The use of illicit drugs among Australians is a significant public health problem and is associated with considerable social costs and harms . Use among young Australians is especially concerning, with nearly one-quarter of teenagers aged between 14–19 years reporting having tried an illicit drug in their lifetime . In 2010, ecstasy was the second most commonly used illicit drug in Australia after cannabis. Although the prevalence of ecstasy use in adolescents is relatively low, with less than three per cent of 14–19 year olds reporting any use in the past 12 months , for those teenagers who do use ecstasy, the potential for harm is considerable. Ecstasy use has been associated with a range of serious adverse effects including an increased likelihood of having a mental illness and greater levels of psychological distress . Furthermore, early initiation to substance use is a risk factor for a range of negative consequences including using other drugs in adulthood, juvenile offending, poor academic performance, delinquency and school dropout [3–6].
In recent times, concern has mounted about the manufacture and misuse of New and Emerging Drugs (NEDs), a general term used to refer to substances that are not under international control . Also known as ‘emerging psychoactive substances’, ‘legal highs’ and ‘synthetic drugs’, NEDs are specifically designed to mimic the effects of existing illicit substances, such as ecstasy, by slightly changing their chemical structure . The term NEDs includes a wide range of synthetic substances, however there are two common types: synthetic cathinones, stimulant-like substances intended to imitate ecstasy and amphetamine, and synthetic cannabinoids, compounds designed to mimic the effects of cannabis [8–10]. Statistics from the United States indicate that in 2012, less than one per cent of American tenth-graders (aged 15 years) had used a synthetic cathinone in the past year, but almost nine per cent had used synthetic marijuana . In addition, a recent United Nations report indicated that adolescents as young as 15 years old are using NEDs in the European Union (EU) . Although there is no available data on the prevalence or age of NED use among young Australians, internet monitoring analyses indicate that there are a large number of emerging substances available to Australian consumers through online retailers [12, 13]. Indeed, the rate at which these drugs are emerging is alarming, with 73 new psychoactive substances notified for the first time in the EU in 2012 . This rapid growth and availability of NEDs, at both a global and local level, and the likely harms associated with their use, are a potential cause for concern.
Although NEDs are manufactured to imitate the effects of existing substances, the use of NEDs is associated with a number of unique risks and challenges compared to established illicit drugs. Firstly, since these substances are emerging so rapidly and are constantly changing, very little data exist on their toxicology and the risks associated with their use . Short-term side effects reported by users include agitation, psychosis, insomnia, palpitations and nausea [10, 16], however there is a complete lack of knowledge about the effects of NEDs in the long term. Further compounding this problem is the huge array of NEDs that are available, all of which are likely to have different effects and different risk profiles . Secondly, the fact that these substances are often marketed as ‘legal highs’, ‘bath salts’ or ‘plant food’ is likely to influence people’s perceptions of the risks associated with their use . That is, young people are led to incorrectly believe that these substances are low-risk and safe to use, despite there being no evidence to support this. In light of the uncertainty about the adverse effects of NEDs, and the huge potential for young people to misuse these substances, the United Nations has urged governments to educate adolescents about NEDs through drug prevention programs [7, 9]. Therefore, there is a clear need to respond to this new public health challenge with the development of evidence-based prevention programs for NEDs.
Given the overlap in the age of use, risk factors and potential harms associated with ecstasy and NED use [2, 7], as well as the fact that NEDs are often produced to imitate the psychoactive effects of ecstasy, it is logical to deliver prevention for these substances simultaneously. School is the ideal location to implement such prevention, as young people spend over a quarter of their waking lives at school  and in many States in Australia, delivering drug education at school is mandatory. Despite the existence of school-based prevention programs, their efficacy has been limited, especially their ability to change behaviour and reduce substance use [20, 21]. This is likely due to obstacles that impede program implementation, such as a lack of resources in terms of teachers, time and money available , as well as the fact that teachers often make unfavourable adaptations to program content [23, 24]. Internet-based programs appear to overcome these barriers and offer greater accessibility, affordability, and feasibility of use compared to traditional programs [25, 26]. Despite these advantages, few Internet-based prevention programs have been developed for illicit drugs, with most focussing on alcohol and tobacco use , and there are no existing Internet-based programs specifically targeting ecstasy misuse and the growing phenomenon and use of NEDs. In response to this, the aim of the current study is to build on the successful Climate Schools framework to develop and evaluate an online, school-based prevention program solely for ecstasy and NEDs.
The Climate Schools framework
The Climate Schools courses are school-based prevention programs for alcohol and other drugs, based on a harm minimisation approach and social learning principles. The Climate Schools courses are delivered via the Internet, and engage students through online cartoon storylines. A number of Climate Schools courses have previously been trialled among Australian school students, with results supporting their feasibility and efficacy in reducing harmful alcohol and cannabis use [28–31]. Specifically, the Climate Schools: Alcohol Module has been evaluated with two separate cluster randomised controlled trials (RCTs) and has been found to increase alcohol-related knowledge, decrease positive expectancies about alcohol and to reduce average alcohol consumption, the frequency of binge drinking and alcohol-related harms among Australian Year 8 students [30, 31]. Furthermore, a recent cluster RCT (n = 764 students) of the Climate Schools: Alcohol and Cannabis course in 10 Sydney secondary schools [28, 29] was also successful in increasing cannabis and alcohol-related knowledge, and decreasing the average consumption of alcohol use and the frequency of cannabis use and binge drinking amongst young people. It is also important to note that both teachers and students rated the Climate Schools programs as an enjoyable, useful and relevant drug education resource. Therefore, these results position the Climate Schools platform as a sound foundation upon which to base a new prevention program that specifically addresses ecstasy and NEDs.
Aims and hypotheses
The aim of the current study is to determine whether the successful Climate Schools
framework can be extended to the prevention of established illicit drugs, such as ecstasy, as well as emerging drugs. To our knowledge, this will be the first trial of an Internet-based prevention program targeting ecstasy and NED use among young people. Specifically, the proposed study will seek to determine whether the Climate Schools: Ecstasy and Emerging Drugs Module
is more effective than school-based health education as usual in:
Increasing ecstasy- and NED-related knowledge
Reducing intentions to use ecstasy and NEDs
Preventing the uptake and reducing the use of ecstasy and NEDs
Secondary aims include examining the effects of the intervention on ecstasy- and NED-related beliefs and attitudes, peer pressure resistance, mental health outcomes, other substance use and truancy.