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Beginning in the late 1980s, a new “rave” subculture emerged. It was characterized by all-night technodance parties and the use of illicit drugs, particularly 3,4-methylendioxymethamphetamine (MDMA; also known as “ecstasy,” “E,” “X,” and “XTC”). Originating in Great Britain, the trend for youth to attend these parties became strong in Canada around 1991 and has reportedly been growing exponentially ever since, as has an overall increase in MDMA use (1,2). Despite these increases, very little is known about the overall drug-use patterns of individuals who attend raves and how these patterns relate to MDMA use. MDMA is classified as an empathogen or enactogen (3) because the subjective experience has been described as intensely emotional and as creating the perception that one can experience the emotions of others (4). Users typically report the impression of feeling clear-headed, serene, euphoric, and sensual; significant visual illusions common to LSD and other psychedelics generally do not occur (4–6). As recently as 1986, some physicians believed ecstasy to be a safe drug (7). However, recent research has revealed many negative effects associated with ecstasy use. Acute adverse effects include restlessness, ataxia, tremor, myoclonus, diarrhea, and the most severe side effect, hyperthermia (8). MDMA use has been associated with sudden death and cardiovascular collapse (9), with the most common cause of death being hyperthermia (10). The behavioural and environmental factors that often coexist with MDMA consumption (for example, concomitant ingestion of other illicit drugs and high ambient temperature) may increase the risk for severe adverse effects, particularly cardiovascular complications and hyperthermia. Prolonged exercise (for example, dancing), high ambient temperatures, and high humidity are typical in rave and club environments and are believed to potentiate the neurologic toxicity of MDMA (11,12). Indeed, in the US emergency room visits related to MDMA consumption have increased from 637 in 1997 to 1143 in 1998 (13). The possible long-term consequences of MDMA use have also generated concern. It has been reported that repeated administration of MDMA in laboratory animals diminishes serotonin and dopamine levels and damages the nerve terminals from which serotonin is released, in a dose-related manner and with incomplete recovery (14–17). With some controversy, many researchers nonetheless regard animal studies on MDMA to be relevant to human use. For example, the finding that the loss of serotonergic (5-HT) axons in monkeys is greater than in rats given a fourfold greater dosage of MDMA has led some to conclude that MDMA is potentially far more neurotoxic in primates than in nonprimate mammals (18). According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), recent use is higher for ecstasy than for amphetamines and LSD (19). Although similar results have been reported in the US (20), very little is known about the patterns of MDMA consumption in Canada. While some general surveys have identified illicit drug-use patterns of high school students (21–24), university students (25,26), and university athletes (27), none have targeted individuals who attend rave parties—individuals thought to be at greater risk for MDMA use. The Centre for Addiction and Mental Health (CAMH) produced a study that surveyed 7800 university students across Canada (25). This study identified 10.2% of the population as using illicit drugs other than cannabis. Alcohol was noted as the drug of choice among university students, with 92% of the population having tried it at least once. Quebec students had the highest rate of both cannabis and alcohol use in the previous 12 months (28.7% and 88.3%, respectively). MDMA was reportedly used by 4% of the entire sample; in accordance with the EMCDDA study (19), this reveals the greatest prevalence for lifetime use, compared with drugs other than cigarettes, cannabis, or alcohol. Although the prevalence of ecstasy use might not appear to be salient, it comprises a substantial proportion of the 10.2% trying any drug other than alcohol or cannabis. Another series of surveys was conducted by Parent Resources Institute for Drug Education (PRIDE) every other year between 1987 and 1992. These studies surveyed students in grades 6 through 12 and found that 14.1% of the population used cannabis in 1991–1992, while 5.7% of the population used hallucinogens (21,22). While such surveys indicate the usage of an age group similar to that assumed to attend rave parties, a sequence of experimentation has yet to be identified in Canada. Australian and European studies have, however, identified the progression or patterns of drug use. The following drug-use sequence was found in a survey of 10 812 students in Norway (aged 14 to 17 years): 1) alcohol, 2) cigarettes, 3) cannabis, 4) amphetamines, 5) ecstasy, and 6) heroin (28). This study suggested that adolescents with a pattern of polydrug use have used ecstasy and that ecstasy is significantly associated with attendance at house parties and with subcultural music preferences. In Australia, studies of rave populations found that 90% of attendees had tried LSD, 76% had tried ecstasy, and 69% had tried amphetamine (29). The researchers noted that LSD is a possible sequential gateway drug to other substances and indicated the popularity of both ecstasy and amphetamines among rave attendees. Our study aimed to delineate the drug consumption histories of those attending raves in Montreal, Canada, and to determine whether these are similar to the histories found elsewhere. In addition, we attempted to determine the popularity of MDMA in this group and to identify potential specific sequences of drug experimentation within samples of rave-attending individuals.
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