“ECSTASY” (METHYLENEDIOXYMETHAMPHETAMINE OR MDMA)⁺

Ecstasy is emerging, or continuing to emerge, as a drug of abuse in all but five Pulse Check cities: Detroit, Miami, New Orleans, New York, and Portland (Exhibit 1). However, it has been reported as emerging in those five cities during previous reporting Pulse Check periods, suggesting it has either leveled off or—as is likely the case in Miami and New York—is now an established drug of abuse.

ECSTASY: THE DRUG

How available is ecstasy in Pulse Check communities? (Exhibit 2) Ecstasy, typically in pill form, is considered widely available by the majority (25) of the 40 law enforcement and epidemiologic/ethnographic sources. Only three sources consider it not very available: in Billings^E, El Paso^L, and Sioux Falls^L. The remainder consider it somewhat available.

Exhibit 1.
Where is ecstasy emerging across the 20 Pulse Check cities?

d

Since the last reporting period, about half of the responding law enforcement and epidemiologic/ethnographic sources report that ecstasy availability has increased, and approximately half report that it has remained stable, often at elevated levels. Only two report declines: in Miami^E and Sioux Falls^L.

How is ecstasy referred to across the country, and how are logos and packaging used as marketing tools? (Exhibit 3) In order to market their product, “cooks” in many areas produce ecstasy pills in a variety of colors and shapes, with numerous logos, labels, and stamps. Corporate names, fashion designers, and cartoon characters are often featured, with constant changes in some cities as different fads come and go. Many users derive their slang terminology from these logos, labels, and shapes. “X,” however, remains the most common slang name for ecstasy, as reported in nearly every Pulse Check site. “E” is also common, as are “roll” and “XTC.”

Exhibit 2. How available is ecstasy, and how has availability changed, across the 20 Pulse Check cities (fall 2001 vs spring 2002)?

d

As reported in past Pulse Checks, tablets continue to be sold predominantly as loose pills. Additionally, pills are sometimes packaged in small plastic bags, plastic prescription bottles, plastic wrap, folded paper, coin bags, and tinfoil. Cigarette packs, a more unusual packaging, are reported in St. Louis. Some large-quantity packaging is reported: in Detroit, a “jar” contains 3,200 pills; in Denver, up to 20,000 pills are heat-sealed in plastic and strapped to the body.

What substances are added to or sold as ecstasy? During this reporting period, fewer sources report adulterated ecstasy than in the last Pulse Check. Reported adulterants include mescaline and methamphetamine in Memphis, and codeine, dextromethorphan (DXM), and paramethoxyamphetamine (PMA) in Los Angeles. Mescaline, previously reported in Sioux Falls, has not been seen there in the past year. In Seattle, adulterants are less toxic than those reported in the last Pulse Check. Fraud is now more common there: for example, one batch of confiscated “ecstasy” actually consisted of hormone replacement pills. Fraudulent substitutions are also reported in Detroit and St. Louis. According to the New York non-methadone treatment source, most clients in the program “fully believe that the drug is a mix of cocaine and something else.” In the Miami area, the medical examiner recently detected 147 “methylated amphetamine compounds”—substances sold as ecstasy—in decedents.

What are street-level ecstasy prices across the country? (Exhibit 4) Pill prices range from lows of $5 in El Paso and $7 in New Orleans to a high of $100 in St. Louis, but the most common prices are about $20–$25. In New York, ecstasy is cheaper on the street than in clubs. Conversely, in Seattle, prices are lower at raves than in the community. Prices appear relatively stable since the last reporting period. The only reported changes are an increase in New York^E and declines in Philadelphia^E and Miami^L. Reduced price sales in Miami are at the single-pill and 100-pill level, paralleling a shift in user demographics. The high profit margin is an incentive for users to sell ecstasy at clubs, raves, and to friends. Once these young user-dealers cover their costs, unlike the more organized wholesale-level dealers, they keep the leftovers as a personal “stash,” sell to friends at discount, or even give them away. High profits are also evident in Los Angeles.

Exhibit 3.
How is ecstasy referred to and marketed across the 20 Pulse Check cities?*

City		Slang terms	Marketing labels, logos, colors, shapes
Northeast	Boston, MA	X, MDMA, adam, essence, flipping, rolling	Logos: bulldog, calvin klein, hearts, lightning, mcdonalds, nikes, playboy, tulips, yin and yang signs, many more
	New York, NY	NR	Yes (but names unavailable)
	Philadelphia, PA	E	None
	Portland, ME	X, E, pure X, roll	NR
South	Baltimore, MD	X, E, essence, eve, lovers, speed	None
	Columbia, SC	E, four-leaf-clover, rolls, S, smurfs	Tablets of all colors Logos: balloons, cartoon characters, diamonds
	El Paso, TX	E, tachas	Red pill with E
	Memphis, TN	X, XTC, adam, beans, clarity, lover’s special, rolls, stacks, double stacks, tabs	None
	Miami, FL	X, E, beans, mercedes, rolls, roll X	All kinds, change often
	New Orleans, LA	X, XTC, pill, tabs	None
	Washington, DC	X, E, igloo, mercedes, pikachu, pills, rolls	Different colors, round shape; E, animals, igloo, mercedes, pikachu, pills, rolls
Midwest	Chicago, IL	X, E, rolls	Cartoon stamps Logos: CK (for calvin klein), mitsubishi, motorola, other corporate names and fashion brand names
	Detroit, MI	X, E	Logos vary widely
	Sioux Falls, SD	X, E, roll, snackies (more mescaline based), speedies (more amphetamine based)	Logos: elephants, mitsubishi, nike, sun face
	St. Louis, MO	X, E, XTC, candy, rolls, shamrock, tabs	Proliferation of logos
West	Billings, MT	Peace, serenity, tranquility	None
	Denver, CO	X, E, adam, the bean, pills, rolls, tabs, wafers	Batman, jimmy neutron, many more (change continually)
	Honolulu, HI	X, E	None
	Los Angeles, CA	Love drug	Logos: blue dolphin, calvin klein, dove, blue smile, ferarri, green apple, mitsubishi
	Seattle, WA	X, E	Logos: mcdonalds, mitsubishi, yin-yang
*Bolded names are new since the last reporting period. Sources: Law enforcement, epidemiologic/ethnographic, and treatment respondents

ECSTASY: THE MARKET

Profit by the pill... Los Angeles provides an example of ecstasy’s high profit potential: A wholesale-level dealer pays $8 per pill (a “boat” of 1,000 pills for $8,000). The pills are sold to mid-level and then low-level dealers. The user pays up to $40 per pill.

Who sells ecstasy? As reported in previous Pulse Checks, young adults (18–30 years) continue to be the predominant street-level ecstasy sellers, according to the majority of responding law enforcement and epidemiologic/ethnographic sources. However, sources in Baltimore, Detroit, Honolulu, Los Angeles, Memphis, and St. Louis report ecstasy sellers as evenly split between young adults and adolescents. Moreover, sources in El Paso, New Orleans, and Seattle report sellers as primarily adolescents. Only one source in Baltimore reports adults older than 30 as the predominant sellers.

Ecstasy sellers continue to be predominantly independent, according to the majority of responding law enforcement and epidemiologic/ ethnographic sources. Both independent and organized sellers are reported in El Paso, Miami, and Portland (ME).

Nearly all respondents believe that sellers are very likely or somewhat likely to use their own ecstasy (see Highlights Exhibit 8). Only one (Miami^E) believes that sellers are not very likely to use it. Sellers in Memphis are more likely to use than last year. In Denver, adolescents tend to sell single pills and to use themselves, while adults (25–35 years) sell larger quantities and do not typically use.

Are ecstasy sellers involved in other crimes? As reported in the past, street-level ecstasy sellers are not typically involved in other crimes or violence. Among those who are, the most common crime continues to be drug-assisted rape, reported in nine cities: Columbia (SC)^L, Denver^L, Detroit^L, Honolulu^L, Los Angeles^L, Memphis^L, New Orleans^L, New York^E, and Sioux Falls^L. Nonviolent crime is reported in eight cities: Billings^L, Detroit^L, El Paso^L,E, Honolulu^L, Los Angeles^L, Memphis^E, St. Louis^E, and Sioux Falls^L. Two examples of nonviolent crimes are tagging and vandalism in El Paso, and petty theft and shoplifting in St. Louis.

Where are ecstasy markets located? Ecstasy sales span all geographic areas:

• All three types of areas (central city, suburban, and rural) are reported in half of the Pulse Check cities: Baltimore^L, Columbia (SC)^L, Memphis^L, Miami^E, New York^L, Philadelphia^L, Portland (ME)^L, and Washington, DC^L.
• Central city market locations are more prominent in Billings^L, Honolulu^L, New York^E, New Orleans^L, and Washington, DC^E.
• Central city and suburban locations are equally common in Baltimore^E, Chicago^E, Denver^E, Honolulu^E, Los Angeles^L, Memphis^E, St. Louis^L, and Seattle^L.
• Suburban areas are the primary market sites in Boston^L, Detroit^E, El Paso^L,E, Miami^L, St. Louis^E, and Sioux Falls^L.

Whereas markets for drugs like heroin and cocaine are increasingly moving indoors in some cities, the ecstasy market is continuing to move outdoors. Disrupting the market therefore requires new and broader strategies. More than half of responding law enforcement and epidemiologic/ethnographic sources now report that ecstasy is sold both indoors and outdoors: Baltimore^L, Billings^L, Columbia^L, Denver^L, El Paso^L, Honolulu^L,E, Memphis^E, Miami^L,E, New York^L, Philadelphia^L, Portland (ME)^L, St. Louis^E, and Sioux Falls^L. One source (El Paso^E) reports only outdoor sales. Elsewhere, the drug is still sold primarily indoors.

The most commonly reported indoor market locations, according to law enforcement sources, are still raves and concerts (reported in nearly every Pulse Check city), followed (in descending order of report frequency) by nightclubs and bars, college campuses, parties, private residences, schools, cars, hotels or motels, and the Internet.

How is ecstasy sold? Ecstasy sales are often venue oriented and usually involve acquaintance networks or private introductions to sellers. Hand-to- hand exchanges are common. In some cities, sellers approach buyers or buyers approach sellers, as reported in Honolulu, Philadelphia, Portland (ME), Seattle, Sioux Falls, and Washington, DC. Beepers and cell phones are mentioned in only five cities (Columbia [SC], Los Angeles, New Orleans, St. Louis, and Sioux Falls), and prearranged meetings are mentioned in only two (Chicago and Memphis). In Chicago, hawkers walk around in semipublic settings, such as nightclubs and raves, announcing “caps” or “rolls,” while in Seattle buyers know who to ask for at the door, and that person directs them to the sellers. By contrast, in Boston, most drugs are sold before users enter clubs.

What other drugs do ecstasy dealers sell? Law enforcement and epidemiologic/ethnographic sources in nine Pulse Check cities report that ecstasy sellers do not typically sell other drugs. In the other cities, the most common other drugs sold, as reported in the last Pulse Check, are club drugs, including GHB, ketamine, and, to a lesser extent, LSD. Marijuana is sold by ecstasy dealers in nearly half the Pulse Check cities (Baltimore, Billings, Denver, El Paso, Miami, Philadelphia, Portland, Seattle, and Sioux Falls), methamphetamine in four cities (Billings, Denver, Philadelphia, and Washington, DC), powder cocaine in another four cities (Baltimore, Columbia [SC], Miami, and Philadelphia), crack in three (Baltimore, Denver, and Washington, DC), and other pills, typically benzodiazepines and opiates, in Memphis and Philadelphia.

The ecstasy market has changed somewhat (fall 2001 vs spring 2002)....
New marketing strategies include changing pill colors, shapes, logos, and labels:	Columbia, SCL: Pills come in more colors than during the last reporting period. Home-pressed pills are no longer seen, nor are mercedes or elephant logos. Denver, COL: Logos and labeling are constantly changing, depending on the latest fads. St. Louis, MOE: An increase in logos reflects the proliferation of pills, many of which are really contaminants. Seattle, WAL: Pills now come in blue and orange, not just white as in the past—reflecting an increase in availability and variety of pills and a broadening in the number and creativity of domestic cooks.
New trafficking techniques are reported:	Miami, FLE: Body packing of ecstasy from Canada has increased. Some smuggling by cruise ship passengers is reported.
Markets continue spreading beyond the club and rave scenes:	Chicago, ILL: Ecstasy is being seen on the street for the first time. New York, NYE: Ecstasy continues to spread outside of raves, especially on the streets and in buildings, particularly in The Bronx and Staten Island. St. Louis, MOE. Once associated only with raves inside the city, ecstasy has now moved to high schools and colleges in suburban areas and might eventually reach rural schools. Seattle, WAL,E: Ecstasy has “jumped out of the pack of other party drugs” and is hitting schools and the streets: “Every kid in school knows someone who can get it.”
More adolescents and young adults are selling ecstasy in some cities:	Miami, FLL: Young adults continue to be more involved, especially via connections in high schools. Los Angeles, CAL: More adolescents are selling than in the past. Seattle, WAL: More young adults are actively involved.
Some new seller groups are reported:	Philadelphia, PAL: New organized Russian and Israeli groups are reported. Portland, MEL: Occasional organized groups of out-of-State promoters are becoming more frequent. Washington, DCE: Club owners, bartenders, and bouncers are increasingly allowing people to sell ecstasy on their premises.

ECSTASY: THE USERS

How many ecstasy users are in treatment? Despite ecstasy’s increasing involvement in mortality and emergency department episodes in many cities, clients in treatment generally do not report ecstasy as a primary drug of abuse. Further, only a handful of Pulse Check treatment sources report that clients in their programs use it as a secondary or tertiary drug: Seattle^N (10 percent); Philadelphia^M (8 percent); Baltimore^M (<5 percent); Miami^N (4 percent); and Portland^N (4 percent). However, slight increases are reported in all those programs, as well as in other programs where the numbers are lower.

Some theories about why ecstasy numbers in treatment appear low... Columbia, SCE: “The numbers are small and probably underestimated because they don’t seek treatment.” Memphis, TNN: “The drug is not in the program because we serve mostly adults. But the problem is rising in the community, especially among adolescents at parties. I anticipate seeing more young adults showing up in the future.” Los Angeles, CAE: “Ecstasy is slower to show up in indicators than other drugs because people are not always asked about it.” New York, NYM: “The program doesn’t test for it (ecstasy). It’s generally not seen in this older chronic ‘doper’ population.”

Exhibit 4. How much does a pill (one dose) of ecstasy cost in the 20 Pulse Check cities?

City Price Northeast Boston, MAL $20–$25 Boston, MAE $25 New York, NYL $25–$38 New York, NYE $15–$25 (street) $25–$35 (clubs) Philadelphia, PAL $20–$35 Philadelphia, PAE $15–$20 Portland, MEL $25 South Baltimore, MDL $18–$20 Columbia, SCL $25–$30 El Paso, TXL $20 El Paso, TXE $5–$8 Memphis, TNL $20 Memphis, TNE $25 Miami, FLL $11–$18 New Orleans, LAL $7 Washington, DCL $18–$25 Washington, DCE $20–$35 Midwest Chicago, ILL $25 Chicago, ILE $20–$40 Detroit, MIL,E $20–$30 St. Louis, MOL $100 St. Louis, MOE $20–$30 Sioux Falls, SDL $30–$50 West Billings, MTL $25 Denver, COL $25 Denver, COE $10–$20 Honolulu, HIL $25–$45 Honolulu, HIE $17–$40 Los Angeles, CAE $25–$40 Seattle, WAL,E $10–$20 (raves) $20–$30 (street)

Who uses ecstasy? Ecstasy users tend to be young adults (18–30 years), particularly according to epidemiologic/ethnographic sources. However, several non-methadone sources believe that adolescents are the primary user group (in Billings, Columbia, Portland, Seattle, and Sioux Falls), while several sources, both among epidemiologists/ethnographers and treatment providers, believe that young adults and adolescents are equally likely to use the drug. As reported in past Pulse Checks, ecstasy users tend to be evenly split between the genders (see Crack Exhibit 6). Also as reported previously, Whites predominate as ecstasy users in nearly all cities. Hispanics are named as the primary user group in only two cities (Los Angeles^N and Miami^N), as are Blacks (in Baltimore^E,M and Washington, DC^N). All three groups appear equally represented in New York^E. Whites and Asians are equally likely to use ecstasy in Honolulu^E. In Los Angeles, three distinct user groups are reported: the “ravers,” who tend to be White, followed by the “hip-hop crowd,” who are generally Black, and then the gay circuit partygoers.

Ecstasy users tend to come from middle socioeconomic backgrounds. However, low socioeconomic groups are mentioned as predominant in Baltimore^E,M, Billings^N, Chicago^N, Los Angeles^N, and Philadelphia^M, while high socioeconomic groups are mentioned in Denver^E, Detroit^E, Honolulu^E, Los Angeles^E, Miami^N, St. Louis^E, Sioux Falls^E, and Washington, DC^E. The suburbs are mentioned slightly more often than the central city as the area where ecstasy users are most likely to live.

Where do users take ecstasy? As reported in past Pulse Checks, nearly all epidemiologic/ethnographic and treatment sources report that ecstasy is used predominantly in groups or among friends. It is equally likely to be used in public and private settings, most typically (in descending order of report frequency, with 10 or more reports each) at raves, private parties, nightclubs or bars, private residences, and college campuses. In some cities, ecstasy is sold but not used in specific settings: the most frequent instances are high schools (as in Chicago, Detroit, Honolulu, and Miami), the streets (as in El Paso, Miami, and New York), and in or around malls (as in El Paso, Miami, and New York). Conversely, ecstasy is used but not sold at parties and raves in Sioux Falls.

How and with what other drugs is ecstasy taken? Ecstasy tablets are almost always consumed orally, as reported in past Pulse Checks. Exceptions, however, are occasionally reported. In Boston, for example, some users in their late teens and early twenties inject ecstasy and ketamine intramuscularly. In Sioux Falls, an increasing number of users report crushing and snorting ecstasy.

Ecstasy continues to be taken, either in combination with or sequentially, with alcohol, marijuana, or both. It is also taken with an array other substances, both legal and illegal:

• LSD: Boston, Chicago, Denver, Los Angeles, and St. Louis
• GHB: Boston, Miami, Los Angeles, and Sioux Falls
• Ketamine: Boston, Denver, El Paso, and Los Angeles
• Prescription pills (benzodiazepines or antidepressants): Los Angeles, Memphis, and Miami
• Heroin: New York and Philadelphia
• Cough syrup: Philadelphia
• Camphor/menthol inhalants: Memphis
• Sildenafil (Viagra®): Miami and St. Louis
• Nitrous oxide: Chicago

The changing nature of ecstasy users and use patterns (fall 2001 vs spring 2002)...
Younger students are using ecstasy in some cities:	Baltimore, MDE: Anecdotal evidence is increasing about ecstasy use in middle schools. Boston, MAE: Ecstasy use is increasing slowly but steadily among minority high school students. Additionally, it is increasing among students in private schools.
Increasing use is reported among some minorities and socioeconomic groups:	Memphis, TNE: Since the last reporting period, socioeconomic status has been shifting from high to middle. New York, NYE: Blacks are increasingly using ecstasy, and Hispanics are a growing market for street ecstasy. St. Louis, MON: Blacks continue to increase as an ecstasy-using population. Sioux Falls, SDN: More American Indians are using ecstasy.
Use is increasing in some rural areas:	El Paso, TXE: Ecstasy use, which had been limited to warehouses in the central city, has moved further out into rural areas—largely because police have moved the users out. St. Louis, MOE: A growing number of rural residents are coming into the city to buy ecstasy. Sioux Falls, SDN: American Indians are increasingly using ecstasy on rural reservations.
Some use settings are shifting:	Baltimore, MDE: Ecstasy is increasingly used on the street. El Paso, TXE: In addition to the new raves in rural areas, raves of 200–300 adolescents at a time are taking place clandestinely at night on unpoliced, unlit golf courses within the city. Ravers, who can easily disperse, find each other by using laser pointers or by putting “glow sticks” around their wrists and necks. Los Angeles, CAE: Ecstasy use is becoming more prevalent in private settings, such as residences and parties. It is not just a club drug anymore. St. Louis, MOE: Ecstasy is increasingly used while alone, not just in groups and among friends, as in the past.
Some drug combinations have changed:	El Paso, TXE: Ketamine use with ecstasy is a new phenomenon. Miami, FLE: Since September 11, more combinations—although fewer cases—have been reported. Also, LSD use is less reported than in the past. Sioux Falls, SDN: Marijuana use with ecstasy is increasing.

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⁺ The following symbols appear throughout these Highlights to indicate type of respondent: ^LLaw enforcement respondent, ^EEpidemiologic/ethnographic respondent, ^NNon-methadone treatment respondent, and ^MMethadone treatment respondent.

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