Evidence map›Paper›PMID 41796977›Full record

ArticleDrug and alcohol review2026

Exploring the Utility and Appropriateness of Dose Thresholds for Issuing of Public Drug Alerts on High-Dose MDMA: A Qualitative Study.

Jack Freestone, Harriet MacDonald, Stassi Kypri, Brendan Clifford, Krista J Siefried, Nadine Ezard

Abstract read
In one paragraph

Article in Drug and alcohol review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Jack FreestoneNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.ORCID 0000-0002-7503-7540
Harriet MacDonaldNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.
Stassi KypriNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.
Brendan CliffordNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.ORCID 0000-0002-9178-9013
Krista J SiefriedNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.ORCID 0000-0002-6534-3325
Nadine EzardNational Centre for Clinical Research on Emerging Drugs, Sydney, Australia.ORCID 0000-0002-7495-8305

Funding

Australian Department of Health, Disability and AgeingNational Centre for Clinical Research on Emerging Drugs
6 · The paper itself

Abstract

introductionDrug alerts are sometimes issued when samples are found to exceed a pre-determined dose threshold. In Australia, it is common for alerts to be issued when MDMA pills contain ≥ 150 mg of MDMA free-base or 179 mg hydrochloride. Nineteen such alerts were issued in Australia in 2024, raising concerns that repeat alerts may lose impact over time. This study examined experts' viewpoints on the appropriateness and utility of using a 150 mg threshold to trigger high-dose MDMA alerts.

methodsFifteen participants responsible for the design and dissemination of drug-alerts in Australia completed an online survey and seven participated in a focus group. The survey and focus group elicited reflections on the use of thresholds when issuing alerts about high-dose MDMA. Data were thematically analysed using a qualitative description methodology.

resultsAlthough thresholds are binary and cannot account for evolving trends in MDMA manufacture or consumption, most agreed that 150 mg free-base is a reasonable threshold for issuing alerts. It was noted that 150 mg of MDMA may cause harm, that high-dose alerts are contingent on a threshold, and that thresholds enable rapid communications. Due to Australia's limited capacity to monitor community perceptions of alerts, there was little evidence to justify a change in the threshold. DISCUSSION AND

conclusionsNotifying communities about products containing ≥ 150 mg MDMA remains a harm-reduction priority. Establishing a database containing dosage and purity results for all analytically tested samples and increasing efforts to monitor community responses to and perceptions of drug alerts may improve future risk communication.

Indexed as

HallucinogensN-Methyl-3,4-methylenedioxyamphetamineAustraliaDose-Response Relationship, DrugFocus GroupsHumansQualitative ResearchHallucinogensN-Methyl-3,4-methylenedioxyamphetaminedrug toxicityecstasyharm reductionMDMApublic health alerts

Identifiers

PMID41796977
PMCPMC12968355

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.