Shifting characteristics of ecstasy users ages 12-34 in the United States, 2007-2014

Background: Ecstasy/MDMA has been one of the most prevalent party drugs for decades, and powder ecstasy recently increased in popularity. We examined trends in use to determine who to best target for prevention and harm reduction. Methods: Secondary analysis of the 2007-2014 National Survey on Drug Use and Health, a repeated cross-sectional, nationally representative probability sample, was conducted Linear trends in past-year ecstasy use and trends in demographic and other past-year substance use characteristics among ecstasy users were examined among participants ages 12-34 (N = 332,560). Results: Past-year prevalence of ecstasy use was stable across years at 2% (P = 0.693). Over time, the proportion of ecstasy users with a college degree increased from 11.5% in 2007/08 to 24.5% in 2013/14 (P < 0.001). The proportion of users who were age 12-17 decreased, as did proportions of users who are non-Hispanic black, and reported income < $20,000/year (Ps < 0.001). Prevalence of past-year use of marijuana, LSD, ketamine, and DMT/AMT/Foxy increased among ecstasy users (Ps < 0.05); DMT/AMT/Foxy use increased more than fourfold from 2.1% in 2007/08 to 8.7% in 2013/14. Perception of great risk associated with LSD use decreased among users and ease of obtaining LSD increased (Ps < 0.05). Past-year use of 5 or more other substances also increased over time (P < 0.05). Conclusions: Ecstasy use in the US appears to be increasing among those with college degrees and use of other substances among ecstasy users is growing particularly use of otherwise rare substances such as tryptamines. Results inform prevention and harm reduction strategies in this increasingly shifting group of ecstasy users.