Although very rarely reported, opioids may also be found in tablets royalmedspharma.com sold as MDMA. In the period from 2019 to 2023, caffeine, 4-CMC (4), amphetamine, cocaine and MDA were the adulterants most commonly found in MDMA samples (tablets and powders/crystals) submitted to drug-checking organisations belonging to the TEDI network. Again, these data should be interpreted with caution and not necessarily be seen as statistically representative of the market as a whole. Crystal MDMA appeared on the European market at that time, as a response to a fall in consumer confidence due to concerns about the low quality of ecstasy. However, adulteration is commonplace, and therefore these tablets may contain a variety of substances in addition to, or instead of, MDMA. Retail quantities sold online are often dispatched in post and parcels from EU Member States to consumer markets in Europe and globally, and cryptocurrencies are often used to settle these online transactions.
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These signals were reported to the EU Early Warning System from 2022 onwards, based on identifications occurring in Spain, the Netherlands and Austria, and there are similar indications for the United Kingdom (Pascoe et al., 2022). One relatively recent adulteration pattern is the increase of synthetic cathinones mis-sold as MDMA or used to adulterate MDMA. Interestingly, synthesis by-products were also commonly reported, about which little is known and which may pose additional risks to consumers. A number of substances can also be sold as MDMA, in what is sometimes called mis-selling or adulteration by substitution – whereby another substance is passed off as MDMA to the consumer. Adulteration of MDMA occurs by adding other psychoactive substances, typically stimulants, to MDMA in tablet, powder or crystal form.
According to survey data, the two largest MDMA consumer markets per capita in the European Union are the Netherlands and Ireland, with 6 % or more people aged 15 to 34 reporting to have consumed MDMA in the last year. Some of the high-strength ecstasy tablets are scored to allow consumers to divide them into smaller portions. These identifications of high-strength ecstasy tablets prompted harm reduction organisations to issue alerts. In December 2023, beige-golden ecstasy pills with an Audi-logo containing over 300 milligrams of MDMA (between 316 and 324 milligrams) were submitted to drug testing in the Netherlands (DIMS, 2023). However, this trend appears to be changing, as ecstasy tablets have tended to contain less MDMA since 201
A review of MDMA-related mortality in Australia and three European countries (Portugal, Finland and Türkiye) showed an increase in the number of fatalities between 2011 and 2017 (Roxburgh et al., 2021
(a) In clinical trials, doses of MDMA capable of producing subjective effects vary from 1.5 to 1.7 mg/kg of body weight, or approximately 105 to 119 milligrams for a 70-kilogram individual. Some tablets even contain stamping that indicate the quantity of MDMA present, although this is not always accurate and may also constitute a health risk. For example, in August 2023, tablets containing 350 milligrams of MDMA were seized in Spain. Meanwhile, data from drug-checking services suggest that approximately 85 % of the powders tested in 2023 contained between 80 and 100 % MDMA (81 % in 2022). Data reported to drug-checking services are generally in agreement with these trend
These detections have generally been small in quantity with the powders containing a range of different substances – always ketamine and MDMA, and typically additional substances including cocaine, caffeine or cathinone
Adulteration of MDMA occurs by adding other psychoactive substances, typically stimulants, to MDMA in tablet, powder or crystal form. PMK glycidate, first reported in Europe in 2013, had a particular role in this resurgence (see Section Production - designer precursors substitute scheduled MDMA starting materials). In 2009 and the following years, it was therefore unlikely that consumers who purchased ecstasy in Europe would obtain unadulterated MDMA. In 2009, on average, only 31 % of the tablets analysed contained MDMA alone, compared with almost 100 % in 2004. This includes law enforcement pressure, a variety of factors affecting MDMA production, such as the availability of MDMA precursors, and, more generally, globalisation of the illicit drug supply chain
Surrey Young People’s Substance Use Service
Crystal MDMA was marketed as a purer product compared to ecstasy tablets, an assertion that was and remains largely true (see Section The trend of large tablets containing more MDMA may be reversing). One way to observe these cycles is to monitor rates of adulteration, as expressed by the percentage of tested samples royalmedspharma.com of seized ecstasy tablets that contain MDMA and no other scheduled substances. Together, these two data sources suggests that the large majority of MDMA users buy the drug themselves, and that a smaller proportion obtains it for free, despite marked differences among EU countries. Some substances found in these drugs can be toxic, even at low doses and even pure MDMA can be dangerous.