1. Do consumers of ecstasy-type pills take preventative measures to avoid bad effects from ecstasy-type pills? Dr Fairlie McIlwraith Associate Professor Rosa Alati

2. Acknowledgements National Drug and Alcohol Research Centre University of New South Wales Ecstasy and related Drug Reporting System – survey participants and key experts – research teams from each jurisdiction

3. Precautionary strategiesPrecautionary strategies in 2012in 2012

4. Previous research findings Regular ecstasy users generally had a perception of risk, reasonably well informed, using harm reduction strategies Normalisation of ecstasy use Pleasure a compelling reason for use Mostly taken in a social environment. Friends may provide a sense of security Group decision making

5. Previous research findings Ecstasy the second most commonly used illicit drug in Australia Highest use in 20-29 age group, with recent use by 1 in 10 Decrease from 2007 2010 National Drug Strategy Household Survey

6. Ecstasy and related drug reporting system National monitoring system of people who regularly use ecstasy Annual survey in all states and territories Key expert interviews Existing data

7. Method  A national sample of 606 people who regularly use ecstasy recruited through purposive sampling for confidential, face- to-face interviews of approximately one hour.  Criteria for participation were being at least 16 years old, having used ecstasy-type stimulants at least six times in the previous six months, and having lived for the past year in the capital city where the interview took place.  Participants gave informed consent.  Ethical clearance was obtained nationally and in each state and territory.

8. Demographic characteristics of survey participants Mean age 25 years Two thirds male 87% heterosexual Half had tertiary qualifications 84% employed or studying (full-time, part- time or in combination)

9. Ecstasy purity rated as low, 2003-12

10. 2012 What precautions did you generally take to avoid bad effects from ecstasy-type pills in the last six months?

11. Precautions taken

12. Nearly one in five (19%) responded ‘none’

13. Should we worry?!

14. Rating of ecstasy purity

15. Lab testing results confirm that quality mixed

16. Number of people purchased from, by whether took precautions Precautions 0123≥4 Yes (%) n = 462 115212539 No (%) n = 108 39232243

17. Who is not taking precautions?

18. Similar demographic characteristics Similar proportion had experienced problems caused by drugs (social, legal, risky behaviour, responsibilities) Similar level of mental health (self reported problems and K10)

19. In the last six months about what proportion of your friends and acquaintances have used ecstasy?

20. Proportion of friends who use ecstasy by whether precautions taken

21. No significant differences Ecstasy use Age first used ecstasy and when use became regular Length of time using ecstasy Frequency and amount Ecstasy market Perceptions of purity and availability Who they purchased from & frequency of purchases

22. Other risky behaviour by those who reported not taking precautions Significantly less likely to have Recently used an emerging psychoactive substance, 23% compared with 35% Significantly more likely Unprotected sex with a casual partner while using drugs, 57% compared with 43%

23. Those who reported not taking precautions differed significantly around alcohol use Drank alcohol more often in the previous six months, a mean of 68 days compared with 57 days More likely to have had more than 5 standard drinks the last time they had ecstasy, 72% compared with 62% More likely to have driven under the influence of alcohol, 68% compared with 54% Higher mean score on Alcohol Use Disorder Identification Test (AUDIT)

24. Alcohol Use Disorders Identification Test (AUDIT)

25. Important differences Those who said they did not take precautions were more likely to have higher use of alcohol unprotected sex with a casual partner when using drugs a larger proportion of their friends using ecstasy

26. Conclusions Combination of ecstasy use with high alcohol use associated with less precautionary behaviour Friendship networks amongst ecstasy users can work for or against harm reduction