Ecstasy: the comeback pill

The crowd heaves as the dance-music DJs Paul Oakenfold, Jeremy Healy and Judge Jules spin tunes from the stage hour after hour. Ten thousand people are dancing outdoors, at the former holiday village of Mosney in Co Meath. The crowd are drinking more water than alcohol, to ensure they don’t dehydrate. This is Homelands, the biggest dance festival of 2000, a 14-hour marathon fuelled by ecstasy.

The rave scene began in London and Manchester in 1987, the so-called summer of love. By the early 1990s dance culture, and its byproduct “E”, had become established on Irish campuses and in Irish nightclubs. But by the time of festivals such as Homelands and Creamfields, with their loved-up, euphoric crowds, the drug’s potency had plummeted. Drug gangs were adding agents to bulk up the powder pressed to make the pills. They reduced levels of methylenedioxymethamphetamine, or MDMA, the chemical that caused the euphoric rushes and made the pills so popular.

Users would complain of having to pop a handful of pills on a night out for the same high provided by one tablet a few years earlier. “They weren’t the same any more, and the comedown wasn’t as clean either. You’d be all over the place for a few days,” says one former heavy user of the drug.

Ecstasy use seems to have peaked around 2003, when the Garda seized €9.7 million worth of the drug. As the dance music synonymous with the drug waned in popularity, and as Ireland and most of Europe became more affluent, cocaine replaced ecstasy as the recreational drug of choice. Ecstasy had all but disappeared by 2010, when the Garda seized just €88,000 worth of the drug.

But now it is making a reappearance. Seizures of the pills this year are already higher than at any point in the past eight years. And 2013 is the third successive year that finds of ecstasy have increased.

Early-warning system
Although data about deaths from ecstasy – a rare phenomenon in any case – are not available for the last three years, the period over which the drug appears to have re-established itself, other indicators suggest the drug is once again a significant component of the illegal drug market.

In addition to the increased Garda seizures, higher levels of MDMA have been detected in lab tests. This suggests MDMA esctasy has supplanted the synthetic chemicals that mimic ecstasy and were once sold in head shops, the retailers of “legal highs” that became popular in the 2000s before being shut down in 2010.

Some health and security professionals are are also convinced that ecstasy use is growing fast. Dr Jean Long of the Health Research Board says the HSE's early-warning system is indicating increased use of the drug in Ireland. "We have noticed an increase in ecstasy use," she says of 2012 and 2013. "It's mainly through hospital admissions, from people having negative effects and through deaths. The UK is noticing exactly the same thing. There is more MDMA in each tablet and they are more available."

Long believes that for a number of years so-called recreational drug users were taking pills they believed were ecstasy but were really a less potent pill, containing BZP and PMMA, two stimulants sold as “party pills” in head shops before they were banned. “MDMA has, in the past year or two, come back with a force,” she says.

The experience in Europe is similar, though less pronounced. A new report by the European Monitoring Centre for Drugs and Drug Addiction notes declines of up to 50 per cent in the volume of seizures of drugs such as cocaine, amphetamines and heroin between 2001 and 2011. But the report asks whether ecstasy is making a comeback.

Seizures of the drug across Europe peaked at 23 million tablets in 2002, then fell sharply through most of that decade. In 2009 just 2.5 million tablets were seized. Since then the figure has risen again.

The European monitoring report says the downward trend for so many years was attributable to strengthened controls and targeted seizures across Europe of PMK, a key “precursor” drug used to make MDMA.

“There are, however, indications of a recent resurgence of the ecstasy market, although not to the levels seen earlier,” the European report says. “MDMA appears to be becoming more common, and high-purity powder is available in Europe. Ecstasy producers may have responded to precursor controls by moving to the use of pre-precursors or ‘masked precursors’, which are essential chemicals that can be legally imported as non-controlled substances and then converted into the precursor chemicals necessary for MDMA production.”

More potent
The increased use of ecstasy in Ireland is partly due to the higher potency, says Jean Long of the Health Research Board. It's also down to greater supply in recent years of the chemicals used in illegal laboratories, mainly in eastern Europe and China.

At the forensic-science laboratory at Garda headquarters, Hugh Coyle, one of its staff, agrees that gangs’ use of these “pre-precursors”, which Europe has not yet banned, is the most likely reason that production and, in turn, consumption of the drug have increased.

Coyle and his colleagues do not test the potency or purity of drugs, but he suggests the greater availability of large quantities of chemicals to make MDMA would also explain why tablets now in circulation might contain more of the substance.

Coyle and his colleagues test drugs seized by the Garda to confirm that the substance seized is illegal and to establish the precise type of drug for the purposes of criminal prosecution. “The levels [of MDMA] we were finding had fallen up to 2010 and were at their lowest levels. The head shops had taken off at that stage.”

The rise and fall of head shops has also affected consumption of ecstasy. Coyle points out that in 2010 his laboratory processed just 56 drugs confirmed as MDMA. But in 2011, the first full year after the head-shop ban, that jumped to 391 cases.

“People seemed to move away from MDMA when the head shops were open, but since they have closed, people have drifted back to MDMA. The problem with any of it is that you just don’t know what you are taking. When we were testing the head-shop products we might not get the same results or find the same substances in two [pills] taken out of the same packet.”

The ecstasy MDMA that drug dealers are now selling is just as unreliable. “Just because it’s the same colour with the same logo as the stuff they got the previous weekend doesn’t mean it’s the same. Taking this stuff is Russian roulette.”

Under the radar
Consultants in emergency departments in some of the biggest hospitals in the country say they have seen no spike in cases of chronic adverse reaction to the drug in the past few years.

Dr Eamonn Brazil, an emergency-medicine consultant at the Mater hospital in Dublin, says trying to determine what drugs a patient has consumed is difficult. “We have no hard figures on that.”

The number of patients arriving in his department with drug-related issues is so high that a spike in ecstasy-related cases may not be noticed for some time.

“It’s common for us. We wouldn’t even remark on it. We would see one or two people [with MDMA ecstasy-related adverse reactions] on a Thursday, Friday, Saturday and Sunday. But you have to keep in mind that we would get 200 patients in the 24 hours of, say, a Friday.”

Dr David Menzies, a consultant in emergency medicine at St Vincent’s University Hospital, in south Dublin, says few users end up in emergency departments during a night out. “It’s a drug that’s under the radar. It gets mixed up with alcohol and it doesn’t present as a phenomenon in itself.” He adds that extreme adverse reactions, including renal failure, are very rare.

Dr Bobby Smith, a consultant child and adolescent psychologist who works with young drug users in south Dublin and across the southeast, believes the Garda figures for seizures of MDMA ecstasy indicate changing trends among drug users. He cautions against taking solace in the fact that emergency departments and drug-treatment centres are not seeing increases in people with adverse effects. Even at the peak of its popularity ecstasy was not known for that, he says. “People present for treatment when they can’t control or stop themselves, and ecstasy doesn’t appear to cause that problem.”

Thierry Mulliez has worked for two decades with adolescents and young people in the area of alcohol and drug abuse. He has noticed an increase in the numbers seeking counselling for MDMA ecstasy use at his clinic, Asc Galway.

He believes that although users do not become physically addicted to the drug, they often find it hard to socialise without it and continue to use it despite trying to stop. “I think since the head shops closed MDMA [ecstasy] has become more popular,” he says.

Most of the people he sees are in their 20s and dissatisfied with what they see as an unravelling in their lives, having tried unsuccessfully to stop using MDMA-based ecstasy. “They might have lost a job or lost interest in things, or maybe their partners want nothing to do with them because they said they would stop and they haven’t.”

He points out that many of those now using MDMA ecstasy were not part of the club or pub scene when the drug was first popular and are so unaware of the bad publicity the drug received then. “I think cost is a factor, too. In Galway, cocaine is €80 a gramme, but you can get pills for €5. So younger people mightn’t have much money – maybe €20, which wouldn’t buy too many pints. But that’s two pills and two pints and that’s you sorted for the night. That’s the way they look at it.”

Ecstasy: Harmless or hazardous?

Ecstasy has two images. Since it became mainstream, media have branded it a “killer designer drug” and heavily covered the rare deaths from the pill, while also frequently glamorising the “designer drug” and its associated culture.

In November 1995 an English teenager, Leah Betts, collapsed and later died after taking ecstasy. A photograph of Betts in a coma (below) was widely published, and a clear link made between ecstasy and her death. It later transpired that Betts had died from water intoxification, caused partly by her drinking too much water to avoid dehydration, and partly by side effects of the drug itself.

Despite initially misrepresenting the causes of Betts’s death, the media seemed to learn little. It can still be hard to work out whether it’s a dangerous substance.

“Users don’t get dependent on ecstasy, but they may get dependent on the high they get from it,” says Dr Jean Long of the Health Research Board. “But you just don’t know who is going to have a negative reaction, and that’s why you don’t want people taking it.”

Long says that once a negative reaction begins, users are in serious trouble. “You can’t do very much for them. You can stabilise them, but you can’t reverse the problem with the brain.”

Youth workers say young people can make poor decisions when they are on the drug, as they are more trusting and less aware of danger. This can lead to crisis pregnancies, to STDs or to people being attacked after ending up in situations they would normally avoid.

The European Monitoring Centre for Drugs and Drug Addiction concedes that deaths from ecstasy are rare, and fewer than 1 per cent of drug users seeking treatment internationally cite ecstasy as their primary drug. Tablets with higher levels of MDMA, such as those currently in circulation, can be more dangerous than pills with low levels. The centre says fatalities have been noted when more than 300mg of the drug has been consumed. Purity levels in Europe have typically been between 60mg and 70mg, but are rising. Some tablets contain as much as 130mg. A person buying a drug will never know its chemical make-up, so the precise dangers of any tablet are impossible to know.

Dr Bobby Smith, who works with young drug users, believes MDMA is a gateway drug to heroin. “I remember being involved in adolescent services in 2003,” he says of the peak year for ecstasy. “They had things called party packs: a few ecstasy tablets and some heroin. You smoked a bit of gear to come down off the ecstasy. And then when we did studies later of heroin users, between 20 per and 25 per cent had become addicted in that way, smoking it after taking ecstasy.”