How safe are your drugs?

Last week a teenager died after taking one tablet of 'pure' ecstasy. James Collard asks the vital question...

As teenager Leah Betts fought, and then lost, her very public struggle for life last week, no one who followed the blow-by-blow press coverage could have failed to be moved. Yet just as one part of the population listened, terrified, to the news, and learnt that Ecstasy is also known as E, or doves, or snowballs, another set of viewers were thinking "God! What are they talking about? Snowballs haven't been around for years", followed closely by a disturbing thought: that if ITN is as wide of the mark about this, an area we know about, just how accurate are they when we don't?

The barely disguised bemusement of establishment reaction last week, and the media's inexpert scrabbling together of background information, highlights the fact that the rise of rave culture, and the great wave of recreational drug use that has grown up alongside it, have created the deepest generational schism since the birth of rock 'n' roll.

A shared enjoyment of Ecstasy is, surely, one of the few experiences that binds together young Britons of all classes: the working-class Manchester boy does it, as does the young gay businessman in Islington, the wide- boy ducking and diving in Essex and, if one magazine is to be believed, the guests at society weddings. There are an estimated one million users of Ecstasy every week, and most say that it seems a safer, more sociable drug than alcohol, which kills, one way or another, considerably more peopleevery day. Or that, while drinking can make people aggressive, morose or sleepy, E has the opposite effect. Or even that taking E has transformed their lives.

E has certainly transformed clubland. There, the peculiar character of the drug has forged a constituency where lagered-up sexism and overt homophobia are unacceptable. A cruel event such as Leah Betts's death rudely punctures the innocent, peace-and-love way that E culture likes to see itself. Yet this innocence is only skin-deep anyway. Since the heady days of the "second summer of love", criminal syndicates have replaced small-time club dealers, and drug supplies have hurtled out of control. Which poses the question for everyone: just how safe are drugs, and how can we know?

Drugs have long attracted shocking headlines, for reasons that go beyond their mere effects, as Marek Kohn explained in Dope Girls, his book examining the birth of the British drugs underground. He argued that societies' fears about drugs often reflect deeper anxieties, and that drugs were outlawed not for their pharmacology but because of their association with what were regarded as dangerous social groups.

But the current panic about Ecstasy strikes Kohn as different, in that it seems to him to be founded largely on a concern for young people's physical rather than their moral health. "Pleasure is no longer seen as intrinsically immoral or dangerous, as it has been from the 1920s until recently. Youth-oriented programming recognises that drugs are now part of the landscape. Many media commentators have 'been there, done that', and so the debate moves on to issues of harm-reduction in drug-taking."

Most Ecstasy-related deaths (Leah Betts is thought to be the 53rd person in this country to die after taking the drug) have been attributed to heat-stroke, where the blood becomes so hot that it loses its ability to clot, resulting in massive internal bleeding. Research suggests, and the experiences of many users back this up, that people on MDMA ("pure" Ecstasy) can lose their awareness of overheating. They can dance for hours, in a sweaty club or rave, and the body's warning signals somehow fail to get through. Much of the work of harm-prevention around E centres on teaching users to take rests from dancing and drink lots of water, but clearly there is also much work to be done in making clubs safer. Effective air-conditioning is not the norm in British clubs, but it's encouraging to see that some new venues (such as The End, shortly opening in London) have taken this sort of criticism seriously, by having good air-conditioning and even water fountains by the dance floor. (Though it is also worth noting that some authorities believe allergic reactions to MDMA may play a part in these deaths by heat-stroke.)

The Manchester-based drugs advisory group Lifeline has been a pioneer in harm reduction, working inside local clubs, with the full co-operation of Manchester City Council and often, it is said, with the support of the police, many of whom recognise the futility of raids and closures.

"When even a government minister suggests that 'Just Say No' might no longer be an entirely adequate strategy, things are clearly changing," says Marek Kohn. "In many respects this is analogous with the Safer Sex campaigns, that when you can't stop something you have to try to minimise risks."

Myths about Es are spread by both sides of this national divide about drugs. While the press print scare stories about pills containing ground glass or rat poison, clubbers themselves often describe pills as "a bit smacky" or "full of k" (ketamine, an animal tranquilliser). And yet the evidence does not really support these assertions. According to Alan Haughton of Lifeline, "We have never come across either heroin or ketamine sold in Es."

But the mythology may be rooted in some truths. When E first arrived in Britain in the mid-Eighties, supplies consisted largely of "pure" MDMA. But demand soon outstripped supply and any number of substances were being sold in the name of Ecstasy, from amphetamines MDA and MDEA, which are cheaper and easier to produce, to crude mixtures of LSD and speed. Since then, supplies have stabilised somewhat and, according to Nicholas Saunders, author of Ecstasy and the Dance Culture, the oft-repeated claim that "Es aren't what they used to be" is not entirely accurate.

"On the contrary," says Saunders, "the government lab at Aldermaston records that the purity of Ecstasy tablets seized has, in terms of its MDMA content, actually increased over the last two years. Perhaps people blame the supply rather than admit that they have taken so much that it no longer does what it used to. But there are pockets of bad supply. A recent study in Manchester recorded that none of the tablets tested contained any MDMA at all."

Supplies are by no means reliable and, to tackle the problem, Saunders has set up a site on the Internet detailing pills on sale in the UK, something he sees as a continuation of previous consumer work on ordinary household products. His task is not easy, with new pills appearing constantly, and existing ones being imitated countless times, often with different ingredients. Indeed, having been out of the country for three months, he suspects much of information on his site is already out of date.

In any case, Alan Haughton of Lifeline is inclined to think that the issue of "purity" is something of a red herring. "I'm not saying Es are always pure MDMA - they're not. But the real problem is that people react to Ecstasy in completely different ways. It is not the same for everyone - and no one really knows why this is or how any individual might be affected. You can't even compare it to a game of Russian roulette, because this particular gun has about two million chambers."

Leah Betts's death is a case in point. All of the early reports concentrated on the idea of a contaminated E, but it was later confirmed that she had taken pure MDMA. Moreover, it is damage to her brain, and not overheating, that is thought to have caused her death. More perplexing still, many of Leah's friends are thought to have taken exactly the same drug and all are apparently unharmed.

One possible area for concern is the level of MDMA contained in any tablet. In Amsterdam, the Safe House project works with drugs producers and with clubbers themselves, with the support of the government, to test not only the purity of drug supplies but also the levels of MDMA they contain. In Britain no such controls exist. Even with the paucity of knowledge about the effects of MDMA, it is logical to speculate that, as with any drug, the chances of ill-effects in any individual increase with the quantity.

No one knows exactly how many people use Ecstasy, nor exactly what they are using, nor the drug's full range of physical and psychological effects. Even statistics about the number of "E-casualties" cannot be agreed upon. It is clear, however, that in the absence of hard facts MDMA is going through what has been likened to clinical trials, with millions of human guinea-pigs across the world. To look on the bright side, the evidence suggests that in this context it is performing well, or at least considerably better than some prescription and over-the-counter drugs. Not to mention the legal drug, alcohol.

The problem is that "E" has come to mean almost any pill which people take in a night-club. There is a multiplying variety of amphetamines, an understanding of which requires a pharmacological expertise way beyond most people. Much of the E generation has moved on from issues of purity by adopting drugs cocktails far more complicated than anything found in a single pill.

Feeling tired? Take a few tabs of speed, and maybe a quarter of a trip. Needing a bit of a lift? Scrounge a line of coke. Coming down a bit? Pop another half of E, often washed down, not with the Evian water of yesteryear, but with a vodka and lemonade. And at the end of the night, just one quick line, then a Valium to "level you out". And as if today's shopping list isn't enough (and it isn't, for some), there are rumours of a new drug coming along which has the "warmth" of E and the "visuals" of LSD.

While any single one of these drugs carries health warnings, both in the long and the short term, a mixture of them can be especially dangerous. And while most of these substances are illegal and/or impure, drug users are set on a kind of magical mystery tour of misinformation, mythology, alarmism and actual danger. Which, some would tell you, is all part of the thrill.