MDMA: a European love story (on use)

Historically, MDMA has been one of the most used illicit stimulant drugs in Europe, associated with patterns of consumption in the context of nightlife and recreational settings. Around 11.5 million adults in the European Union (aged 15-64) have used MDMA at least once in their lifetime. European consumers have access to a diverse set of MDMA products, mainly ecstasy tablets, crystals and powders, however, some ‘novelty’ products are also becoming available. Although patterns of consumption have not changed significantly throughout the years, ecstasy tablet consumers are expected to ingest more of the substance per use episode, given the increase in MDMA content per tablet verified over the last decade.

Since they emerged on the European drug market in the 1990s, ‘ecstasy’ tablets were the most common form of MDMA consumed in Europe, but following a period where consumer trust in these products was low around the early 2000’s, crystals and powders gained a portion of the market. Tablets and crystals/powders share the EU MDMA market in parallel, with some variability among countries in terms of preference. Data from the 2021 European Web Survey on Drugs (EWSD) found that tablets were used by 42 % of the 17 098 respondents who used MDMA in the last 12 months, compared with 24 % for powder/crystal. Around 33 % of respondents reported using both forms of the drug. 

General population surveys in many countries showed that MDMA prevalence was declining from peak levels attained in the early to mid-2000s. Of the 11 European countries that undertook surveys since 2020 and provided confidence intervals, 1 reported higher estimates than their previous comparable survey, 9 reported stable estimates and 1 reported a decrease. In recent years, however, the picture has remained mixed with no clear upward or downward trends. Where prevalence is higher, it may suggest that MDMA is no longer a niche or subcultural drug limited to dance clubs and parties in those markets. Wastewater data from 2022, show that the highest indications of MDMA use are found in cities in Belgium, Czechia, the Netherlands, Spain and Portugal, but vary considerably across study locations. Looking at longer-term trends in wastewater analysis, in most cases the levels increased between 2011-2016, and have fluctuated after this. Of the 62 cities that have data on MDMA residues in municipal wastewater for 2021 and 2022, 28 reported an increase (mostly in cities in southern and central Europe), 7 a stable situation and 27 a decrease (mostly in northern Europe).

This oral presentation will provide an overview of the use of MDMA in Europe, with a particular focus on information collected through the 2024 round of the EWSD, coordinated by the European Union Drugs Agency.