Patterns of use and harm reduction practices of ecstasy users in Australia

Harm reduction refers to the use of strategies to prevent or reduce harmful consequences associated with illicit drug use. There is a paucity of research concerning the harm reduction practices employed by ecstasy users. This study aimed to explore the prevalence, nature and factors associated with harm reduction practices employed by ecstasy users in Australia, with a specific focus on the practice of preloading and postloading--the use of pharmaceuticals and natural products prior and subsequent to ecstasy use. One hundred and sixteen Australian residents aged 18 years and over who had used ecstasy at least once in their lifetime were recruited via convenience sampling, 'snowballing' and via web-based advertisements and completed an anonymous questionnaire. Participants reported using a wide range of strategies for minimising ecstasy-associated harm. The most common strategies used for reducing negative side effects, 'comedown' or neurotoxicity were drinking water, limiting or reducing ecstasy use, taking breaks and taking vitamins or other natural substances. Forty percent of the sample had tested their ecstasy pills for the presence of MDMA. Forty-one percent and 47% of participants had engaged in pre- and postloading, respectively, with the most common pre- and postloading substances being multivitamins, 5-HTP, magnesium and fruit or fruit juice. Younger mean age and 'high' total occasions of ecstasy use was significantly associated with preloading, and 'high' total use and frequency of use was associated with postloading. The results indicate that ecstasy users are aware of the potential for harm associated with ecstasy use and attempt to minimise harm by actively employing strategies. By exploring the pattern of harm reduction practices among ecstasy users, this study has highlighted the need for further research into the efficacy and potential clinical drug interactions associated with such practices, as well as the need for investigation of how such practices may affect patterns of ecstasy use.