How Can We Stop Ecstasy Killing People?

A "Green Rolex", the pills causing trouble in Belfast.

This week, Belfast’s club scene has been rocked with rumours of links between pills and the “sudden and unexplained deaths” of eight people in their twenties and thirties. Although the PSNI and the Chief Medical Officer have been quick to stress that they're awaiting results of toxicology reports before they establish a drug link, social media and local papers have been flooded with warnings about "Green Rolexes". A batch of the pills, which are light green and stamped with Rolex’s crown logo, were seized by the PSNI, who issued a warning that they might contain the potentially toxic MDMA substitutes PMA and PMMA.

Although we can’t yet state with certainty that PMA/PMMA were involved in the deaths, Mike Power, author of Drugs 2.0, told me, “When there are eight deaths in a limited geographical area like you’ve identified, my instinct would be that there’s some kind of toxic adulterant in the ecstasy supply in that area.”

The fact that PMA/PMMA are being mentioned at all is cause for concern; when they hit the headlines, a string of localised deaths usually follow. From December, 2012 to January, 2013, four people in Lancashire and Derbyshire died after taking what is widely thought to have been PMA/PMMA. Similar instances have occurred in Wales, Scotland, Israel and Canada, and though the police don’t usually warn against a specific type of pill, for fear of it seeming like an endorsement of others, when PMA/PMMA is mentioned the rules change. The police's response to what's happened this week in Belfast has mirrored that of Greater Manchester Police after a string of deaths in April. A warning has been put out that heart-shaped tablets circulating in the region may have been contaminated with PMA/PMMA – or, as the media have imaginatively dubbed the pills thought to contain them, “Dr Death".

Tablets containing PMMA recovered by the DEA. (Photo via)

So what exactly are PMA/PMMA and why are they so dangerous? They’re very closely related to MDMA, but their chemical structure make them far more toxic. When taken at low doses, they have basically the same effect as E: loss of inhibitions paired with a rise in empathy and energy levels. It’s when they're taken at higher doses that PMA/PMMA become more dangerous.

The chemicals have a much steeper dose response curve than MDMA, so the more you take, the more rapidly dangerous it becomes. This might not be so bad if you knew what you were taking, but the main problem is when the chemicals are sold as MDMA. PMA/PMMA take a lot longer to kick in than MDMA and the effects at the start are more subtle, so when the user feels they aren’t working, they take more. Unsurprisingly, this is where the problems start.

It isn’t just the risk of PMA/PMMA contamination that makes pills dangerous, though. The real danger lies in the ambiguity surrounding the contents of any pill. There's an ever-growing list of chemicals being passed off as MDMA; some, like PMA/PMMA, can be more harmful, others less so. But the crux of the problem is that it’s very hard to practice any sort of harm reduction when you have no idea what you're ingesting. As Power warned, “These days, if people take tablets with a logo printed on them and believe it to be MDMA, then they’re really not aware of the nature of the drug market under current controls.”

And it's that clandestine nature of the drug market that's arguably the biggest contributor to drug-related deaths. As Power says, “You’ve got so many complicating factors in a prohibitive market that it makes harm reduction almost impossible. When you have no quality control and, at the same time, no enforcement, this is the likely outcome. Sadly, this is the kind of thing that will continue to happen.”

Making fake pills in Indonesia. However, these contain Malaria tablets rather than PMA/PMMA.

One proposed solution to the ecstasy problem is to set up public-funded clinics where people can take their pills to be tested under laboratory conditions – a system that's been used in the Netherlands since the mid-90s. There, you can walk into somewhere like Trimbos Institution in Utrecht and have your pills scientifically tested for free and without any legal repercussions. This system has lead to both a reduction in pill-related deaths and an increase in the purity of pills supplied – if a dealer knows their clients can have their pills tested, they're less likely to try passing off other drugs as MDMA.

The UK government has so far rejected the idea of testing clinics. When I talked to Michael Copeland, the MLA for East Belfast – one of the areas most affected by the drug trade in Northern Ireland – he explained why he was against the idea. “The problem with testing clinics is, even if you have one pill tested, you don’t know what’s in the full batch. The two pills could look the same but contain totally different chemicals. The only way to prevent drug-related deaths is to kill the market. To me, it’s all about education. If there were no market – nobody would be selling it.”

He was also keen to highlight the fact that pill-testing clinics do not remove the demand or the secondary harms that the drug trade produces, such as crime and the cost to society. “The truth is, whether these things are ‘safe’ or not there’s an undeniable link between the sale of them and gang crime in the area.”

As it currently stands in the UK, the only way you can find out what's in a pill is to buy testing kits off the internet. However, as Power explained to me, pills like the Green Rolex are made specifically to get round these tests. “They put in 50mg of PMA, then 65mg of MDMA, and the trouble is that a home testing kit cannot identify all the contents of a mixed pill. So you can’t just drop a PMA pill in one and it comes out with PMA – that’s not happening. It comes out with the substance that’s present in the most volume, so they’re made to fool those tests."

One vocal supporter of state-funded testing clinics is Johnboy Davidson, founder of Enlighten Harm Reduction and the man behind pillreports.com – an online, A-to-Z record of ecstasy pills where users can upload their own experiences with certain pills, as well as identifying features of the pill, such as stamps and colour. I called him up to find out what we can do to reduce the harms of mystery pills.

Johnboy Davidson, founder of Pill Reports.

VICE: Hey, Johnboy. So, Pill Reports exists to help people know what they're taking. What motivated you to set up the website?
Johnboy Davidson: Just that: education. Harm reduction is a major part of drug policy in most developed nations, but very few have the political will to actually do it. Pill Reports exists to help users help themselves and others. We are the warning system that attempts to head off these sorts of incidents before they happen. You don't read the stories about all the bad pills we identify and discourage people from using because, thankfully, we can sometimes intercede before people die. And this is what we achieve with no funding and a volunteer effort. Imagine what could be done if a government tried to do the same.

The site is a valuable tool, but it seems like copycat stamps and the development of designer drugs is occurring at such a rate that, even after looking up a tablet on your database, there’s still a huge ambiguity about what it contains.
Ever since there have been pills with logos, there's been copycatting. But that's branding for you. From Sony TVs to Gucci bags on the street corner, it's the same old game. This has always been the case – only testing will let you know what's in a pill. Everything else is just rumour and hearsay.

Do you think that public-funded testing centres could potentially save lives?
Yes. Undoubtedly. Go look at the rates of death in countries like the Netherlands and you'll see that it's far lower than other countries that don't allow testing. You know what's also lower in the Netherlands? Rates of usage of drugs. Drug testing does not encourage drug use. In fact, it discourages it. Study after study shows this. But politicians would rather let people die, as an example to others, than make the simplest effort to save lives.

Thanks, Johnboy.

Follow Matthew on Twitter: @matthewfrancey

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