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


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 royalmedspharma.com is to monitor rates of adulteration, as expressed by the percentage of tested samples of seized ecstasy tablets that contain MDMA and no other scheduled substances. Despite this, on average, only a minority of EWSD respondents reported obtaining the drug online, although this varied widely across countries. MDMA is one of the most frequently traded drugs online across a range of platforms, including darknet markets (see Section Trafficking and distribution — online trade and distribution on darknet markets) as well as surface web and social media platform

(1) The European Web Survey on Drugs (EWSD) is a voluntary, anonymous survey run by the EUDA and its partners targeting directly people who use drugs who are 18 years old or older, and are living in one of the participating countries. Alcohol was co-consumed across 67 % of all MDMA-related hospital emergencies, and the other drugs commonly consumed alongside MDMA included cocaine, royalmedspharma.com amphetamine, methamphetamine, ketamine, heroin, GHB and cannabis. MDMA is reported in small numbers of drug-induced deaths, and in most countries less than 1 in 20 cases involve the drug. This increase coincided with a period of increased purity and availability of MDMA in these markets, suggesting that changes in MDMA supply may result in serious public health risks.


Given the option, it is clear that people who use MDMA and other drugs will embrace harm reduction approaches, and support their development. Harm reduction is not a principle that policy makers will need to force upon people who use MDMA or other drugs in nightlife and party settings. Significant numbers of people not only like MDMA’s effects and are willing to take known risks (health and legal) to enjoy them, but they seem to prefer it to most available substitutes. Perhaps most obviously it demonstrates, yet again, the futility of putting enforcement, targeting either people who use or supply, at the forefront of the policy response to drugs. The EMCDDA also reported in 2019 that ‘transactions involving quantities of MDMA tablets royalmedspharma.com indicative of the middle level of the market account for more than double the revenue of sales of retail-level quantities’.
MDMA rarely cited as a reason for entering drug treatment in Europe
By combining these data, the estimated annual value of the retail market for MDMA in Europe is at least EUR 594 million, around 90 % of which can be attributed to frequent users. The price data used was the average retail price for MDMA in royalmedspharma.com the country concerned, drawn from the EUDA’s annual data collection (see Section Price and purity). For some countries (Belgium, Croatia, Denmark, France, Malta, Netherlands, Norway and Türkiye) no data were available from the EWSD. The annual amounts used, in tablets, could be estimated for each survey participant based on their responses to questions on the number of tablets used on a typical day, multiplied by the number of days they said they used the drug in a year. As such, only last year prevalence and last month prevalence data are required to distinguish these two group


(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

Rates of adulteration of ecstasy tablets, their MDMA content and their price tend to reflect broader changes in the factors that affect the MDMA market. MDMA is most commonly found on the European market in the form of ecstasy tablets, relatively pure crystals or powders (finely ground crystals of MDMA that are typically mixed with other substances). Analysis of drugs sold as MDMA/ecstasy in Australia shows that these contain a wide range of substances, and some contain no MDMA at all.
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Although often used interchangeably, ecstasy and MDMA are not necessarily synonyms. Additionally, particularly with instant messaging applications, transactions may be organised online, but completed using in-person pick-up or ‘dead-drop’ delivery. Recently, however, social media platforms and instant messaging applications have become particularly dynamic online channels through which MDMA is sold to consumers.
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