Researchpaper
Hair testing to assess both known and unknown use of drugs amongst ecstasy users in the electronic dance music scene
Joseph J.Palamara,b,*,Alberto Salomonec,EnricoGeracec,DanieleDiCorciac, MarcoVincentic,d,CharlesM. Clelandb,e
aNewYorkUniversityLangoneMedicalCenter,DepartmentofPopulationHealth,NewYork,NY,USA
bCenterforDrugUseandHIVResearch,NewYorkUniversityRoryMeyersCollegeofNursing,NewYork,NY,USA
cCentroRegionaleAntidopingediTossicologia“A.Bertinaria”,Orbassano,Turin,Italy
dDipartimentodiChimica,UniversitàdiTorino,Turin,Italy
eNewYorkUniversityRoryMeyersCollegeofNursing,NewYork,NY,USA
ARTICLE INFO
Articlehistory:
Received5April2017
Receivedinrevisedform18June2017 Accepted10July2017
Keywords:
MDMA
Newpsychoactivesubstances Syntheticcathinones Hair-testing Adulterants
ABSTRACT
Background:Dataonbothknownandunknowndruguseintheelectronicdancemusic(EDM)sceneis importanttoinformpreventionandharmreduction.Whilesurveysarethemostcommonmethodof queryingdruguse,additionalbiologicaldatacanhelpvalidateuseanddetectunknown/unintentional useofdrugssuchasnewpsychoactivesubstances(NPS).Wesoughttodeterminetheextentofboth knownandunknownuseofvarioussubstancesinthishigh-riskscene.
Methods:Wehair-tested90self-reportedpast-yearecstasy/MDMA/MollyusersattendingEDMpartiesin NewYorkCityduringthesummerof2016usingUHPLC–MS/MS.Resultswerecomparedtoself-reported past-yearuse.
Results:Threequarters(74.4%)testedpositiveforMDMA,athird(33.3%)testedpositiveforanNPS,and 27.8% tested positive specifically for one or more synthetic cathinones (e.g., butylone, ethylone, pentylone,methylone,alpha-PVP).Half(51.1%)ofparticipantstestedpositiveforadrugnotself-reported, with mosttesting positiveforsyntheticcathinones (72.0%),methamphetamine (69.0%),otherNPS stimulants(e.g.,4-FA,5/6-APB;66.7%),ornewdissociatives(e.g.,methoxetamine,diphenidine;60.0%).
Attendingpartieseveryotherweekormoreoften,reportinghigher-frequencyecstasypilluse,having testedone’secstasy,andhavingfoundoutone’secstasywasadulterated,wereriskfactorsfortesting positiveforsyntheticcathinonesandNPSingeneral.
Conclusion:Hairtestingappearstobeavaluableadditiontodrugepidemiologystudies.ManyEDMparty attendees—eventhosewhotesttheirecstasy—areunknowinglyusingNPSand/orotherdrugs.Prevention informationandharmreductionmayhelpreduceunknown/unintentionaluse.
©2017ElsevierB.V.Allrightsreserved.
Introduction
Electronicdancemusic(EDM)partiesarehigh-riskscenesfor both known and unknown use of a variety of psychoactive substances.Recentstudiesindicatethatillicitdruguseishighly prevalent amongst nightclub and festival attendees (Hughes, Moxham-Hall, Ritter, Weatherburn, & MacCoun, 2017; Miller, Byrnes, Branner, Voas, & Johnson, 2013; Miller et al., 2015;
Nordfjaern,Bretteville-Jensen,Edland-Gryt,&Gripenberg,2016;
Palamar,Barratt,Ferris,&Winstock,2016;Palamar,Griffin-Tomas,
&Ompad,2015;Palamar,Salomone,Vincenti,&Cleland,2016).A recent national survey of Australian dance festival-attending adults foundthat 78.1%of recentusers reportedusingan illicit drugattheirlast-attendedfestival,andofusers,85.1%reporteduse of ecstasy (Hughes et al., 2017).A recent study of EDMparty attendeesinNewYorkCity(NYC)estimatedlifetimeuseofecstasy/
MDMAor“Molly”amongstyoungadult(age18–25)attendeesto be42.8%(95%CI:32.8,52.7)(Palamar,Acosta,Ompad,&Cleland, 2016).“Molly”isacommonstreetnameforpowderorcrystalline MDMA intheUS;thus,since ecstasyand Mollyare bothstreet namesforMDMA,someepidemiologysurveysintheUSnowuse thesetermsinterchangeablyorincombination(Palamar,2017).
DancefestivalshavebecomecommonintheUSinrecentyears, and drug use amongst individuals in these scenes has been associated with severe adverse outcomes including death
* Correspondingauthorat:DepartmentofPopulationHealth,227E.30thStreet, 7thFloor,NewYork,NY10016,USA.
E-mailaddress:joseph.palamar@nyumc.org(J.J.Palamar).
http://dx.doi.org/10.1016/j.drugpo.2017.07.010 0955-3959/©2017ElsevierB.V.Allrightsreserved.
ContentslistsavailableatScienceDirect
International Journal of Drug Policy
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o
(CentersforDiseaseControlandPrevention,2010;Friedmanetal., 2017; Ridpath et al., 2014). For example, an investigation of 22individualspoisonedatalargedancefestivalinNYCfoundthat 65%(11 of 17)of individuals toxicology-tested afterpoisoning tested positive for methylone(a synthetic cathinone) (Ridpath etal.,2014).However,itisunknownhowmanyoftheseindividuals wereawaretheywereusingmethyloneoriftheybelievedthey wereusingMDMA.Whileuseofmoretraditionaldrugssuchas ecstasyismostcommonintheseenvironments,hundredsofnew psychoactivesubstances(NPS)suchasmethylonehaveemergedin recent years (European Monitoring Centre for Drugs and Drug Addiction,2015;U.S.DrugEnforcementAdministration,2016)and manyhavebeendetectedasadulterants inorreplacements for traditionaldrugssuchasecstasy(Bruntetal.,2016;Caudevilla- Gálligo, Ventura, Indave Ruiz, & Fornís, 2013; Palamar, Acosta, Ompadetal.,2016;VidalGineetal.,2016).Biologicalconfirmation ofself-reporteduseisinformativeasithelpsvalidateprevalence, but research on unintentional or unknown use of drugs— particularlyNPS—isimportanttofurtherguidecontinuedpreven- tion,education,andharmreductioneffortswithinthesehigh-risk scenes.
ResearchersatEuropeanorganisationssuchasEnergyControl in Spain (Caudevilla-Gálligo et al., 2013; Giné, Espinosa, &
Vilamala,2014),theDrugInformationMonitoringSystem(DIMS) in the Netherlands (Brunt & Niesink, 2011), and international collaborative organisations such as the Trans European Drug Information(TEDI)project(Bruntetal.,2016)havebeentesting contents of traditional drugs such as ecstasy and have been detectingNPSsuchassyntheticcathinonesinsamples.NPSsuchas syntheticcathinones—aloneorincombinationwithecstasyorone another—especiallyiftakenunknowingly,canpotentiallyleadtoa higher likelihood of adverse effects than solely MDMA (Brunt, Koeter, Niesink, & van den Brink, 2012). While these studies providegreatinsightintodrugadulterationinEurope,veryfew formaldrug-testingstudieshavebeenconductedin theUS and thesestudieswereconducteddecadesago(e.g.,Baggotetal.,2000;
Renfroe,1986).Moreover,whiletestresultsofdrugproduct(e.g., pill/powdertesting)are informative,researchis alsoneeded to helpdeterminethecharacteristicsofindividualswhohavealready (oftenunknowingly)usedspecificNPS—oftenundertheassump- tionitisecstasyor“Molly”.
HairtestingforNPSisanimportantnewadditiontobiological testing. While blood, urine, and saliva are often adequate for assessingcurrentintoxicationorveryrecentuse(usewithinthe pastfewdays)(Jufer,Walsh,Cone,&Sampson-Cone,2006;Smith- Kielland,Skuterud,&Mørland,1999;Vindenesetal.,2011;Wille etal.,2009),manydrugs—includingNPS—canbedetectedinhair months after use. For example, synthetic cathinones can be detectedinhairsamples24monthsafteruse(dependingonlength ofhair)(Kintz,Salomone,&Vincenti,2015;Lendoiroetal.,2017;
Rust,Baumgartner, Dally,&Kraemer, 2012; Salomone,Palamar, Gerace,DiCorcia,&Vincenti,2017;Vincenti,Salomone,Gerace,&
Pirro, 2013). Most standard drug tests only test for select traditional drugs and not NPS; however, hairtesting allows us totestforawiderarrayofsubstancesandforamoreextensive periodafteruse.In2015,wepilotedourhair-testingmethodology asanadditiontoadruguseepidemiologysurveyofindividualsin theEDMsceneandpublisheddataderivedfrom48ecstasyusers (Palamar,Salomoneetal.,2016).However,resultswerelimited,in part,becauseonlylifetimedrugusewasqueried.Inthispaper,we expanduponthisoriginalstudyandreportonandcompareself- reportedpast-year drug use and biological hair test results of 90individualsintheEDMsceneinNYCwhoreportedpast-year ecstasy use. Specifically, our aims of this study were to (1) determineprevalence of testing positive for specific drugs and drug classes, (2) determine the extent of discordant reporting
(definedasreportingnouseofadrug,buttestingpositiveforthat drug), and (3) delineate characteristics of testing positive or providing a discordantreportfor selectdrugclasses. While we expected most individuals to test positive for MDMA, we hypothesizedthatalargeportionofindividualswouldtestpositive fordrugsnotreportedlyused.
Methods
Participantsandprocedure
1087 individuals entering EDM parties in New York City weresurveyedfromMaythroughSeptember2016.Partieswere randomlyselectedusingtime-spacesampling (MacKellaretal., 2007; Palamar, Acosta, Sherman, Ompad, & Cleland, 2016).
Individuals were eligible if they (1)were about to attend the selectedpartyand(2)identifiedasage18–40.Individualswere approached and asked if they were attending the randomly selected party. Those determined eligible were asked if they wouldtakea surveyaboutdrug use.After providinginformed consent, participants completed the survey on a tablet.
Participants who completed the survey were compensated
$10.Uponcompletion,asubsetofparticipantswasaskedifthey were willing to provide a hair sample to be tested for “new drugs such as ‘bath salts”'. If the participant agreed, the recruiter cut a small lock of hair (100 hairs) from the participant—asclosetohisorherscalpaspossibleusingaclean scissor. Insomecases, male participantsvolunteeredtoclipor buzz body hairfrom the arm, chest,or leg withan electronic razor. Hair was folded in a piece of tin foil and stored in an envelopelabelledwiththeparticipant’sstudyIDnumberwhich waslinked tothe participant’ssurveyresponses. We collected 178 hair samples from a subset of those surveyed. Due to limited funding and extreme environmental conditions not conducive to hair testing (e.g., windy/rainy days) on some recruitment days, we only obtained hair samples from a convenience sampleof those surveyed.
Measures
Participants were asked their age, sex, race/ethnicity, and educational attainment. Age, race/ethnicity, and educational attainmentweredichotomisedintovariablesindicatingwhether theyidentifiedasage25–40(vs.age18–24[“youngadults”]),white (vs.non-white),andhavingearnedacollegedegreeorhigher(vs.
less than a college degree), respectively. Participants werealso asked how often they attended rave/nightclub/festival/dance parties with answeroptions: never, a few times a year, every coupleofmonths,everymonth,everyotherweek,andeveryweek or more often (Palamar, Barratt et al., 2016). We recoded attendanceintoa dichotomousvariable(viamedian-split)with responsesrecodedintoattendlessthanonceeveryotherweekvs.
attendatleasteveryotherweek.
Thesurveyaskedparticipantsabout“known”lifetimeandpast- yearuseofavarietyoftraditionaldrugsandNPS.Drugsanddrug classesqueriedincluded“ecstasy/MDMA/Molly”,otherMDxdrugs (e.g.,MDA,MDEA),methamphetamine,amphetamine(nonmedi- caluse),ketamine,PCP,anddrugscommonlydefinedasNPSsuch as“bathsalts”(syntheticcathinones),otherNPSstimulants(e.g., 4-FA, 5/6-APB), dissociative NPS (e.g., methoxetamine [MXE]), 2C-B,andPMMA.Particularfocuswaspaidtosyntheticcathinones andparticipantswerequeriedaboutuseof27ofthesecompounds including methylone (“M1”), butylone (“B1”), mephedrone (“MCAT”, “Meow Meow”), alpha-PVP (“Flakka”), and “bath salt unknown or not listed”. Participants were also provided the
opportunitytotype innamesofdrugsthey haveeverusedthat werenotqueriedinthesurvey.
Thosereportinglifetimeuseofecstasywereasked“Haveyou ever tested your ecstasy/Molly using a drug testing kit?” and answeroptionswere“yes”and“no”.Theywerealsoasked“Didyou everfindoutthatyourecstasy/Mollycontainedadrugotherthan MDMA?”andthisquestionwasnotdependentontheirresponseto thequestionaboutdrugtesting.Answeroptionswere“yes”,“no”, and“unsure”andwedichotomisedresponsesinto“yes”vs.“no/
unsure”.Thoseindicatingpast-yearecstasyusewerealsoasked frequency of ecstasy pill use on an ordinal measure (Miech, Johnston, O’Malley, Bachman, & Schulenberg, 2016) which we recodedinto0–2times,3–19times,and20+times.
Hairanalyses
Among the 178 collected samples, 38 participants (21.3%) reportednolifetimeecstasyuse,20(11.2%)reportedlifetimeuse, butnotpast-yearuse,90(50.6%)reportedpast-yearuse,and30 (16.9%) were unanalyzable due to inadequate quantity. These analysesfocusonthe90participantswithanalysablehairsamples whoreportedpast-yearecstasyuse.
Since past-year use (particularly of NPS such as synthetic cathinones) was the primary outcome of interest, only the proximal0–12cmsegmentwasanalysedwheneveralongerhead hairsamplewascollected.Shorterheadhair,aswellasarm,chest andleghairsampleswereanalysedintheirfulllength.Theaverage lengthwas 8.43.6cm (median: 9.0cm, IQR:7.0). Assuming a normal hairgrowthrate (Kintz,2013), themean time frameis about1cmpermonth.Aquantityofatleast20mgwasneededto perform the analysis. The specimens were tested using two previouslypublishedmethodsusingultra-highperformanceliquid chromatography–tandem mass spectrometry (UHPLC–MS/MS).
One(DiCorcia,D’Urso,Gerace,Salomone,&Vincenti,2012)was usedtoscreenforvariouscommondrugsincludingamphetamine, methamphetamine,MDA,MDMA,andMDEA.Theothermethod (Salomone,Gazzilli,DiCorcia,Gerace,&Vincenti,2016)screened for some of the most common NPS—namely 12 synthetic cathinones(i.e.,mephedrone [4-MMC], 4-MEC, methylone, 3,4- MDPV,pentedrone,3-MMC,ethylcathinone,alpha-PVP,butylone, buphedrone,mexedrone,amfepramone),6othereuphoricstimu- lants (i.e., 4-FA, 5/6-APB, 5-MAPB, mCPP, PMA, PMMA), 3 dissociatives (i.e.,MXE,4-MeO-PCP,diphenidine),6psychedelic phenethylamines(i.e.,2C-B,2C-P,25B-NBOMe,25C-NBOMe,25H- NBOMe, 25I-NBOMe), and 4 designer benzodiazepines (i.e., diclazepam,flubromazepam,nifoxipam,pyrazolam).Thissecond method also tested for ketamine and PCP. We also tested for trazodoneasmCPPisametaboliteofthissubstancesoapositive testfortrazodoneinlightofapositivetestformCPPwouldlikely indicate trazodone use rather than use of mCPP (Lendoiro, Jiménez-Morigosa,Cruz,López-Rivadulla,&deCastro,2014).
Thelimitsofdetection(LOD)oftheanalyticalmethodswereset as the minimum criterion to identify the positive samples (DiCorciaetal.,2012;Salomoneetal.,2016).LODvaluesranged from0.006ng/mgforMDMAupto0.027ng/mgforamphetamine foronemethod(DiCorciaetal.,2012), and from0.9pg/mgfor 4-MeO-PCP up to 17pg/mg for 6-APB, for the second method (Salomoneetal.,2016).
Statisticalanalysis
Wefirstexaminedtheprevalenceofself-reporteddruguseand positivetestresults.Whileprevalenceofeachseparatecompound wasexamined,wealsoexaminedprevalenceofdetectingpositive foranysyntheticcathinone,any NPS,andany discordantresult whichwasdefinedasreportingnouseofaspecificdrugbuttesting
positiveforthatdrug.Weexaminedbivariablerelationsbetween thesekeyoutcomesandcovariatesusingchi-square.Buildingupon bivariable statistics focusing on those who tested positive for synthetic cathinones, we examined conditional associations betweeneachcovariateandtestingpositiveusingmultiplebinary logistic regression. Further,we examined associations between each covariatewithtotal numberof positivetestsfor synthetic cathinonesandtotalnumberofpositivetestsforNPSingeneral.
We firstexamined potential differences in a bivariable manner using independent samples t-tests and then we examined all covariates simultaneously by fitting them into generalised negativebinomialregressionmodelswhicharerobusttoskewed discretedata.AllstatisticalanalyseswereconductedusingStataSE 13 (StataCorp, College Station, TX, USA; 2009). This studywas approvedbytheauthors’institutionalreviewboard.
Results
Most participantsidentifiedas youngadults (54.4%), female (53.3%),white(76.7%),andhavingearnedabachelor’sdegreeor higher (62.2%).The majority(55.6%) alsoreportedattendingan EDMpartyeveryotherweekormoreoften.
Table 1 presentspositive test results in comparison to self- reportedpast-yearuse.Three-quarters(74.4%)ofthesampletested positive forMDMA. Allparticipantstesting positiveforMDA or MDEAalsotestedpositiveforMDMA.Halfofthesamplestested positiveforMDAand2outof10(22.2%)ofthosetestingpositive specificallyreportedpast-yearuseofMDA(commonlyreferredto as “sass”or“sassafras” intheUS). Aboutathird of thesample (32.2%)testedpositiveformethamphetamineandoveraquarter (27.8%) of thesample testedpositive for a syntheticcathinone.
Butylone(14.4%),ethylone(11.1%),andpentylone(10.0%)werethe most common synthetic cathinones detected; however, no participants reported past-year use of any of these specific compounds. Likewise, alpha-PVP was detected in 2.2% of the samplewithnoparticipantsreportinguse.However,despite8.9%
ofthesamplereportinguseofmethylone,only3.3%testedpositive forthiscompound.Similarly,while2C-Busewasreportedby11.1%
ofparticipants,onlyoneparticipanttestedpositiveforuse.
Someparticipantstestedpositive for 4-FA(5.6%) or5/6-APB (2.2%)androughlyhalfoftheseparticipantswhotestedpositive alsoreporteduse(Table1).Withregardtodissociatives,morethan half the sample (57.8%) tested positive for ketamine, and the majority (71.2%)of those testing positive alsoreporteduse. All participants who tested positive for another dissociative also testedpositiveforketamine,andhalfofthosetestingpositivefor MXEusealsoreporteduse.Itshouldbenotedthatfiveparticipants testedpositiveformCPP;however,thesecasesalsotestedpositive fortrazodone,suggestingthatmCPPwasnotinfactused(Lendoiro etal.,2014).
Table2presentssamplecharacteristicsaccordingtowhether theparticipanttestedpositiveforMDMA,asyntheticcathinone,or anyNPS,andwhethertheparticipantprovidedadiscordantreport meaningheorshetestedpositiveforadrugdespitereportingthat thedrugwasnever used.Thosewho testedpositivefor MDMA weremorelikelytoreporthavingusedecstasypillsinthelastyear morefrequently,andallindividualsreportingecstasypilluse20+
timestestedpositive(p=0.003).Resultsweresomewhatsimilar for testing positive for synthetic cathinones or for any NPS.
Specifically,thosetestingpositiveforsyntheticcathinones(27.8%) oranyNPS(33.3%)weremorelikelytoreporthavingattendedan EDMparties morefrequently(p=0.015and 0.016, respectively), morelikely toreportmorefrequentecstasy pilluseinthepast 12months(p=0.005and0.015,respectively), andhavingtested theirecstasy(p=0.016and 0.006,respectively), andfindingout theirecstasywas adulterated(p=0.011and0.047, respectively).
Thosetestingpositiveforsyntheticcathinoneswerealsolesslikely toidentifyaswhite(p=0.020).Regardingdiscordantfindings,only those reportinghaving tested theirecstasy wereat higher risk (p=0.016).
Sincethereweremanysignificantdifferencesregardingtesting positivefor syntheticcathinoneuse, wefit allcovariatesintoa multivariable logistic regression model (Table 3).With all else beingequal,whiteparticipantswereat80%loweroddsoftesting Table1
Prevalenceoftestresultsandself-reporteduse(N=90).
DrugName DrugPositive%(n) Self-ReportedPast-YearUse%(n) DiscordantPositive(Past-YearUse)%(n) MDx
MDx(any) 74.4(n=67) 100.0(n=90) 0.0(n=0)
MDMA 74.4(n=67) 100.0(n=90) 0.0(n=0)
MDA 50.0(n=45) 22.2(n=20) 60.0(n=27)
MDEA 15.6(n=14) 0.0(n=0) 100.0(n=1)
CommonStimulants
Amphetamine 41.1(n=37) 40.0(n=36) 37.8(n=14)
Methamphetamine 32.2(n=29) 13.3(n=12) 55.2(n=16)
SyntheticCathinones
SyntheticCathinone(any) 27.8(n=25) 12.2(n=11) 68.0(n=17)
Butylone 14.4(n=13) 0.0(n=0) 100.0(n=13)
Ethylone 11.1(n=10) 0.0(n=0) 100.0(n=10)
Pentylone 10.0(n=9) 0.0(n=0) 100.0(n=9)
Methylone 3.3(n=3) 8.9(n=8) 33.3(n=1)
Alpha-PVP 2.2(n=2) 0.0(n=0) 100.0(n=2)
OtherPsychedelicAmphetamines
2C-B 1.1(n=1) 11.1(n=10) 100.0(n=1)
PMMA 1.1(n=1) 0.0(n=0) 100.0(n=1)
OtherStimulants
4-FA 5.6(n=5) 3.3(n=3) 60.0(n=3)
5/6-APB 2.2(n=2) 2.2(n=2) 50.0(n=1)
Dissociatives
Dissociative(any) 57.8(n=52) 45.6(n=41) 28.8(n=15)
Ketamine 57.8(n=52) 45.6(n=41) 28.8(n=15)
Methoxetamine(MXE) 4.4(n=4) 4.4(n=4) 50.0(n=2)
PCP 2.2(n=2) 0.0(n=0) 00.0(n=0)
Diphenidine 1.1(n=1) 0.0(n=0) 100.0(n=1)
Note.Theself-reportedsyntheticcathinoneusecategoriesincludedallsyntheticcathinonesassessedonthesurvey.ParticipantswerenotaskedspecificallyaboutPMMAor diphenidineuse,butthosewhotestedpositivedidnotreportuseofthesedrugs(orsimilardrugs)viathetype-inmethod.Onlynonmedicaluseofamphetaminewasassessed onthesurveysoitispossiblesomeparticipantsusedinanapprovedmedicalmanner.
Table2
Prevalenceofpositiveanddiscordantresultsforspecificdrugcategoriesaccordingtoparticipantcharacteristics.
FullSample% PositiveforMDMA% PositiveforSyntheticCathinones
%
PositiveforAnyNPS% DiscordantReportofAnyDrug%
Prevalence – 74.4 27.8 33.3 51.1
Age
18–24 54.4 75.5 24.5 30.6 42.9
25–40 45.6 73.2 31.7 36.6 60.1
Sex
Male 46.7 81.0 33.3 38.1 45.2
Female 53.3 68.8 22.9 29.1 56.3
Race/Ethnicity
Non-White 23.3 81.0 47.6* 47.6 52.4
White 76.7 72.5 21.7 29.0 50.7
EducationalAttainment
LessthanaBachelor’sDegree 37.8 70.6 32.4 32.4 50.0
Bachelor’sDegreeorHigher 62.2 76.8 25.0 33.9 51.8
NightclubAttendance
LessThanOnceEveryOtherWeek 44.4 70.0 15.0* 20.0* 42.5
EveryOtherWeekorMoreOften 55.6 78.0 38.0 44.0 58.0
FrequencyofPast-YearEcstasyPillUse
0–2Times 40.0 55.6** 11.1** 16.7* 38.9
3–19Times 52.2 85.1 36.2 42.6 61.7
20+Times 7.8 100.0 57.1 57.1 42.9
HasTestedOne’sEcstasy
No 60.0 68.5 18.5* 22.2** 40.7*
Yes 40.0 83.3 41.7 50.0 66.7
EverFoundOutEcstasyAdulterated
NoorNotSure 61.1 69.1 18.2* 25.5* 45.5
Yes 38.9 82.9 42.9 45.7 60.0
Note.“Discordantreport”referstowhenaparticipant’shairtestedpositiveforadrugthatheorshedidnotreportusing.Comparisonswerecomputedusingchi-square analyses.NPS=newpsychoactivesubstance.
*p<0.05.
** p<0.01.
