"Most of the concern with MDMA adulteration focuses on the plethora of other substances that have been detected in the MDMA supply. This includes novel designer drugs with potentially serious health risks such as synthetic piperazine and cathinone compounds, which were detected in about 5 % of samples overall. Piperazines first appeared in 2000 but saturated the market from 2008–2013, when these compounds were detected in about one-quarter (24 %) of drug items. Cathinones first appeared in our sample in 2010 but predominated from 2012–2016, when they were detected in more than one-sixth (17 %) of samples.
"Other stimulants excluding synthetic piperazines and cathinones were found in one-quarter (25 %) of drug items overall but peaked from 2006–2009 when they were detected in the majority (52–78 %) of samples. Across all years, caffeine (18 %) and methamphetamine (9 %) were the most prevalent stimulant-class adulterants. Pseudo/ephedrine detections peaked in 2004 (17 %) but practically disappeared after 2006, when the federal ban on over-the-counter pseudoephedrine sales took effect (Rigdon, 2012). Two related designer drugs, the substituted amphetamines paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA), have been singled out in the literature as particularly toxic (e.g., Refstad, 2003) but were rarely detected in our sample (n=3), the last time in 2012.
"Psychedelic and dissociative drugs showed sizable fluctuations as adulterants over time. Dextromethorphan (DXM) peaked as an adulterant in 1999 (23 %), ketamine reached maximum prevalence in 2007 (21 %), and the novel psychedelic 5-MeO-DiPT spiked in 2011 (9 %). Since 2015, neither psychedelics nor dissociatives have been detected in more than 2.5 % of samples. Notably, cannabinoids and opioids were rarely detected in alleged MDMA. Overall, just six items (0.1 %) contained cannabinoids, and opioids were detected in only 23 items (0.5 %). Very few opioid detections involved fentanyl or fentanyl analogs (n=6), all of which were reported in 2005 and 2015. Pharmaceuticals (5 %) and supplements (4 %) appeared consistently as adulterants, but their prevalence has generally declined over time. The most commonly detected pharmaceuticals were procaine (18 %), acetaminophen (16 %), lidocaine (11 %), and diphenhydramine (10 %), whereas 78 % of supplement detections involved methylsulfonylmethane (MSM), a substance often prescribed for joint health but also commonly used as an MDMA diluent. Chemical precursors and byproducts were detected in about 3 % of samples overall but reached as high as 12–13 % in certain years. The most common substances identified in this category were MDA 2-aldoxime analog (24 %), a synthesis byproduct of MDA, and dibenzylpiperazine (22 %), a synthesis byproduct of benzylpiperazine (BZP). Lastly, unidentified drugs (2 %) and samples with no active drug (3 %) recorded relatively low prevalence overall.
"Not only did patterns of adulteration vary temporally, but they also differed across representations of MDMA. In Table 3, we report the distribution of detected drugs by the type of MDMA misrepresentation. Adulterated MDMA was significantly more likely to contain other stimulants (62.3 % vs. 41.9 %, p<0.001) and supplements (13.2 % vs. 4.9 %, p<0.001). Conversely, substituted MDMA was significantly more likely to contain MDMA analogs (28.6 % vs. 23.5 %, p<0.05), piperazines (13.2 % vs. 3.1 %, p<0.001), cathinones (14.4 % vs. 2.8 %, p<0.001), psychedelics (4.3 % vs. 0.9 %, p<0.001), opioids (1.5 % vs. 0.1 %, p ≤ 0.01), and unidentified drugs (5.1 % vs. 2.4 %, p<0.05). No significant differences were observed for dissociatives, cannabinoids, pharmaceuticals, and precursors/byproducts."
Eric L. Sevigny, Sylvia Thyssen, Earth Erowid, Russell Lea, Misrepresentation of MDMA in the United States, 1999–2023, Drug and Alcohol Dependence, Volume 264, 2024, 112467, ISSN 0376-8716, doi.org/10.1016/j.drugalcdep.2024.112467.
