Characteristics of acute ecstasy-related toxicity in multiple Dutch medical settings, from 2009 through 2018
Lifetime use of ecstasy was reported by 10.8% of people aged 15 - 64 years in the Netherlands in 2019, the highest rate in Europe. At the same time, a substantial increase in the mean dose in ecstasy tablets has been reported in the Netherlands since 2008, increasing the risk of adverse effects. Various acute clinical presentations related to ecstasy use have been described in single setting case-series, mainly among patients presenting at emergency departments. However, data on acute ecstasy-related adverse health effects in other medical settings are lacking. Here, we aim to inform prevention and harm reduction efforts by investigating the characteristics of ecstasy-related outcomes in a large sample of patients in multiple Dutch medical settings.
Data on acute ecstasy-related emergencies was obtained from 38 different medical organizations consisting of ambulance services, forensic doctors, emergency departments and first aid posts at dance-events throughout the Netherlands, from 2009 through 2018. Associations between patient characteristics and the severity of intoxication were identified using ordinal regression.
1100 severe, 3,588 moderate and 8,564 mild intoxications following ecstasy use were identified (13,527 in total). Males, tourists and patients older than 30 years were more at risk of developing acute ecstasy-related health effects (OR 1.47; 95%CI 1.31, 1.64 and OR 1.72; 95%CI 1.53, 1.94 and OR 1.35; 95%CI 1.17, 1.53, respectively). Concurrent use of ecstasy with alcohol (OR 1.77; 95%CI 1.60, 1.96), GHB (OR 4.64; 95%CI 3.81, 5.65), cocaine (OR 1.44 95%CI 1.16, 1.79), amphetamine (OR 1.34; 95%CI 1.09, 1.65) or ketamine (OR 2.03; 95%CI 1.56, 2.63), increased the risk of a more severe intoxication.
We describe the characteristics of, to our knowledge, the largest sample of ecstasy-related emergencies. We identify a high-risk profile for ecstasy users that can inform prevention and harm-reduction efforts.