3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) use and transitions to injection drug use among street-involved youth

Abstract

Background: Despite the popularity of 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) among young people across North America and Europe, MDMA is rarely explored in studies of young people at high risk of injecting drugs. We conducted a study among street-involved youth who use illicit drugs in Vancouver, Canada, to understand if use of MDMA is associated with initiation of injection drugs. Methods: We followed injection-naïve participants in the At-Risk Youth Study (ARYS), an ongoing prospective cohort of street-involved youth aged 14–26 who use illicit drugs. Bivariate and multivariate extended Cox models with time-updated variables were used to examine the association between MDMA use and initiation of injection drug use between September 2005 and May 2015. Results: Among 483 youth, 306 (63.4%) had a history of MDMA use and 218 (45.1%) had used MDMA in the previous 6 months at baseline. A total of 105 (21.7%) youth initiated injection drug use over the 10-year period, yielding an incidence density of 8.51 (95% confidence interval [CI]: 6.96–10.30) per 100 person-years. MDMA use was not significantly associated with initiating injection drugs at the bivariate (hazard ratio: 0.93, 95% CI: 0.61–1.42) or multivariate (adjusted hazard ratio: 0.88, 95% CI: 0.57–1.35) level, after adjusting for socio-demographic and substance use confounders. Conclusions: Amid ongoing frequent use of MDMA among some young people in North America, we did not observe an elevated risk of injection initiation among those who used MDMA in this cohort of street-involved youth.

Keywords:

• Adolescent
• ecstasy
• injection drug use
• MDMA
• N-methyl-3,4-methylenedioxyamphetamine
• youth

Acknowledgments

We would like to thank all of our study participants for their contributions to this research. We would also like to thank current and past study researchers and staff, including Cody Callon, Carly Hoy, Sabina Dobrer, Seagle Liu, Deborah Graham, Peter Vann, and Steve Kain, for their administrative support.

Author contributions

S.L., A.G., and K.D. designed the study. As lead author, S.L. wrote the first manuscript draft. A.G., K.D., and K.T. provided valuable feedback to the draft, which was incorporated by S.L. into the final manuscript draft. E.N. conducted the statistical analyses and provided revisions to the manuscript. All coauthors approved the final manuscript draft.

Additional information

Funding

This work was supported by the United States National Institutes of Health under grant number U01DA038886. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Kora DeBeck is supported by a Michael Smith Foundation for Health Research/St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award. Stephanie Lake is supported by doctoral scholarships from the Pierre Elliott Trudeau Foundation and the Canadian Institutes of Health Research. Andrew Gaddis is supported by an Independent Research Fellowship from Fulbright Canada.