Recent community surveys of illicit drug use in the UK have estimated that approximately 4% of 16-59 year olds have ever taken ecstasy (Ramsey and Partridge, 1999; Ramsey et al., 2001). This figure represents over 2.5 million people. Use was most commonly reported in the 16-29 year old group (Figure 1). Within this age group, the most popular drugs were (based upon % of respondents reporting ‘use in last year’): cannabis (22%); non-MDMA amphetamines (5%); ecstasy (5%); cocaine (5%); LSD (2%); and psilocybin mushrooms (2%). Figures provided by monitoring systems in other European countries and the USA suggests that levels of use are similar elsewhere (Griffiths & Vingoe, 1997; Johnston et al., 2000; Tossmann et al., 2001). Whilst ecstasy use has remained stable in the UK over the previous 7 years, the proportion of 16-29 year olds reporting use of cocaine has risen sharply from 1% in 1994 to 5% in 2000 (King, 1997; Ramsey & Partridge, 1999; Sharp et al., 2001). This may be because of the consistently high purity or the reduction in price of cocaine (King, 1997), but also its perceived safety compared to ecstasy, which has received substantial negative media attention (Cole et al., in press; Hammersley et al., 2001). The public health consequences of increased cocaine use have been obscured in investigations of ecstasy.

General population studies such as the British Crime Survey (a national survey which includes data on self-reported drug use) have underestimated the prevalence of drug use within particular sub populations (Table 1). These studies have also failed to address the context of substance use and concomitant use with other compounds. Ecstasy is most commonly used, although not exclusively (Hansen et al., 2001), at raves. Whilst rave is a somewhat outmoded term in the UK, it may be considered generic. These events are defined by several unique characteristics which are important when assessing the acute toxic and long-term neurotoxic profile of MDMA and other drugs: (i) larger than average venues, (ii) loud, modern music with 120 or more beats per minute, (iii) high ambient temperatures, (iv) prolonged physical exertion in participants (energetic dancing), and (v) ubiquitous drug use (Henderson, 1993; Henry, 1992; Randall, 1992). Indeed, this latter aspect is perhaps the defining feature of UK raves (Merchant & McDonald, 1994; Weir, 2000).

Whilst ecstasy is the drug most often associated with dance music events, epidemiological evidence indicates that it is only one of several used. Initiates and inexperienced users tend to use ecstasy in isolation (with the exception of alcohol), but as they become more experienced they exhibit a pattern of use that includes the consumption of greater amounts of ecstasy and an increasing combination of other drugs (Hansen et al., 2001). Young people attending dance music events report use of a wide range of compounds and have considerably greater drug experience than the general population of corresponding age. Characteristically, rave attendees ingest a mixture of stimulants and hallucinogens with the vast majority being polydrug users (Boys, 1997; Boys et al., 1999; Cole et al., in press; Curran & Travill, 1997; Davison & Parrott, 1997; Forsyth, 1996; Hammersley et al., 1999; Lenton et al., 1997; Parrott & Stuart 1997; Pedersen & Skrondal, 1999; Riley et al., 2001; Solowij et al., 1992; Cole & Sumnall, submitted; Tossmann et al., 2001; van de Wijngaart et al., 1999; Winstock et al., 2001a). The variable nature of ecstasy tablet content partly underlies this (Cole et al., in press). This very specific polydrug use is termed ‘dance drug’ use because these drugs are used to aid all night dancing (Bean et al., 1997; Collins & Godfrey, 1998; Hammersley et al., 2001 Forsyth, 1996; Measham et al., 2001; Tossmann et al., 2001). Cannabis, alcohol, opiates and/or benzodiazepines are frequently used after the event to aid the ‘come down’ from dance drugs (Forsyth, 1996; McDermott, 1993; Riley et al., 2001; Solowij, 1992; Williams et al., 1998; Williamson et al., 1997; Winstock et al., 2001). Some reports indicate that users also co-administer selective serotonin reuptake inhibitors (SSRI) and/or dietary supplements before or after ecstasy in an attempt to protect themselves from neurotoxicity (McCann & Ricaurte, 1993). Identifying and studying human drug using populations based solely upon consumption of ecstasy has ignored the unique profile of dance drug consumption and has made the assessment of specific risks posed by ecstasy use per se very difficult.

Summary of Available British Data on Ecstasy & Related Psychoactive Drug Use
Percentage Reporting Use Ever used / Use in last year / Use in last month
Survey	Type of Population	Number Surveyed	Age Range	Ecstasy	Non-MDMA Amphetamines (mainly d-amphetamines sulphate)	Cocaine	Cannabis	LSD	Mix Drugs (% reporting)	Reference
2000 British Crime Survey	General population survey	3015	16-29	12/5/3	22/5/2	10/5/2	44/22/14	11/2/<0.5%	Not assessed	Ramsay et al., 2001
Nottingham harm reduction	Dance drug users	125	<= 30	95/-/-	98/-/-	81/-/-	-/-/-	91/-/-	~75%	Akram & Galt, 1999
Release drugs and dance survey	Rave attendees	520	16-29	81/-/-	81/-/-	57/-/-	91/-/-	74/-/-	-	Bean et al., 1997
Glasgow dance scene	Rave attendees	135	14-44	91/87/-	93/77/-	70/59/-	98/96/-	92/79/-	>50%	Forsyth, 1997
Edinburgh, UK dance events	Rave attendees	122	18-29	-/82/74	-/81.1/68.7	-/38.5/18	-/48.4/-	-/30/38	66%	Riley et al., 2001
'Mixmag' survey	Rave culture magazine readers	1151	mean=23.9	96/-/86	92/-/40	75/46/-	91/73/-	71/10/-	~75%	Winstock et al., 2001
Table 1. Summary of UK community surveys of 'dance drug' use. Comparison of results obtained from members of the rave culture with the 2000 British Crime Survey. The British Crime Survey surveyed a total of 13,021 people with regards to use of all types of drug use and analyses data by particular age groups.1 '- ' indicates not assessed.

Percentage of English and Welsh population reporting use of Ecstasy in previous year
Figure 1. Data 1994-2000 taken from the British Crime Survey.

Reference List