Killer pills: Myth or murder?

This is not just another drug scare story. 'Ecstasy' pills containing PMA are killing clubbers in the UK. Find out how to make sure you're not next, and why the government should be doing something about it.

All across Britain the revulsion has been palpable. In February, consumers trusting their supermarkets to sell them what they pay for, found they had been dining on horsemeat rather than beef.

Products were recalled, questions were raised in Parliament. It seemed like a throwback to a previous era. Food scandals such as this were common in the 19th century, when food labelling requirements were non-existent, factories operated without any scrutiny and the main principle of the business was profit for the manufacturers.

Today, across Britain 500,000 ecstasy users are in a similar, but far more deadly situation. In the UK right now there is a state of complete chemical anarchy. Put aside for a moment your natural, healthy scepticism about drug scare stories, because this is real.

There are pills being sold as ecstasy in Britain today that have killed dozens of young people. Reports never specify exactly what happened, blaming MDMA itself, or a "bad batch" of pills. Victims suffer intense over-heating, become panicky, speak quickly and incomprehensibly, convulse, and die.

Among the estimated 30–60 million pills consumed in the UK each year, there are currently batches circulating that contain one of two highly dangerous drugs: PMA and PMMA, either alone or mixed with MDMA.

PMA and PMMA are like MDMA –the chemical name for ecstasy. They are stimulant drugs loosely related to amphetamines, or speed. But PMA/PMMA's chemical structure makes it far more toxic and deadly than either.

When PMA/PMMA is taken by itself it can be mistaken for a low dose of MDMA; users feel more emotionally open, some say they feel energised, others a little lethargic. But the drug is more dangerous than MDMA for a number of reasons: it is more toxic and has a very steep 'dose-response' curve, which means that 100mg will hit you much more than twice as hard as 50mg. The more you take, the more dangerous it gets – fast. What's more, since the drug takes longer to come on than MDMA, and has a milder effect, users often think their pills are weak and take more, chasing the buzz.

But most dangerous of all is when these PMA-laced pills contain other drugs such as mephedrone or MDMA. Ruthless pill-pressers do this to make the drugs seem stronger.

PMA/PMMA, when mixed with ecstasy, can trigger a chain reaction known as serotonin syndrome, where the feel-good chemical that floods users' brains goes into overdrive, causing dangerous overheating and convulsions. There have been dozens of deaths where PMA/PMMA has been found in users' bodies in the last 12 months. In Lancashire and Derbyshire between December 2012 and January 2013, four people died having taken what they thought was ecstasy, with another in Wales in February.

The young people who died were Charlotte Woodiwiss, 20, of Chapel-le-Frith, and Dale Yates, 18, from Buxton, who died in late December. Gareth Ashton, 28, from Wigan, and Jordan Chambers of Poolstock, near Oldham, died in late January. In February, Travis Barber, 19 and from Manchester, died after taking half a pink, heart-shaped pill, though it was uncertain at the time of reporting if this caused his death. Often police forces do not wish to advise users on the particular variety of tablets that killed users since it could be seen as an endorsement for other pills circulating in the area. But Greater Manchester Police put out a warning that the pills they took may have been contaminated with PMA/PMMA: heart-shaped tablets in a variety of colours.

Thomas Philip Jones, 19, of Llangefni, died in Ysbyty Gwynedd in February after a night out in Holyhead, having taken a green pill stamped with an apple.

Newspapers have reported dozens more such cases over the last 12 months. Michael Coleman, 22, and Liam Coffey, 22, of Kinsale, Ireland, died in September 2012 after taking PMA-tainted MDMA powder.

In May 2012, Scott Gowing-Wilks died near Bournemouth. Tests on the pills found at his flat confirmed they contained PMA. In June 2012 Rose Farley, aged 15 from Liverpool, died after taking a pink pill; her friends claim her drink was spiked. Again PMA was suspected, but not yet confirmed.

In February 2012, young mother Nicole Tomlinson, from Darlington became agitated at home after taking pills. She lay on her back moving her legs in a cycling motion and sweated profusely before she collapsed. She, too, had taken PMA-laced pills.

In September 2011 a 20-year-old man in Scotland died after taking several greenish-blue Einstein pills. His friend, who took the pills but survived, talked to Mixmag: "It took three [pills] before I had a decent hit off them. After the third I was so munted I was rolling round the couch, eyes in the back of my head. Then I came back to earth. Instead of leaving it at that we bought more. I did six in probably 15 hours, and nine hours after the last one I was still fucked.

"They were much more tweaky and uncomfortable than normal MDMA should be, and the comedown never really came on. My mate was far worse. He was walking into walls, very confused. He went grey in the face before being taken to hospital. Somehow I survived, but my mate didn't. There was another lad near here who also died."

Three months later, police reported that these pills did indeed contain a mixture of PMMA and MDMA – a killer combination.

Toxicology reports from some of the deaths are still in progress, but Steve Holme of Derbyshire Police confirmed to Mixmag that PMA was found in the bodies of Charlotte Woodiwiss and Dale Yates, along with another as-yet unidentified drug.

New Precursors

So why have these mixed MDMA-PMA/PMMA pills come to market? Why would anyone make a potentially fatal pill in the first place?

MDMA is made using chemicals known as precursors. These have changed over recent years; originally, safrole was used. An essential oil extracted from the roots of certain trees, safrole smells like marzipan and was used in the food flavouring industry until the 1970s, when it was discovered to be carcinogenic. It's internationally controlled, so replacements have been found; these too are now illegal.

PMA/PMMA, on the other hand, are made from anethole, an oil which is similar to aniseed. This substance is not controlled and it is just a couple of steps in the laboratory to turn it to PMA. Some chemists and pill-pressers, looking for a fast buck and a cheap and easy alternative to MDMA, have turned to PMA. Whether they know it's potentially lethal to their customer base and just don't care, we'll never know. It's thought the pills are made overseas, though no one can be certain.

Rumours started emerging online last summer that a batch of dangerous pills was circulating in the UK. Some of the stamps mentioned were "Pink McDonald's", and earlier, "Einsteins", blue pills stamped with 'E=MC2'. The latest batch of pills under suspicion are pink, blue and green tablets in the shape of hearts. But pill logos change each week, with trusted presses rapidly imitated by shady outfits.

PMA's appearance on world markets always leads to localised spates of deaths. In 2007 in Israel, 24 people died when the drug, which was legal, appeared. And in Canada over the last 12 months there have been reports that up to a dozen clubbers have died from the effects of PMA or PMMA. But there are relatively few cases of PMA poisoning in Holland.

The Dutch Model
In February, Mixmag walked into the Trimbos Institute, the Dutch National Centre for Mental Health and Addiction, in Utrecht, to a warm welcome from research associates Daan van Der Gouwe and Sander Rigter. We were there to find out how the Dutch deal with issues of drug purity.

The Drugs Information and Monitoring System gathers data from hundreds of users every week and documents what drugs are on the street. All across the Netherlands, there are around 30 drop-in labs where users can come to have their pills tested, free and without fear of arrest.

A comprehensive database of pills is produced, and the first check workers carry out is to see if their pill is already in this database or not. If it is, then information on contents is offered, along with warnings about the dangers of all drugs. If the pill does not appear, it can be sent to the Trimbos Institute, who first analyse it in-house.

Sander Rigter's in-tray would be a dream for many drug users. Inside many pinch-seal bags there are dozens of different drug types, from heroin to 2CB, and lots of brightly coloured pills, cocaine and amphetamines. But this is work, not pleasure: each of these samples is rigorously tested and all data is entered into the national database. Unknown pills are couriered to a lab in the south to be examined by gas chromatography-mass spectrometry machines. These reveal exactly what is in the tablet. "We do see PMA/PMMA sometimes, but we can warn users that it is present and also put out a nationwide warning, using mass media and the net," says Rigter.

Service director Raymond Niesink is explicit: "Our priority and purpose is to reduce drug use and reduce harm, and to prevent drug use," he says.

In the centre of town lies the Victas drug-testing centre. Inside, Laura Keizer sits in a small clinic and waits for her first visitors of the evening to arrive with estasy tablets for her to test. There's a slightly surreal vibe, sharpened by the knowledge that this drug testing lab is paid for by Dutch taxpayers.

"Sometimes we have clients who are swingers. They come and tell us they couldn't get it up and wonder if it was the pill to blame," says Laura.

However, the atmosphere is serious. One man arrives and hands over a small bag of white powder. It's amphetamine, he says, and he'd like to see if it's safe. It is tested with a number of reagents, and it's fairly pure amphetamine. "I would take it back to my dealer if it was not safe," he says.

Another customer arrives and hands over a pill with a red star. Voluntary drug workers Krijin Roeleveld and Sieke Nijmeijer weigh and examine and test it, and after checking the database confirm that it's likely to contain 135mg of MDMA.

"This system keeps our dealers honest, and us a bit safer," says the client. "They know we can come here and check."

MDMA Deaths

It's important to state clearly that any drug use is dangerous. Even pure MDMA is involved in the deaths of dozens of people in the UK each year.

Between 2006 and 2010 ecstasy featured in the UK, in conjunction with other drugs, on an average of 35 death certificates a year, according to the Office of National Statistics. The average number of deaths in which ecstasy was the only substance present over the same period is 18.

But MDMA is not especially toxic; if it were, hundreds of thousands of people per weekend would be dying from it all over the world. However, it's also true that since 2011, researchers have discovered many pills containing strong doses of MDMA – up to 150mg. With no quality control, users have overdosed.

"Many users have only ever had pills containing stuff like (former 'legal high') BZP," Holme tells me. "Then they buy other pills, take loads of them, face a strong dose of MDMA – and they can die. The harm reduction methods of the 1990s seem to have been lost on this generation of drug users. They need to remember: don't double-drop, don't take more if the effect seems weak. Stay hydrated and stay cool."

Now that PMA/PMMA is appearing in Ecstasy tablets in the UK, what can users do to protect themselves? Johnboy Davidson runs Pillreports.com, a global, crowd-sourced database of information around ecstasy pills. Users post reports and images of pills they have bought, often with photos of pill tests they have carried out.

A simple pill-testing kit called the Marquis Reagent can tell you if a pill contains MDMA or not. They are sold in the UK by the firm EZ-Test. Users scrape a small amount of the pill and drop it inside a small vial containing a chemical, which, if it turns black or dark purple, indicates that the pill contains MDMA or similar drugs. If a pill has only PMA/PMMA, the Marquis Ez-Test will show no reaction. But since the most deadly pills contain PMA/PMMA mixed with MDMA, even this is not 100 per cent safe.

Two more tests are required: the Mandelin Reagent, which shows PMA, but also reacts to MDMA, meaning a killer mixed pill will slip through unnoticed. There is one more test, available online, called Robadope. This will show no result for MDMA, but a red result if there is PMA or MDA (a drug related to MDMA) present. Since MDA is very seldom seen on international markets, a red result
with the Robadope test is a sign the pill is potentially dangerous and should be thrown away.

Davidson says users have to be especially cautious right now. "Reagent tests aren't great for mixed pills. All the usual advice for safer drug use should be followed, only more diligently. Research your pills online. Test them. Start with a half. Monitor yourself for temperature fluctuations outside the norm. Stay hydrated (but don't drink too much). And if in doubt, just don't take them. Better sober than dead," he says.

He says that PMA is appearing in pills thanks to greed and dishonesty. "PMA, when combined with low doses of MDMA, gives a lot more bang for your buck. It is simple economics. The problem comes in when users neck a whole bunch of them. More than one or two pills and it gets dangerous, fast."

What Can We Do?
While tabloid newspapers attributed the latest deaths to 'new, super-strength' varieties of ecstasy, drug users were sceptical. Many Mixmag readers will remember the events of 2010, when two young men in Lincolnshire whose deaths were blamed on then-legal high mephedrone were later found to have taken methadone, the heroin substitute. This is different: it is a real threat, and one that all responsible drug users should heed.

The recreational drug scene is rife with paranoia, misinformation and crookedness, with profit the sole motive. There is no magic bullet that will fix the problem, not even the Dutch pill-testing model, since even pure MDMA poses significant risks for a small minority of users each year. But it would be, at the very least, a step forward.

In a couple of decades from now, successive governments' unwillingness to regulate, control and license the trade in recreational drugs could well be seen as a gross dereliction of its duty to protect the public.

Mike Power's book Drugs 2.0: The Web Revolution that's Changing How the World Gets High, is published by Portobello Books on May 2