Abstract
3,4-Methylenedioxymethamphetamine (MDMA) is a popular entactogen known for its stimulation, pleasure, and socialisation promoting effects. The drug is associated with less harm than many other substances, although there are risks associated with use related to both drug effects and those that arise due to prohibition, such as the consumption of other drugs in place of MDMA due to mischaracterisation at the point of sale. Despite high past-year consumption prevalence of MDMA in Aotearoa New Zealand, little research has examined use of the drug in detail, particularly within the context of legalised drug checking. The current thesis aimed to address this gap and includes four studies which broadly examine the use of MDMA and associated factors in Aotearoa New Zealand, with a focus on motivations, consequences, experience, harm, and harm reduction. Two studies include the findings from a national crosssectional survey, and two studies present reflexive thematic analysis findings of focus group discussions held in the Southern region. Overall, the findings provide a deep and thorough analysis of MDMA use in Aotearoa, highlighting use mostly motivated by socialisation, pleasure, and enhancement of experience. Most participants reflected favourably upon their MDMA experiences, with some reporting personal betterment (e.g., improved emotionality) because of their MDMA use. Harm reduction behaviours were found to be regularly employed by people who use MDMA, although drug checking services (or reagent use) were utilised by only a minority of people who use MDMA, despite significant concern about MDMA supply and the adulteration or substitution with other drugs, particularly cathinones. Although use appears informed by harm reduction strategies, some individuals use MDMA in ways that are associated with increased risk of harm. The findings of this thesis contribute to a growing body of literature regarding drug use and highlight the importance of gaining first person perspectives of drug use, particularly regarding drug pleasures and benefits, and key perspectives of harm reduction such as peers and drug checking. The thesis concludes with recommendations for harm reduction development and future research.