WHEN 26 year old Rory Kavanagh died in a Dublin hospital 10 days ago, after taking half an ecstasy tablet, the spotlight was put on a previously little known aspect of the drug. Latest research suggests that some people may have an idiosyncratic reaction to it with serious, if not fatal, consequences.
Although the exact cause of the death of Rory from Galway who, his parents said, suffered from cardiac arrhythmia, has yet to be determined, it may be relevant that the friend who was with him, and with whom he shared the tablet, suffered no ill effects.
Much research is now concluding that some users are genetically susceptible to ill effects from what was once called the glamour drug. But there is also increasing evidence that many more users risk long term damage to vital organs.
In just five years, this "dance drug" has become the second most popular illegal drug after cannabis in the State. It crosses both class and gender and forms a central part of youth culture.
"The ecstasy problem is huge," according to Detective Noel Clarke of the Dublin Drugs Squad. "Between 1991 and 1995 the rave scene has mushroomed and, with it, ecstasy use."
In 1991 a little over 400 ecstasy tablets were seized in the Republic. Last year, this figure increased to 124,000. In the same period ecstasy related offences increased from 45 to 645. The price of ecstasy has also plummeted from £25 to £10 and the age at which people are beginning to take the drug has fallen to as young as 13.
Last year the Forensic Science Laboratory tested 180,000 tablets seized in the State. According to international estimates, this would account for only one tenth of the total quantity in circulation here: an estimated two million tablets.
Accepting that not all these tablets were bought and that many users take more than one tablet at a time, this would suggest a using population of tens of thousands at least.
Research for these articles and for the academic project on which they are based was conducted in two Dublin schools - one, a middle class school, the other a working class school. It indicated that almost one in every four pupils took ecstasy.
"Ecstasy is everywhere in Ireland, it's in every small village, every town and every city," says Nick Killian, of the National Parents' Council, Post Primary, adding that this was forcefully brought home to him when he visited Mohill, Co Leitrim, last year. "I was told that their biggest problem was ecstasy, particularly in the 14-16 age group.
According to Garda figures the number of people charged in relation to ecstasy, as a proportion of the population, is greater nationally than in Dublin, indicating that ecstasy is used at least as much outside Dublin. Ecstasy use does, however, fluctuate both within and between areas over time.
Ecstasy users vary from the regular user, to the occasional user to the experimental user. Altogether 86 users (including 45 children in the two schools visited) in Dublin, Cork and Waterford were interviewed for this project. More than 40 per cent said they took ecstasy at least once a week, 33 per cent said they took it once a month, while the remainder said they took it less often.
Ecstasy use has grown hand in hand with dance music. Starting in Britain in the mid 1980s the dance scene took 9ff here in the early 1990s. "The explosion of dance music is totally down to ecstasy," says a floor manager in one of Dublin's top music stores. "That's how the rave culture became so popular. If you wanted to dance all night you needed ecstasy."
Where once there were only a few dance clubs there are now up to 10 in Dublin's city centre, a trend reflected across the country. And dance music is now one of the biggest sellers in music stores. Dance acts have become some of the most frequent and biggest selling events in Dublin's Point Depot and top dance bands and DJs also figure prominently in the mainstream charts.
As dance culture merges with mainstream culture, the side effects of ecstasy are slowly surfacing. Last year 414 people, 309 of them for the first time, attended Dublin's main treatment clinic, Trinity Court, because of ecstasy. In 1991, the clinic had no such cases.
ALREADY five people have died in hospital as a result of ecstasy and media reports estimate that another 11 have died from the drug outside hospital. "People are suffering from anxiety, depression, psychosis (paranoid delusions) and depersonalisation (where the person feels he or she is not part of reality)," says Dr Eamon Keenan, consultant psychiatrist with the Eastern Health Board.
Ecstasy is thought to target the chemical in the brain, serotonin, which controls mood. Ecstasy increases the level of serotonin, creating a sense of euphoria and a loving state of mind for three to five hours. Although it is disputed whether they can be applied to humans, animal tests have shown that ecstasy damages the ability to produce serotonin.
Of the 86 users almost 66 per cent had been taking ecstasy for more than a year with more than 40 per cent taking E at least once every week. Over two thirds were taking more than one tablet at a time with 16 per cent taking three tablets or more at a time - indicating quite heavy use.
According to Dr Keenan, the psychiatric problems are mostly acute and short term, but can be chronic.
"In the majority of chronic cases, the user would have been predisposed [with underlying psychological problems] and they would have taken the E and that would have triggered it off. Then again we've had cases reported where there were no predisposed factors. There are other cases where the person has taken it on a few occasions or just once and has had an idiosyncratic reaction."
This theory of individual susceptibility is supported by researchers in Sheffield University. They examined seven deaths from the drug. Most suffered damage not just to the brain, but also the heart and liver. This, it's believed, was the consequence of both an immediate reaction to the drug and damage - caused by long term use.
Of the seven cases, four showed signs of death from heatstroke, yet only two had high temperatures. To explain this it was suggested that the metabolism of their livers might explain the fatal reaction. The enzyme (chemical) which breaks down ecstasy does so more quickly in some people than in others according to the research.
Further research now indicates that users who break down the drug quickly are less likely to suffer short term damage but more at risk of long term damage. Users who break down the drug slowly are more at risk of short term damage, including even death, but less likely to develop long term damage.
Doctors here believe that idiosyncrat reactions account for some, if not most, of the ecstasy deaths. Heatstroke the main killer and is caused by three factors: the direct effect of the drug on the body (it speeds up the heart rate and blood pressure); heat in the clubs and the high temperature caused by dancing.
Dr Des Corrigan, senior lecturer in the School of Pharmacy at Trinity College, points out that most people combat heatstroke by taking breaks and drinking water. "However, for some people, and nobody can predict why it's only for some people, once the process starts it seems to be irreversible - it can't be stopped," he says.
"The really frightening thing about this is its unpredictability. Nobody can tell who's going to have a safe experience and who isn't," adds Dr Corrigan. Moreover, researchers point out that although a user may take ecstasy over a long period of time and suffer no ill effects, he or she is not safe from a fatal reaction.
Glasgow doctor Tom Gilhooly who is currently researching ecstasy deaths in Britain believes idiosyncratic reactions do not explain ecstasy deaths, however. "We just don't know why people are dying. There are an infinite number of variables, but overheating caused by the environment in which people are taking ecstasy - the club - is a crucial factor," he says.
Dr Gilhooly adds that the risk of death is very small: estimated in Britain to be one in 6.8 million. Although there is no medical estimate here, it seems to be higher with an estimated 16 deaths out of probably two to three million tablets taken.
Suggestions that contaminated tablets may cause deaths is disputed by many researchers and this is supported by the fact that the vast majority of tablets tested by the Forensic Laboratory are genuine ecstasy.
BUT doctors are increasingly worried about the tendency of users themselves to mix ecstasy with other drugs. Research conducted among the 86 users indicated that 70 per cent did so: almost one in every two took ecstasy with cannabis, 45 per cent took it with the amphetamine speed and over a quarter took it with alcohol.
"I am very worried by the number taking alcohol: that should be avoided like the plague, because it further dehydrates the body," says Dr Corrigan. Speed, he says, adds to the stimulation of the heart, further increasing the risk of an attack.
In recent years, drug activists in Dublin have seen significant numbers of users smoking heroin because of ecstasy. "The big worry with us is that we're seeing a number of people moving on to heroin as a come down from ecstasy. That number is increasing," says Dr Keenan.
