MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014–2017

Abstract

Context

3,4-Methylenedioxymethamphetamine (MDMA) remains one of the most commonly used recreational drugs in Europe. Monitoring of Emergency Department (ED) presentations with acute toxicity associated with MDMA is important to determine trends in MDMA use and harms.

Methods

Data were extracted from the European Drug Emergencies Network (Euro-DEN) Plus database for all ED presentations with acute toxicity involving MDMA use, alone or in combination with other substances, between 1 January 2014 and 31 December 2017. Geographical distribution, time trends, patient demographics, clinical features, management and outcome were analysed.

Results

Out of 23,947 presentations, 2013 (8.4%) involved MDMA, used alone (88, 4.4%) or with other substances (1925, 95.6%). The proportion of MDMA presentations varied by country, from over 15% in France to less than 5% in Norway. For the 15 sentinel centres where data were available for all four years, MDMA-related presentations peaked in 2016 (10.4% versus 8.1% in 2015, p < 0.0001), thereafter decreasing in 2017 (8.2%, p = 0.0002). 1436 (71.3%) presentations involved males. Females were significantly younger than males (median 23 years, interquartile range, IQR, 20–27 years, versus median 25 years, IQR 21–30 years, p < 0.0001). Compared to presentations of acute toxicity with lone-use cocaine, presentations with lone-use MDMA occurred more frequently during the weekend (58.0% versus 43.9%, p = 0.02), were more frequently medically discharged directly from the ED (74.7% versus 62.4%, p = 0.03), and less frequently received sedation (43.5% versus 66.5%, p = 0.003).

Conclusions

This large multicentre series of MDMA presentations to EDs showed geographical variation and changes in time trends and in patient demographics. Triangulation with data from complementary sources including seizures, prevalence of use and wastewater analysis, will enable a greater understanding of the public health implications of MDMA use in Europe.

Keywords:

• 3,4-Methylenedioxymethamphetamine (MDMA)
• acute toxicity
• recreational use
• Emergency Department
• Euro-DEN Plus

Acknowledgements

The authors thank Laura Müller, MPharm, for useful discussion during manuscript preparation.

Disclosure statement

The authors report no conflict of interest.

Availability of data

Data available on request from the authors.

Additional information

Funding

The Euro-DEN Project received financial support from the DPIP/ISEC Programme of the European Union (2013–2015) (EU DPIP/ISEC: Programme grant number JUST/2012/DPIP/AG/3591) and the Euro-DEN Plus Project has received financial support from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA: CT.15.EPI.0071.1.0 and CT.18.HEA.0033.1.0) from 2015 onwards. Noseda R and Ceschi A received financial support from the Scientific Research Advisory Board of the Ente Ospedaliero Cantonale (ABREOC). Schmid Y and Liechti ME received financial support from the Swiss Centre of Applied Human Toxicology (SCAHT). Liakoni E received financial support from the Burgergemeinde Bern.