New research indicates that previous studies examining the brain alterations caused by ecstasy have focused on unusually heavy users.

The study, which was published in the Journal of Psychopharmacology, suggests that the previous research likely overestimated the extent of serotonergic alterations experienced by the majority of ecstasy users.

Study author Balázs Szigeti of the University of Edinburgh was doing research on another project when he read a neuroimaging study that found evidence that ecstasy use resulted in lower levels of brain serotonin transporter (SERT).

“I found it weird that they called users who take 2 pills twice a month ‘low to moderate users,’ I suspected that it is much more than what the average user takes,” he remarked.

“The difficulty was to get data about ecstasy use patterns to test my hypothesis. I realized that the Global Drug Survey is likely to have the data I need, so I emailed them arguing for a collaboration. They were interested and then we quickly realized that there is a point to be made here.”

The Global Drug Survey (GDS), which is provided in 11 languages, is the largest quantitative anonymous web survey on drug use patterns. The researchers examined data from 11,168 respondents who had reported at least one occasion of ecstasy pill use in the previous year.

Szigeti and his colleagues found that the ecstasy users who participated in previous neuroimaging studies had consumed far more of the drug than the typical user had. On average, the brain imaging participants consumed 720% more pills over a year.

The GDS respondents used 12.2 pills a year on average, while the brain imaging participants reported using an average of 87.3 pills a year.

“Our analysis suggests that ecstasy induced serotonergic alterations are likely to be overestimated for the majority of users. This is good news for ecstasy users and for the medical application of MDMA, but as we emphasize in the paper it does not imply that all ecstasy/MDMA use is harmless,” Szigeti told PsyPost.

But the study — like all research — has limitations.

“GDS, which we use to estimate ecstasy use patterns, is an online survey that people complete on a voluntary basis,” Szigeti explained. “Thus, one major weakness is that our sample of ecstasy use patterns is not random, but rather based on a self selected sample. Unfortunately, this limitation is hard to overcome given the illegal status of the drug.”

“The other major issue is that we only examined brain imaging studies, but not studies directly assessing ecstasy’s impact on cognition and other potential negative outcomes. This omission was due to that most studies did not report in sufficient details the ecstasy use habits of their participants.”

“Besides the implications for ecstasy use, we hope the study will highlight the importance of considering how drugs are used by real users when studying drug use,” Szigeti added. “Such information is often hard to obtain for illegal substances, nonetheless, it is critical for the research to be applicable to real life users. We hope our study helps to highlight this point in the wider substance use field.”

The study, “Are Ecstasy Induced Serotonergic Alterations Overestimated For The Majority Of Users?“, was authored by Balázs Szigeti, Adam R Winstock, David Erritzoe, and Larissa J Maier.

