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This study aimed to determine if: (i) high\u2010dose MDMA drug alerts, and (ii) varied descriptions of dose, effects and actions to reduce harm were associated with intentions to reduce the initial MDMA dose in a hypothetical scenario.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Australians who used MDMA pills\/capsules in the past year completed an online survey. Respondents were randomised into alert (<jats:italic>n<\/jats:italic>\u2009=\u2009441) or control (<jats:italic>n<\/jats:italic>\u2009=\u2009184) conditions, with the former receiving a high\u2010dose MDMA alert with systematically varied descriptions of dose, effects and actions to reduce harm. Multinomial logistic regressions determined the association between receipt of drug alert (and varying alert content) and hypothetical MDMA dosing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Almost half (45.4%) of those in any alert condition reported intention to not use (20.7% of control participants) and 46.7% stated they would use and reduce their initial dose (69.0% of control group). Compared to the control group, those who received an alert were significantly more likely to report intention to not use the drug, as compared to taking a smaller initial dose (adjusted relative risk ratio [aRRR]\u2009=\u20093.28, 95% confidence interval [CI] 2.13, 5.07) or taking the same\/higher initial dose (aRRR\u2009=\u20092.62, 95% CI 1.31, 5.22). There was no significant association between different alert phrasing and intended behaviour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>While there was no significant effect of variation in phrasing, receipt of an alert promoted intended harm reduction behaviours. Future research assessing actual behaviour and different substances (e.g., heroin, methamphetamine) is important to further understand the utility of this public health communication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.14037","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T01:00:02Z","timestamp":1741741202000},"page":"1169-1181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk communication about high\u2010dose MDMA: Impact of a hypothetical drug alert on future MDMA use"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0502-7782","authenticated-orcid":false,"given":"Joel","family":"Keygan","sequence":"first","affiliation":[{"name":"National Drug and Alcohol Research Centre UNSW Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7857-3819","authenticated-orcid":false,"given":"Breanna","family":"Willoughby","sequence":"additional","affiliation":[{"name":"School of Psychology and Public Health, Centre of Alcohol Policy Research La Trobe University  Melbourne Australia"},{"name":"School of Health and Biomedical Sciences RMIT University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raimondo","family":"Bruno","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre UNSW Sydney  Sydney Australia"},{"name":"School of Psychological Sciences University of Tasmania  Hobart Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1015-9379","authenticated-orcid":false,"given":"Monica J.","family":"Barratt","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre UNSW Sydney  Sydney Australia"},{"name":"Criminology and Justice Studies, Social Equity Research Centre and Digital Ethnography Research Centre RMIT University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5705-2026","authenticated-orcid":false,"given":"Amy","family":"Peacock","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre UNSW Sydney  Sydney Australia"},{"name":"School of Psychological Sciences University of Tasmania  Hobart Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200404000-00009"},{"key":"e_1_2_11_3_1","volume-title":"Australian drug trends 2024: key findings from the National Ecstasy and related drugs reporting system (EDRS) interviews","author":"Sutherland R","year":"2024"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-011-2529-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2016.04.016"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2024.112467"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15493"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/ael078"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/14659891.2018.1436607"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.20230681"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1177\/20503245231198472","article-title":"From prohibited to prescribed: the rescheduling of MDMA and psilocybin in Australia","volume":"9","author":"Ritchie OD","year":"2023","journal-title":"Drug Sci Policy Law"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-022-00598-5"},{"key":"e_1_2_11_13_1","first-page":"3","volume-title":"Disruptive psychopharmacology","author":"Liechti ME","year":"2022"},{"key":"e_1_2_11_14_1","unstructured":"Psychonaut Wiki.MDMA.2025. 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