Purpose: Pharmacokinetic, forensic: to evaluate the accuracy of salivary testing for MDMA via Drugwipe "amphetamines" test (an immunochromatographic test) and the associated Drugread device in individuals given a dose of 100 mg MDMA.

Design: Randomized placebo-controlled double-blind crossover (within-subjects) study, wherein all participants received 100 mg MDMA and placebo in sessions scheduled at least 1 wk apart. All participants underwent repeated testing with Drugwipe and provided saliva samples for GC-MS testing.

Subjects: 8 MDMA-experienced volunteers. No information is provided on participant age or gender, but all previous publications from this team have involved male participants aged 18-40 years. No information is provided on recruitment; previous papers indicate recruitment via "word of mouth."

Criteria for Inclusion - Having used ecstasy at least 5 times over a lifetime, being in good physical health as assessed through medical examination, laboratory tests, urinalysis and ECG. Previous studies have also restricted participation to males, but no information on participant gender or gender restrictions provided in this paper.

Measures: Salivary Measure 1 (Drugwipe On Site) - Drugwipe device was wiped on tongue for 10 sec at 0 h (pre-drug), 1.5, 4, 6, 10 and 24 h after MDMA administration.

Salivary Measure II - Drugwipe in laboratory - Saliva was applied directly to the Drugwipe pad in the laboratory, using a volume of saliva from saliva collected from participants (see below) at 0, 1.5, 4, 6, 10 and 24 h post-drug. Drugread was used to assess each sample, with laboratory personnel blind drug condition.

Salivary MDMA via GC-MS - Participants provided 1-2 mL saliva by spitting into plastic tube, with samples collected at 0, 1.5, 4, 6, 10 and 24 h after MDMA or placebo administration.

Analyses: No parametric analyses performed when examining number of positive readings for Drugwipe on-site or in the laboratory. Student's t test was used to compare strength of Drugwipe assay read by Drugread device by comparing across MDMA and placebo conditions and comparing samples taken at 1.5, 4 and 6 h.

Results: Salivary Measure 1 - No positive readings were given at 0 h (pre-drug). Visually scored Drugwipe "amphetamines" test gave positive readings to 7/8 participants at 1.5 h post-drug. Drugwipe gave positive readings to 4/8 participants 4 h post-drug, 3/8 participants at 6 h post-drug and to 2/8 participants at 10 h post-drug. The device did not provide any positive readings at 24 h post-drug. Drugwipe registered a faint color change in an unspecified number of participants tested in the placebo session.

Salivary Measure II - No positive readings were seen at 0 h (pre-drug). All (8/8) participants received positive readings from Drugread-scored Drugwipe assays at 1.5 and 4 h post-drug. 7/8 participants had positive readings at 6 h post-drug, and 5/8 had readings 10 h post-drug. There were no positive readings at 24 h post-drug. When Drugread was used to measure color change by Drugwipe, significantly different readings were found for the MDMA and the placebo conditions at all time points compared (1.5, 4 and 6 h).

Salivary MDMA via GC-MS - On average, GC-MS testing detected 33756 mG of MDMA per L in saliva at 1.5 h, and 1762.7mG per L at 4 h. Levels of MDMA in saliva were not reported for 6, 10 or 24 h. The authors state that MDMA was the only analyte detected by GC-MS in saliva, indicating that other metabolites (like HMMA or MDA) that have been detected in plasma or urine were not detectable in saliva.

Overall Effects: MDMA was detectable in saliva via the Drugwipe immunochromatography assay and through GC-MS. However, a count of positive readings in on-site (visually scored) Drugwipe compared to laboratory readings (using device measuring light reflectance of test) suggest that Drugwipe is more accurate when it is read with the new device (Drugread) rather than when visually inspected. Though it a faint color change appeared on placebo sessions, a comparison of samples taken during MDMA sessions and placebo sessions that used Drugread-scored tests found that the two produced significantly different readings at 1.5, 4 and 6 h after drug administration. Furthermore, assays read by Drugread varied in arbitrary "Drugread units" seemed to follow the same time-course in concentration as did salivary concentration measured via GC-MS. MDMA was the only metabolite detected in saliva with GC-MS. It would seem that the Drugwipe "amphetamines" test is an adequate, though not perfect, means of detecting MDMA in saliva.

Adverse Effects: None reported in this paper.

Comments: This paper reports findings from one of a series of pharmacokinetic and forensic studies performed by the same team. The authors state that despite its being less accurate than GC-MS after 6 or more hours have elapsed since MDMA/ecstasy use, this inaccuracy would not detract from using it in the context of traffic arrests, as most of the subjective effects of ecstasy have disappeared by 6 h post-drug. The authors also hypothesize that it is also simpler and potentially less distressing to collect samples of saliva than it is to collect blood or urine samples. In previous reports, this team has tried to detect MDMA in plasma, urine and sweat. In their previous report, members of the same team detected MDA and trace amounts of HMMA in saliva, but in this report, they were unable to detect MDA or HMMA in saliva. As is the case with other papers by this team, the sample size is small and all participants are male, and thus generalizing findings to larger samples or to females may not be warranted.