A Scoping Review of Australian Literature on People Who Use MDMA and Their Harm Reduction Practices

Background: Discourses around MDMA are often predominantly concerned with identifying risk and characterizing harm. Reluctance from Australian governments to reform drug policy and implement harm reduction services has created a policy and service gap, and it is therefore pertinent to consider how people who use MDMA mediate potential harms, and how this knowledge can inform approaches to drug use and policy reform. This community-led scoping review aimed to identify Australian literature on the practices of harm reduction strategies by people who use MDMA. Methods: Seven topic-specific and multidisciplinary databases were searched in February 2023 in line with conventional scoping review methodology. Eligible articles were published from 2002 onwards, reported on the voices of people who use MDMA as primary evidence within the context of Australia, and included at least one strategy to reduce harm. Data were analyzed by drawing on conventional content analysis and thematic analysis frameworks. Results: Twenty-three peer-reviewed and gray literature sources were included. Five key themes were identified on how people mediate harms and enhance the pleasurable aspects of MDMA use: drug consumption practices, planning and preparation, testing drugs, accessing health services, and community care practices. Conclusion: The results suggest that people who use MDMA take care to identify and reduce unwanted harms. The way people who use MDMA make decisions around drugs is mediated by peer groups and online technologies, as well as broader social and cultural contexts of drug use and drug prohibition. More qualitative, participatory, and action research projects are recommended to accurately reflect the views and needs of people who use MDMA and meaningfully shape service reform.