Public Release: 

Rolling on Molly: US H.S. seniors underreport ecstasy use when not asked about Molly

NYU and Columbia U. researchers find survey word-choice matters when asking teens about ecstasy/MDMA use

New York University

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."

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On the web: http://bit.ly/1YnFbNM

Researcher Affiliations:

Joseph J. Palamar, 1,2
Katherine Keyes, 3
Charles M. Cleland 2,4
1 Department of Population Health, New York University Langone Medical Center, New York, NY;
2 Center for Drug Use and HIV Research, New York University College of Nursing;
3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY;
4 New York University Rory Meyers College of Nursing, New York, NY, USA

Acknowledgements: This project was funded by the National Institutes of Health (K01 DA-038800, PI: Palamar, P30 DA011041, PI: Deren, K01 AA021511, PI: Keyes, and 01 DA-01411, PI: Johnston). The Inter-University Consortium for Political and Social Research and Monitoring the Future principal investigators had no role in analysis, interpretation of results, or in the decision to submit the manuscript for publication.

The author would like to thank the principal investigators of Monitoring the Future (PIs: Johnston, Bachman, O'Malley, and Schulenberg) at The University of Michigan, Institute for Social Research, Survey Research Center, and the Interuniversity Consortium for Political and Social Research for providing access to these data. Monitoring the Future data were collected through a research grant (R01 DA-01411) from the National Institute on Drug Abuse (NIDA). J. Palamar, K. Keyes, and C. Cleland are funded by the National Institutes of Health (K01 DA038800, K01 AA021511, and P30 DA011041, respectively).

About CDUHR

The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit http://www.cduhr.org.

About the Columbia University Mailman School of Public Health

The Mailman School of Public Health is recognized as an international thought leader addressing critical public health issues ranging from emerging infectious diseases and urban health disparities to the implications of health policy decisions. The Mailman School is committed to creating knowledge, translating science for impact, and educating the next generation of public health leaders. Since 1922, the Mailman School has been at the forefront of public health research, education, and community collaboration. Addressing everything from chronic disease to HIV/AIDS to healthcare policy, the School tackles today's pressing public health issues, translating research into action. http://www.mailman.columbia.edu

About NYU Langone Medical Center

NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals--Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center's dedicated inpatient orthopaedic hospital; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the Medical Center--plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to http://www.NYULMC.org

About the NYU Rory Meyers College of Nursing

NYU Rory Meyers College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science with a major in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Nursing Practice degree and a Doctor of Philosophy in nursing research and theory development.

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