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Perhaps most obviously it demonstrates, yet again, the futility of putting enforcement, targeting either people who use or supply, at the forefront of the policy response to drugs. The EMCDDA also reported in 2019 that ‘transactions involving quantities of MDMA tablets indicative of the middle level of the market account for more than double the revenue of sales of retail-level quantities’. Prevalence of drug use data tables including general population surveys and wastewater analysis (all substances) Alcohol was co-consumed across 67 % of all MDMA-related hospital emergencies, and the other drugs commonly consumed alongside MDMA included cocaine, amphetamine, methamphetamine, ketamine, heroin, GHB and cannabis. The share of acute drug-toxicity presentations involving MDMA increased as compared to other substances and the previous year (or MDMA was reported for the first time) in 10 of the Euro-DEN hospitals. The majority of drug-induced deaths in Türkiye are among younger people, predominantly males, and are more likely to involve stimulant drugs rather than buy ecstasy opioids, compared with the European Union and Norwa


Rates of adulteration of ecstasy tablets, their MDMA content and their price tend to reflect broader changes in the factors that affect the MDMA market. MDMA is most commonly found on the European market in the form of ecstasy tablets, relatively pure crystals or powders (finely ground crystals of MDMA that are typically mixed with other substances). For example, many people who use drugs recreationally access internet-based resources to obtain and exchange advice and information about their drugs of choice, with experienced ‘recreational’ drug users frequently offering experiential ‘knowledge’ to young people new to dance club scenes. (1) The European Web Survey on Drugs (EWSD) is a voluntary, anonymous survey run by the EUDA and its partners targeting directly people who use drugs who are 18 years old or older, and are living in one of the participating countries. When using wastewater data to estimate MDMA markets, the use of MDMA is based on the excreted parent drug, rather than on an excreted metabolite (which is the case for some other drugs, such as cocaine and heroin). Demand-based estimates may underestimate the size of drug markets for a number of reasons, including difficulty reaching some groups of users, and underreporting of prevalence and quantities used by respondent


MDMA is reported in small numbers of drug-induced deaths, and in most countries less than 1 in 20 cases involve the drug. While affected by limitations and uncertainties, this type of data analysis shows great promise as a complementary information source to monitor the size and changes in drug markets (Quireyns et al., 2023). It was possible to construct estimates of city-level MDMA market sizes by combining wastewater data with country-level data for average retail purity and price. Demand-based estimates may underestimate the size of drug markets for a number of reasons, including difficulty reaching some groups of users, and underreporting of prevalence and quantities used by respondents. Estimates of amounts used suggest that about 72.4 million ecstasy tablets were consumed in the European Union in 2021. In the case of Belgium, Czechia, France, Luxembourg, Malta, Norway and Portugal, no recent data for last month prevalence of MDMA were reported, so data were impute


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For countries reporting data in 2022, a considerable retail price range was observed, with prices per ecstasy tablet ranging from EUR 4 to EUR 19 (mean) and prices of MDMA powder from EUR 6 to EUR 50 per gram. Occasionally, tablets containing 250 milligrams or more of MDMA are encountered on EU drug markets. This trend may be a combination of the scheduling of PMK glycidate, and a reduction in demand for MDMA during the COVID-19 pandemic, and is in line with the changes observed in the adulteration of ecstasy tablets (see Section Ecstasy adulteration is responsive to market pressures