of taking ecstasy is made more
difficult by a number of features of the illicit market in which it is
manufactured and sold. Although the term ‘ecstasy’ is supposed to
refer to MDMA, in reality a number of substances with similar effects to MDMA
are commonly sold as ‘ecstasy’, including MDEA, MDA and
PMA.4,8,9 Users are generally unaware of the
actual substance they are taking and this can cause problems when they
experience effects that they were not anticipating or take additional doses
before the full effects of the original dose are manifest leading to
overdose.10 Ecstasy manufactured on the black
market also varies in quality and potency (personal communication, New Zealand
Police, 2002), and is cut with a range of adulterants such as caffeine and
aspirin, or with other drugs such as methamphetamine, ketamine and
ephedrine.8 Again, these features are unknown
to the user and can have important implications for effects and harm. Finally,
ecstasy users tend to be poly-drug users and this exposes them to the risks and
harms of combining ecstasy with other
drugs.6
A number of record seizures of ecstasy have been made by New
Zealand Customs and Police in recent years. Total seizures of ecstasy increased
from fewer than 3000 tablets in 1998, to 73 000 tablets in 2001, to 220 000
tablets in 2002 (personal communication, National Drug Intelligence Bureau,
2002). The dramatic increase in seizures has fuelled speculation about the
extent of use of ecstasy and the current conditions of supply. Unlike
methamphetamine, a drug that is also commonly associated with the dance party
scene, there is no known domestic manufacture of ecstasy in New Zealand
(personal communication, National Drug Intelligence Bureau,
2002).3 The synthesis of ecstasy is a complex
process that requires sophisticated and closely monitored precursor chemicals,
such as oil of Sassafras. The difficulty of manufacture has precluded the
establishment of any large-scale domestic production in New Zealand to date.
Only one case of ecstasy manufacture has ever been detected and this was on a
small scale (personal communication, New Zealand Police, 2002). All of the
ecstasy used in New Zealand is smuggled into the country from overseas; mainly
from Western Europe but more recently from
Asia.3 New Zealand is generally considered to
have relatively effective border controls, as evidenced by the success against
heroin importation in the 1970s.11 The high
price of ecstasy in New Zealand3 and its
apparent availability in urban centres such as Auckland and Wellington have led
the popular media to characterise it as the drug of choice of young,
high-income-earning
professionals.11,12
This paper draws on data from the 1998 and 2001 National
Drug Surveys to examine changes in the use of ecstasy, current conditions of
supply, harms related to use, and the demographic characteristics of users in
New Zealand. The prevalence of ecstasy use is put into the wider context of drug
use in New Zealand through comparison with data relating to the use of marijuana
and amphetamines from the same surveys.
MethodsThe National Drug Survey
interviews a sample of approximately 5500 people aged 15–45 years about
their alcohol, tobacco, marijuana and other drug use, using a Computer Assisted
Telephone Interview (CATI) system. Telephone numbers are selected using a
stratified random digit dialling method so that each household (of a particular
stratum) nationwide has an equal chance of being called. To represent the
different socioeconomic characteristics of the population the country was
divided into 33 strata. A proportionate sample from each stratum was then taken.
Within each household, one person is randomly selected for an interview.
Interviewers receive intensive training at the beginning of the survey, and a
supervisor is present at each shift to monitor the quality and consistency of
interviewing, and to handle any special problems. Each telephone number is
called up to at least ten times in an effort to reach those seldom at home. The
1998 and 2001 surveys achieved response rates of 79% and 80% respectively. More
details of the methodology can be found in Wilkins et al,
2002.13
During the interview, respondents are asked whether they have ever used substances from a list of drug types for recreational purposes. Ecstasy is included in this list. To enhance recognition by respondents interviewers read out a number of common terms and technical names for each drug type and for ecstasy they read ‘E’ and ‘MDMA’. Questions are also asked about ‘stimulants’, which are described by the interviewer as ‘uppers, speed, amphetamine, methamphetamine’. In 2001, those who had used ecstasy in the last 12 months were asked a number of additional questions about their experience of use and supply. These included questions about whether use had harmed eight areas of their lives in the previous 12 months, and how price and availability compared with a year earlier. All respondents were asked a range of general demographic questions including age, gender, ethnicity, marital status, employment status, occupation and income. The findings of the two surveys were analysed for differences between the two samples as a whole, and for differences between the subgroups of the two samples using chi-square tests. All comparisons were tested at a 1% level for statistical significance after adjusting for design effects. Only significant changes are reported. Ninety nine per cent confidence intervals are reported. All analyses were conducted using SAS software. A descriptive analysis is presented of the demographic characteristics of last-year ecstasy users. Descriptive comparisons are made between males aged 18–29 who used ecstasy in the last year and those who did not. ResultsPrevalence
of use Last-year use of ecstasy by those aged 15–45 years increased
from 1.5% (1.0, 1.9) in 1998, to 3.4% (2.7, 4.1) in 2001. Increases were found
for those aged 20–24 (from 3.2% (1.4, 5.1) in 1998 to 10.0% (6.9, 13.2) in
2001) and 25–29 (from 2.5% (0.9, 4.1) to 6.3% (3.8, 8.9)).
Most of the increase in ecstasy use was due to increased use
by men (Figures 1 and 2). Last-year use by men aged 20–24 increased from
4.3% (1.4, 7.3) in 1998, to 12.5% (8.0, 17.1) in 2001, and last-year use by men
aged 25–29 increased from 3.2% (0.8, 5.7) to 8.8% (4.8, 12.9).
Figure 1. Last-year use of ecstasy by men by age group,
1998 and 2001
 Figure 2. Last-year use of ecstasy by women by age
group, 1998 and 2001
 Between 1998 and 2001, ecstasy use increased from 1.5% (1.0,
1.9) to 3.4% (2.7, 4.1), and stimulant use (uppers, speed, amphetamine,
methamphetamine) increased from 2.9% (2.2, 3.5) to 5.0% (4.2, 5.8), while there
was no statistical change in marijuana use (19.9% (18.3, 21.4) and 20.3% (18.8,
21.9)) (Figure 3).
Figure 3. Last-year use of ecstasy, stimulants, and
marijuana, 1998 and 2001
 Conditions of ecstasy
supply in 2001 In 2001, those who had used ecstasy in the previous 12
months were asked how the availability of the drug compared with that of a year
earlier. Forty three per cent of users thought it was ‘easier’ to
get ecstasy, 33% said it was ‘about the same’, 13% thought it was
‘harder’, and 11% ‘did not know’.
These respondents were also asked how the price of the drug
compared with that of a year earlier. Forty one per cent thought the price was
about the same, 29% thought it was lower, 16% said the price was higher, and 13%
did not know.
Self-reported harms from
ecstasy use in 2001 In 2001, last-year ecstasy users were asked whether
the use of ecstasy had harmed eight areas of their lives in the previous year
(Table 1). About one in ten reported problems related to ‘energy and
vitality’, ‘financial position’, ‘health’, and
‘outlook on life’. Approximately one in twenty reported problems
with ‘friendships and social life’ and ‘home life’.
Problems related to ‘work and work opportunities’ and
‘children’s health’ were rare.
Table 1. Identified areas of life that were harmfully
affected by the use of ecstasy in the last year, 2001
Demographics of last-year
ecstasy users in 2001 Ecstasy users were overwhelming male (70%) and from
the 18–29 age cohorts. Ecstasy users were particularly concentrated in the
20–29 age groups (67% of all users). Forty one per cent were 20–24
compared with 13% of the whole sample, and 26% were 25–29 compared with
13% of the whole sample. Only 5% of ecstasy users were 15–17, while this
age group made up 12% of the whole sample.
Ecstasy users were overwhelming European (84%) or Maori
(13%), as opposed to Asian (1%) or Pacific Island peoples (1%). A similar ethnic
bias was displayed in the comparison of men aged 18–29 who had used
ecstasy in the last year with those who had not. The ecstasy-using group were
more likely to be European (82% vs 72%) and less likely to be Asian (2% vs 8%)
or Pacific Island peoples (2% vs 6%), while numbers of Maori were comparable
(14% both groups).
Ecstasy users were predominantly single (68%), as opposed to
living with a partner (ie, either married or defacto, 20%) or separated from a
partner (widowed, divorced or separated, 12%). When males aged 18–29 who
used ecstasy in the last year were compared with those who did not, the
ecstasy-using group were more likely to be single (74% vs 60%) than living with
a partner (19% vs 36%).
Ecstasy users had a broad range of occupations with some in
managerial positions (10%) and professional positions with university degrees
(8%), but many others were in clerical/sales (34%), manual employment (15%), and
skilled trade jobs (21%) (Table 2).
Table 2. Occupations of last-year ecstasy users in
2001
Comparison of males aged 18–29 who used ecstasy in the
last year with those who did not showed that more of the ecstasy-using group
were employed in clerical/sales positions (31% vs 20%) and fewer were manual
workers (18% vs 28%), while employment in skilled trade (25% vs 23%) and
managerial positions (10% vs 8%) was comparable (Table 3).
Respondents were asked about the amount of income they
usually receive ‘in the hand’ (ie, after taxes). Consistent with the
range of occupations reported, ecstasy users reported a broad range of net
incomes. Twenty per cent of ecstasy users earned less than $10 000, and 61%
earned less than $30 000. Ten per cent of ecstasy users earned $50 000 or more.
Comparison of men aged 18–29 who used ecstasy in the last year with those
who had not found the ecstasy users earned only slightly more than those who
hadn’t used ecstasy. More of the ecstasy-using group earned $30
000–$39 999 (25% vs 20%) and $40 000–$49 999 (13% vs 10%), but fewer
earned $50 000+ (5% vs 8%).
Table 3. Occupations of men aged 18–29 who used
ecstasy and did not use ecstasy in last year, 2001
Discussion
Comparison of the findings from National Drug Surveys in
1998 and 2001 indicates increased use of ecstasy in New Zealand. Due to the
difficulties of surveying illicit drug
users,14,15 and in particular heavy drug
users,16 these figures are likely to
underestimate the true number of ecstasy users to some extent and consequently
are best thought of as conservative estimates. However, the consistency of the
survey methodology between the survey waves suggests the increase in use is
likely to be fairly accurate. In combination with the increased use of
amphetamines, and no change in cannabis use,17
these findings indicate some change in the nature of drug use in New Zealand.
However, cannabis remains New Zealand’s most-widely-used illicit drug,
with 20% of those aged 15–45 reporting last-year
use.18
Comparison of the changes in the prevalence of ecstasy use
with changes in the use of stimulants (uppers, speed, amphetamine,
methamphetamine) from the 1998 and 2001 surveys reveals some interesting
differences despite both drugs being commonly associated with the dance party
scene. As reported previously, increases in stimulant use were found among those
aged 15–17 (1.6% (0.2, 3.0) in 1998 to 5.3% (2.8, 7.9) in 2001) and
20–24 (5.8% (3.4, 8.2) to 10.5% (7.3, 13.7)), and among men aged
15–17 years (1.5% (0.0, 3.2) to 5.7% (2.2,
9.2)).18 As reported here, increases in ecstasy
use were found among those aged 20–24 (3.2% (1.4, 5.1) to 10.0% (6.9,
13.20)) and 25–29 (2.5% (0.9, 4.1) to 6.3% (3.8, 8.9)), and among men aged
20–24 (4.3% (1.4, 7.3) to 12.5% (8.0, 17.1)) and 25–29 years (3.2%
(0.8, 5.7) to 8.8% (4.8, 12.9)). The increases in ecstasy use were larger than
for stimulants in many of the age cohorts despite the absence of any domestic
manufacture of ecstasy in New Zealand. However, there was no significant change
in ecstasy use by those aged 15–17 (0.8% (0.0, 1.7) to 1.4% (0.1, 2.7))
compared with a fairly large and significant change in stimulant use in the same
age group (1.6% (0.2, 3.0) to 5.3% (2.8, 7.9)). In 2001, 15.0% (7.6, 22.3) of
men aged 18–19 had used stimulants in the last year (the highest
prevalence of stimulant use for any age cohort for
men)18 compared with only 6.6% (1.4, 11.7) of
men aged 18–19 using ecstasy in the last year. This may indicate some
cultural, social or economic separation between the use of amphetamine and the
use of ecstasy by young people in New Zealand. It may be the case that locally
manufactured amphetamine is easier for young people to access than
internationally smuggled ecstasy.
Reports in 2001 of easier availability and lower prices for
ecstasy compared with a year earlier suggest improving conditions of supply
despite record seizures of the drug by Customs and Police. However, these data
indicate only changes in availability
and prices and not absolute conditions of supply. It still may be the case that
internationally smuggled ecstasy is more difficult to obtain than locally
produced methamphetamine and cannabis.
A minority of ecstasy users reported problems related to
their use of ecstasy. The areas in which problems were most commonly reported
were ‘energy and vitality’, ‘financial position’,
‘health’ and ‘outlook on life’. Many of these problems
are consistent with the amphetamine attributes of ecstasy, which allow users to
sustain long periods of intensive physical activity, such as dancing, while
under the influence of the drug but result in exhaustion and depression in the
days after use.5,6 The relatively low level of
problems related to ‘friendship and social life’ (5%) may reflect
the empathy-enhancing qualities of ecstasy as opposed to the aggression
sometimes reported by amphetamine users. The low level of problems experienced
with ‘work and work opportunities’ (1%) may reflect the fact that
unlike traditional amphetamines, which are sometimes used to extend endurance at
work, the empathy-inducing qualities of ecstasy restrict its use to leisure
contexts.
The eight questions asked about the harms relating to
ecstasy use in the 2001 survey can provide only a very broad assessment of the
health consequences of use. Respondents were not asked about specific problems
and were not able to express the seriousness of the harms they had experienced.
Time constraints on the length of the interview meant detailed questioning about
the harms of any one drug were not feasible in a population-level drug survey of
this type. An Australian study of regular ecstasy users (three times or more in
the last year) that drew on a snowball sample and conducted in-depth questioning
about harms found users commonly reporting a range of psychological and physical
side effects.6 These included blurred vision
(46% of participants), numbness (42%), confusion (30%) and anxiety (27%) while
experiencing the effects of the drug, and loss of energy (61%), irritability
(60%), muscle aches (58%), insomnia (52%), depression (50%), confusion (36%),
anxiety (33%) and paranoia (31%) in the days after
use.6 A high proportion of the participants in
the Australian study reported binge and intravenous use of ecstasy, and
extensive poly-drug use, all of which may have had an impact on the extent of
harms reported.
The popular perception of ecstasy users in New Zealand, as
portrayed in the popular media, is often of young, high-income-earning
professionals involved in the dance party scene. The examination of the
demographic characteristics of last-year ecstasy users from the 2001 National
Drug Survey provided only mixed evidence to support this popular stereotype.
Ecstasy users were predominantly male and from the 20–29 year age cohorts,
but were from a broad range of occupational backgrounds and income-earning
capacities. Ecstasy users were more likely to be European, single, have
clerical/sales employment, and earn middle-level incomes.
Author information:
Chris Wilkins, Researcher; Krishna Bhatta, Statistician; Megan Pledger,
Statistician; Sally Casswell, Professor and Director, Centre for Social and
Health Outcomes Research and Evaluation (SHORE), Massey University,
Auckland
Acknowledgements:
The national drug comparison survey was a project of the Alcohol & Public
Health Research Unit (APHRU) at the University of Auckland, which was funded as
a programme of the Health Research Council and the Alcohol Advisory Council. The
funding for the survey was provided by the Health Research Council as an
investigator-initiated grant to Professor Sally Casswell. The project was led by
Dr Chris Wilkins with Rachael Lane, Mary Blade and Heather Seal. The data
management and statistical analysis were carried out by Dr Krishna Bhatta and Dr
Megan Pledger, assisted by Michael Ford and Alistair Stewart. We acknowledge the
time and willingness of participants to respond to the survey, without whom the
project could not have taken place.
Correspondence: Dr
Chris Wilkins, Centre for Social and Health Outcomes Research and Evaluation
(SHORE), Massey University, PO Box 6137, Auckland. Fax: (09) 366 5149; email: c.wilkins@massey.ac.nz
References:
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