Agonies and ecstasies: the continuing story

November 16th 2015

Today (16th) sees the 20th anniversary of the tragic death of Leah Betts. The family decision to make public a photo of Leah in intensive care, which then became the centrepiece of a subsequent anti-drug campaign, made her one of the most iconic drug deaths of recent times.

Yet memories fade fast; during the first week of Channel Five in 1997, I went with a camera crew to the Sanctuary, a 3500 capacity legal rave venue in Milton Keynes to try and ascertain among the dancers what impact Leah’s death had on their own drug-taking. The answers fell roughly into two camps; some had switched to amphetamine, but the majority just felt Leah had been one of the unlucky ones. And to a large extent they were right; Leah took her pills at home, not in a hot steamy club, and subsequently died of dilutional hyponaetremia – in other words, she drank too much water probably in the mistaken belief that this would offset the effects of MDMA – a catastrophic misreading of the perfectly valid harm reduction message about not getting dehydrated.

For many years after, ecstasy use began to decline as rave culture passed into the mainstream and then into memory. But despite all the drugs that have come along since including ketamine, GHB, mephedrone and all the newer novel psychoactive substances, ecstasy has remained the clubbers favourite drug: of the illegal drugs, second only to cannabis in the Global Drug Survey and actually saw a near 4% upturn in use among those aged 16-24 according to the latest government general population drug survey published in July.

Back in the day, there were many dire predictions about the long term brain damage that ecstasy would cause; in particular that the ravers of the 1990s would grow up with higher than average rates of depression because of serotonin depletion. There is no evidence that this has happened, but as far as I can tell, the reasons why most people come through their MDMA experiences unharmed, while some succumb to acute effects remains a mystery.

What is undeniable though, is that MDMA-related deaths have been on the rise in the past five years. In England and Wales, the figure went from 48 in 2010 to 85 in 2014 and those involving PMA/PMMA from 0 in 2010 to 29 in 2013, although they fell to 24 in 2014. These increases are probably due to a combination of two factors.

Firstly, the drug itself has been going through changes. Purity fell dramatically around 2007-8 when a large consignment of the main precursor drug was seized in the Far East. Chemists switched to another, more easily available chemical and in so doing, introduced PMA/PMMA into the mix causing death clusters across the UK. Then by contrast some very strong pills and MDMA crystal hit the streets, some samples approaching two or three times the standard dose.

The second factor is that we now have a new generation of experimenters and users who weren’t even born when Leah Betts died – and so were not exposed to some important harm reduction messages of the day. Now it is impossible to know how many saw/heard those messages and took notice of them and for sure, there were regularly recorded MDMA deaths from 1989 0nwards. But at least, central government, local councils, the police, national radio stations, higher education and the medical profession were in various away actively involved in trying to keep young people as safe as possible. Most of that has gone away, and moreover, off the back of tougher licensing regulations where many venue owners won’t allow drug workers in for fear of attracting police and council attention – the illegal rave has come back which attracts younger people who can’t get into the clubs and where drug use escapes any checks. A look at the death toll of recent years reveals the majority are teenagers, some of whom had attended these unregulated events.

Wales, Austria and the Netherlands are three countries offering club drug testing services, but test results appear later online or relayed back to the venue and even the one English charity offering onsite testing would be breaking the law if samples were handed back. Legal, technical and ethical questions remain, but testing at least offers a more scientific appraisal of drugs in immediate local circulation than what often passes for ‘drug alerts’ which rarely reach the end users anyway. But beyond testing more generally, maybe if harm reduction was not quite so toxic a phrase in official circles, more credible and potentially life-saving messages could be put out via credible sources without being attacked for ‘condoning drug use’.