Three NIDA-funded ethnographic studies presented at the MDMA/Ecstasy Conference illustrate the diversity and complexity of MDMA use in the United States. The studies showed both similarities and differences in patterns of MDMA use and associated sexual behaviors among homosexual men in Boston and New York City, predominantly white heterosexual users in central Ohio, and a racially diverse group of users in Hartford, Connecticut. The studies employed a variety of research techniques, such as on-site observation and interaction with ecstasy users in clubs, informal and structured interviews, and small focus groups, to ascertain who uses MDMA, their patterns of drug use and related behaviors, and the settings in which they use drugs.

Preliminary findings from these studies suggest that targeted drug abuse prevention approaches that address specific factors that are associated with MDMA use by different types of users and in different regions of the country are needed to reduce MDMA abuse. Further research to understand the factors that increase or reduce the risks for drug use in these groups is needed to shape prevention initiatives, the researchers indicated.

MDMA Use Among Men Who Have Sex With Men

A field study conducted by Dr. Patricia Case of Harvard Medical School in Boston found considerable individual, group, and regional variations in patterns of MDMA use among club-drug-using men who have sex with men (MSM) in Boston and New York. More than 50 percent of men interviewed in the study frequently used MDMA in combination with other drugs and 11 percent had injected mainly anabolic steroids within the last 3 months. MSM reported that MDMA use usually occurs with other drugs, including ketamine, cocaine, methamphetamine, and Viagra. Some users primarily engage in uncontrolled drug use, others also take MDMA frequently but according to a set schedule with other drugs to achieve special effects, and still others use MDMA occasionally in connection with special circumstances or holidays.

The MSM in this study were very sexually active and reported unprotected sex while using MDMA although not so often as with other drugs, such as methamphetamine. MDMA prevention messages have had little effect on MSM. This population expressed more concern about the risks of GHB (gamma-hydroxybutyrate), a central nervous system depressant, because of reported overdose deaths from that drug in both cities.

MDMA Use in Central Ohio

Dr. Robert Carlson and colleagues of Wright State University School of Medicine in Dayton, Ohio, conducted a pilot study of MDMA use among 28 individuals in 2 focus groups in Dayton and Columbus. Participants were evenly divided between men and women who were almost exclusively heterosexual. Like the MSM study, the Ohio study showed tremendous variations in patterns of MDMA use.

One-third of the study population said they had used other club drugs, such as ketamine and GHB, and high alcohol use was common. Dance clubs were popular settings for MDMA use among college students and other young adults, who tended to use MDMA to enhance sociability. MDMA users at raves were younger, less educated, and more likely to have a drug-using lifestyle than were the club-goers. Participants said they also used MDMA at parties, lakes, beaches, high schools, and in cars.

"MDMA is seen as a relatively benign drug," Dr. Carlson said. "Most people hear of very few negative consequences from friends, although they do express concern about adulterants in the pills they are getting." None of the participants reported any negative effects of MDMA use on memory, cognition, or work performance. Condom use during sex appeared to be the norm, but several women reported having sex with men they had not intended to be with after taking MDMA.

MDMA Use Among Urban Youth in Hartford, Connecticut

Dr. Jean Schensul, of the Institute for Community Research in Hartford, Connecticut, reported information from observations and interviews with urban youths in party and club settings combined with survey data obtained during a 15-month study of youths in Hartford. Study participants were 16 to 24 years old, 70 percent male, 40 percent Hispanic, 38 percent African American, and 22 percent Caucasian, Asian, and mixed race or ethnicity. MDMA use in this population is linked to their social networks, club-going, and parties. MDMA is often used with other drugs, including marijuana, PCP, and alcohol.

"These youth have limited access to accurate sources of information and are uninformed about the risks of MDMA use and drug mixing," Dr. Schensul said. They are exposed to popular hip-hop magazines and rap music lyrics that promote the connection between ecstasy, the "good life," and better sex. The study shows that MDMA use has spread from the suburbs to the city and is increasing the already high levels of risk of unprotected sex and sexually transmitted diseases among these economically vulnerable young people. The findings suggest that culturally and developmentally appropriate prevention approaches that focus on reducing harmful behaviors are needed for this population, Dr. Schensul said.