US high school seniors underreport MDMA use when not asked about ‘Molly’

National surveys suggest ecstasy (the street name for the drug MDMA) use has decreased substantially among adolescents and young adults in the US since 2001; however, the recent phenomenon of “Molly” (ecstasy marketed as “pure MDMA”) may be leading to underreporting of use as not all users are aware that “Molly” is a form of ecstasy.

A new study, published in Drug and Alcohol Dependence by researchers affiliated with New York University’s Center for Drug Use and HIV Research (CDUHR), compared self-reported ecstasy/MDMA use with and without “Molly” in the definition. Researchers found that reported lifetime use (8.0% vs. 5.5%) was significantly higher with Molly in the definition.

“Differences in reported use appear to be driven by those reporting use only a couple of times,” said Joseph J. Palamar, PhD, MPH, an affiliate of CDUHR and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC). “This is troubling, as it suggests that ecstasy use—at least among infrequent users—is being underreported when Molly isn’t included in the definition.”

The article, “Underreporting of Ecstasy Use among High School Seniors in the U.S.,” draws data from Monitoring the Future (MTF), a nationwide ongoing annual study of the behaviors, attitudes, and values of American secondary school students. The MTF survey is administered in approximately 130 public and private schools throughout 48 states in the US. Roughly 15,000 high school seniors are assessed annually.

Analyses focused on data collected from high school seniors (12th graders) in 2014 (N = 6,250; modal age: 18). Three randomly distributed survey forms asked about ecstasy use, and one form included “Molly” in the definition. Self-reported lifetime, 12-month, and 30-day ecstasy use were compared to determine whether including “Molly” in the definition was associated with higher prevalence or frequency of use.

The researchers focused their analysis on the 6,250 students who answered ecstasy questions on the survey forms. Their findings suggest that underreporting of ecstasy use is associated with less experienced users and users that did not report recent use.

“Street names for drugs tend to change over time and it’s important to consider these names when asking people about use,” said Dr. Palamar. “Underreported use may suggest prevalence or popularity of a potentially dangerous drug is decreasing and this may equate to less public health concern.”

As the researchers have shown, national surveys underestimated the prevalence of ecstasy use in the U.S. when “Molly” was not included in the definition of ecstasy.

“The takeaway is that national and local surveys should maintain vigilance in assessing current street names of drugs in order to more accurately assess prevalence,” said Katherine Keyes, PhD, MPH, assistant professor of epidemiology at the Columbia University Mailman School of Public Health.

“Adolescents and young adults require better education about ecstasy and about drugs in general,” cautions Dr. Palamar. “We need to try to prevent use among those at risk for using, and try to reduce the potential harm among those who decide to use. We’ve been finding that Molly is increasingly adulterated with other drugs such as bath salts, so those who insist on using need to educate themselves as much as possible about ecstasy. We must do a better job at providing the public with the necessary information to help prevent any more Molly-related deaths from occurring at dance festivals.”