A random-effects meta-analysis was conducted to examine the association between ecstasy use and risky sexual behavior. Analysis of 17 studies revealed a small to moderate sized effect (mean weighted r = 0.211, 95% CI: 0.085–0.336). Random-effects homogeneity testing was non-significant, thus formal moderator analyses were not performed. Moreover, numerical and visual diagnostics suggested that publication bias was not a concern. It is hoped that the present meta-analytic findings and recommendations will encourage investigators to broaden their research methodologies and will stimulate new insights into the association between ecstasy use and risky sexual behavior.
The drug, 3,4-methylenedioxymethamphetamine, or MDMA, was first synthesized in 1914, but the recreational use of the drug did not emerge until the late 1970s and early 1980s (McElrath, 2005). Although recreational MDMA, or ecstasy, use has historically been associated with partying and the young adult “club scene,” it has, in recent years, gravitated to new environments, and ecstasy is now used by a broader array of people (Sterk, Klein, & Elifson, 2008). The lifetime prevalence rate of ecstasy use among adults in the United States is around 10% (Keyes, Martins, & Hasin, 2008) and the corresponding lifetime estimate for adolescents is 5.5% (Johnston, O'Malley, Bachman, & Schulenberg, 2011). The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) estimates the lifetime prevalence rate of ecstasy use for the United Kingdom at 8.6% (http://www.emcdda.europa.eu/online/annual-report/2010/library/table6). As regards to annual (past year) prevalence rates for ecstasy use, the United Nations World Drug Report indicates estimates of 1.4% and 1.6% for the United States and United Kingdom, respectively (United Nations Office on Drugs and Crime, 2011). Because of its potential for misuse and harm, MDMA (ecstasy) is classified by the U.S. Drug Enforcement Agency as a Schedule I substance. Ecstasy use is associated with a multitude of physiological and psychological effects, including dehydration, euphoria, increased energy, a heightened sense of perceived interpersonal connectedness, greater sexual arousal, and increased cognitive impairment (Klitzman et al., 2002 and Rosenbaum, 2002). The combination of impaired cognitive functioning, such as poor decision-making and diminished judgment, coupled with heightened sexual arousal is particularly problematic and places people at increased risk for unsafe sexual behavior.
