In The Festival Harm Reduction Project series, we examine drug use at music festivals and clubs across the globe, and explore what artists, organizers, harm reduction groups, and concert-goers are doing to make nightlife safer.
On a Saturday night two weeks ago in Toronto, a 24-year-old woman died after collapsing in a nightclub in the city. Four other people were also hospitalized that same night after they were all taken ill—one in the same venue, and three in a different one. The local papers reported that woman who died and the people who wound up in hospital were all the victims of suspected drug overdoses involving MDMA. The press also reported that these incidents were likely caused by "a bad batch of street level drugs."
This description of events is fairly typical whenever there's a drug fatality in the nightlife scene, and is true of Canada just as much it is of the UK and US. Ecstasy deaths are often immediately reported as overdoses, before toxicology reports are available, and attributed to super-strength tablets that have been laced with toxic substances and are infiltrating nightclubs.
There is a big problem with this narrative: it's usually inaccurate at best and gives the public a superficial view of the actual dangers of taking ecstasy and how to mitigate them.
Ecstasy fatalities grab a lot of attention, despite being one of the rarest types of drug deaths. The most recently available from the Center for Disease Control showed that 52,404 people in the US died of drug-related causes in 2015. Opioids (prescription and illicit) were the main driver, contributing to 33,091 of those deaths. While the CDC doesn't record ecstasy deaths, a 2009 study estimated about 50 occur a year. How drug deaths are reported on in the media—and in turn how they are discussed in common parlance—is often misleading and sensationalized, loaded with prejudice about drug users and perpetuating potentially dangerous urban legends. Even the term "overdose," when used to describe the fatal results of taking MDMA, is often imprecise.
"The word overdose is misleading in a lot of situations, but particularly with MDMA," Henry Fischer, policy director at drug policy think tank VolteFace told THUMP. Fischer said the term is generally unhelpful when talking about deaths caused by illicit substances because an overdose is the ingestion of more than the recommended amount of a drug, and there aren't "doses" of illegal drugs, as such. "If you've taken more than you should have to enjoy the effects, if you've had an unpleasant time, is that an overdose?"
Although no regulated dose of MDMA exists, harm reduction experts tend to agree that a recreational amount can be between 75-100 mg. However the Colorado-based harm reduction organization DanceSafe warns that there have been many fatalities even within that range. "In the vast majority of cases of MDMA-related deaths, where no other drugs were found in the person's bloodstream, the deceased had taken a dose within the normal range for appropriate therapeutic or recreational use," DanceSafe said on its website.
According to the organization, the problem with describing ecstasy deaths as overdoses is that it sends the message that the danger is in taking too much. However with ecstasy, the dangers are more complex than that because its various effects are dependent upon the circumstances it's consumed in.
The leading cause of MDMA-related deaths is believed to be complications from heat stroke. Taking ecstasy doesn't directly cause heat stroke, but it does increase the risk of it by raising body temperature and inhibiting natural thermoregulation. The risk is made even greater by the fact that users are often dancing for prolonged periods of time in a hot environment and not drinking enough water (which can lead to heat stroke even without taking any drugs). Offering chillout areas, free water, and keeping temperatures cool in clubs are all good harm reduction measures venues and event organizers should be taking to mitigate these risks.
However, adding to the complex nature of ecstasy, there is also a danger of drinking too much water. A number of people have died of hyponatremia (water toxicity) when high on MDMA, including the British teenager Leah Betts whose ecstasy-related death on her 18th birthday caused a public moral outcry. In these cases, the body retains water, particularly affecting the brain cells, and leading to the shutdown of primary bodily functions such as breathing and heartbeat. Although still in the early stages of research, it is thought women are more at risk of ecstasy-related hyponatremia than men. Owing to the water problems when taking ecstasy, drinking sports drinks containing electrolytes is recommended as a way to help prevent both heatstroke and water toxicity.
Another cause of death—as was the suspected case with the Toronto death—is adulterants in MDMA. Fischer said that in those cases, calling it an overdose only serves to attribute the cause of death to MDMA when in reality it was another toxin altogether. It also steers attention away from the real dangers of an unregulated drug trade, where chemicals are produced on the black market and their contents are simply unknown.
A particular concern in recent years has been PMA getting into pills. It's a stimulant with similar effects to MMA but with much higher toxicity levels. There have been a number of reports in the media about "dodgy" or "rogue" batches of pills, either cut with PMA or just PMA being sold as MDMA. Harry Shapiro, the Director of the UK charity Drug Wise, said that using the term "dodgy batch" is inaccurate, and that it erroneously implies that "good" batches of pills exist. "All ecstasy batches have the potential to be rogue because there is no medically supplied ecstasy," he said.
Pill testing—the checking of drugs for the presence of unwanted contaminants—is the only way to know what is in something. However, few venues offer such services on-site, especially in the US where stringent drug laws inhibit such harm reduction measures. Additionally, pill testing can only tell someone if there is a presence of the desired substance, but it can't accurately tell you everything else that's in it, or its purity.
Shapiro said that while he thinks there are many instances of the media irresponsibly reporting on drug fatalities, he doesn't think the use of the word overdose is too much of a problem. "The harm reduction likely to help people is happening with the consent of the police and venue owners—that's where this plays out," Shapiro said. "I don't think if the Daily Mail [the popular UK right-wing tabloid] calls a death an overdose that it gets in the way of harm reduction. What does get in the way are those not cooperating with the people who want to promote potentially life saving interventions," he said.
Shapiro said that using the term overdose to describe a drug fatality was more a matter of semantics, but does think there is a larger problem of how language is used in relation to drugs. What is more damaging according to Shapiro is hateful language in relation to drug users. Descriptions of "junkies" and "zombies" in "shooting galleries" dehumanizes people and passes a value judgement on the worth of the deceased's life.
Fischer agreed that language and accuracy in reporting on drug fatalities matters. "There are ways to increase the danger and to decrease it, and it's more useful to talk about harm reduction or drug policy reform," he said. "Directing attention at the drug and the amount is an oversimplification."
Anna Codrea-Rado is THUMP's News Editor. Follow her on Twitter.