A rapid scoping review of self-initiated harm reduction strategies for ecstasy (MDMA) users in recreational settings

Abstract

Abstract Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Self-initiated harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. Methods: A rapid scoping review was conducted using adapted JBI methodology. The objectives were to describe the strategies employed by ecstasy users to minimise harm, the sources of information they rely on, and to assess the content of user-oriented websites regarding detrimental effects and harm reduction practices. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches. Results: Twenty reports representing 19 studies (one RCT, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of self-initiated harm reduction strategies were reported, including drug checking, dose control (including buying from trusted sources), seeking peer support (e.g., looking out for friends), hydration management and temperature regulation (e.g., monitoring water consumption, taking rest breaks, and avoiding alcohol), avoiding polydrug use, and pre- / post-loading. Information on ecstasy’s effects and/or harm reduction practices is obtained from a variety of sources including friends, nightclubs, drug leaflets, and user-oriented websites. Fourteen websites providing ecstasy-specific harm reduction information were also identified and quality assessed. However, only two webpages provided citations to the evidence used for the content. Conclusions: The provision and quality assessment of ecstasy harm reduction advice from various sources has been collectively analysed for the first time. We hope and anticipate that use of this rapid scoping review will facilitate more comprehensive, evidence-based harm reduction messaging, reducing the likelihood of future ADRs and life-threatening health consequences related to ecstasy use.