Purpose: Neuropsychological, physiological; to compare the incidence of self-reported physiological and psychological problems in novice, moderate and heavy ecstasy users

Design: Retrospective (non-experimental) between-subjects design, with drug use (novice, moderate or heavy ecstasy use) serving as a between-subjects variable, and with all participants completing on-line surveys. The entire sample contained a larger number of people who reported never using ecstasy, but data from these respondents is not examined.

Subjects: 282 ecstasy users mostly residing in Europe or North America. Respondents were recruited through various means, including placing announcements about the website on relevant e-mail lists and groups, postings on other web pages and announcements at the researchers' university. Matching - No attempt was made to explicitly match ecstasy users and non-ecstasy users.

Criteria for Inclusion, Novice ecstasy users - Having reported using ecstasy 1-9 times over a lifetime. Moderate ecstasy users - Having reported using ecstasy 10-99 times over a lifetime. Heavy ecstasy users - Having reported using ecstasy 100 or more times over a lifetime. All groups - No further information provided in this report, but a previous report by Rodgers and colleagues may contain more relevant information, assuming either the sample or the sampling process for the two studies was similar. In Rodgers et al (2001), all respondents were required to complete all measures at the website, could show no signs of mischievous completion (i.e. grossly discrepant demographic information, self-reported intoxication during time of measure completion), only one response per individual IP address was allowed (to reduce or eliminate effects of multiple completions from the same individual). It is assumed that Parrott et al. used the same qualifications, but this is not reported.

Drug Use Parameters - Little or no information is provided on drug use parameters for ecstasy or drugs other than ecstasy. Actual total lifetime doses were not provided for any group; 109/282 reported 1-9 total uses of ecstasy, 136/282 reported 10-99 total uses of ecstasy and 37/282 reported 100 or more uses of ecstasy over a lifetime. Average dose per use not provided. A crude estimate would be 1.5 tablets per use for novice users, 1.84 tablets per use for moderate users, and 2.33 tablets per use for heavy users. (Actual figures, 100% of novice users reported 1-2 tablets per use. 84% of moderate users reported 1-2 tablets per use, 13% reported 3-4 tablets per use and 3% reported 4 or more tablets per use. 62% of heavy users reported 1-2 tablets per use, 24% reported using 3-4 tablets per use and 14% reported using 4 or more tablets per use.) No information is provided on duration of use, frequency of use or time elapsed between last use and study day for novice, moderate or heavy users. 91% of novice users reported a maximum weekly dose of 1-2 tablets and 9% of novice users reported maximum weekly dose of 3-9 tablets, and none reported a maximum weekly dose. 23% of moderate users reported 1-2 tablets maximum weekly dose, 68% reported 3-9 tablets as maximum weekly dose and 9% of reporting 10 or more tablets maximum weekly dose. No heavy users reported a maximum weekly dose of 1-2 tablets, 65% reported 3-9 tablets as maximum weekly dose and 35% reported maximum weekly dose of 10 or more tablets. Other drugs - No information is provided specifically in amount of other drugs used or percentage of sample using other drugs, but cannabis use was reported by a large number of ecstasy users in the study of Rodgers et al (2001). An unspecified number of ecstasy users also reported having used unspecified amounts of alcohol, nicotine, amphetamines, cocaine and LSD.

Group Demographics and Matched Variables - The authors did not explicitly match groups on any demographic variables. No information is provided on gender composition, mean, median or modal age or educational attainment of the sample.

Information from the study

Measures: Author-derived on-line forced choice (yes/no) measure of presence versus absence of self-reported symptoms occurring "off-drug," with period of time elapsed between last use and appearance or occurrence of reported complaint left unspecified. Symptoms listed were poor memory, poor concentration, depression, anxiety, mood fluctuation, impulsivity, weight loss, infections, tremors/twitches, poor sleep, and sexual problems.

Analyses: All responses were analyzed via 2 x 3 chi-square analysis, with response (yes versus no) as one level and extent of lifetime ecstasy use (novice, moderate or heavy ecstasy user) as the other level.

Results-Significant Differences Found: There was a significant relationship between extent of self-reported lifetime ecstasy use and the presence of the following self-reported symptoms respondents attributed to ecstasy use; depression, mood fluctuation, anxiety, poor concentration, memory problems, weight loss, infection, and tremors or twitches. The largest differences between user groups were for memory problems (19% novice users, 52% moderate users and 70% heavy users), poor concentration (32% novice users, 62% moderate users and 70% heavy users) and infections (5% novice users, 9% moderate users and 35% heavy users).

Results-No Significant Differences: There were no significant relationships between total lifetime ecstasy use and presence or absence of impulsivity, poor sleep or sexual problems that the respondents attributed to ecstasy use.

Overall Effects: An on-line study of self-reported ecstasy users found people reporting higher lifetime ecstasy consumption reported a greater number of health complaints they attributed to ecstasy use. Novice users (reporting lifetime ecstasy use of 1-9 times) were least likely to list health complaints, and heavy users (those reporting lifetime ecstasy use of 100 or more times) were most likely to list health problems to their ecstasy use. Self-reported health complaints associated with self-reported lifetime ecstasy consumption included changes in mood (depression, anxiety, mood fluctuations), poor concentration, poor memory, and a list of physiological complaints (weight loss, infections, tremors/twitches). However, presence of off-drug impulsivity attributed to ecstasy use was not associated with extent of lifetime ecstasy consumption (though more heavy users complained of impulsivity than moderate users, and a greater number of moderate users listed this complaint than novice users). Complaints of poor sleep or sexual problems were not associated with lifetime ecstasy use.

Comments: This is the first report of an on-line assessments of health complaints experienced by ecstasy users. Nevertheless, as a research study, it leaves a lot to be desired. The authors do not provide enough information for estimating specific parameters of drug use other than lifetime use and average dose per use, and even here, ranges are provided instead of means. Since all data is provided through self-report only, perceived presence of health complaints cannot be verified via observation or clinical diagnosis. Furthermore, respondents' beliefs about the cause of a given health complaint may not reflect actual causality. It is possible that people mistakenly attribute the cause of a symptom to ecstasy use, and conversely it is possible for people to ignore a symptom that is actually caused by ecstasy use. A previous report by Fox and colleagues (Fox et al. 2001b) (including Parrott as a co-author), found no association between self-reported problems attributed to ecstasy use and performance on tests of memory and executive function. Since no information is provided on symptom responses provided by users of other drugs, or of those reporting no drug use, it is difficult to tell whether symptoms reported by novice, moderate or heavy users exceed the rate at which the same symptoms are reported in other groups of respondents. Because responses to the measure of symptoms referred to "off-drug" state without requesting information for time elapsed since ecstasy use and appearance of a given symptom, the symptoms reported here could be residual or sub-acute effects of ecstasy use rather than long-term effects. Lastly, it should be noted that self-reported total lifetime use is highly related to size of average dose per use and maximum weekly dose, so that other drug use parameters, such as usual average dose per use or maximum dose per use, may better explain the reported associations than lifetime ecstasy use.