Four suspected ecstasy overdose deaths on the East Coast in the last few weeks have put the drug, long popular in rave-crazed Los Angeles, back in the headlines.
One of the first reactions among ravers and even some sympathetic medical professionals is that whatever those victims took, it wasn't ecstasy. That has long been the stance of E's boosters -- that the substance, also known as MDMA or molly, is relatively safe.
But evidence proves time and again that ecstasy can kill all by itself, a message often lost when these kinds of deaths occur:
Labor Day Weekend's Electric Zoo electronic dance music festival on New York's Randalls Island was cancelled after the second in a planned three days when two concertgoers died of apparent overdoses.
Three days later it was reported that 19-year-old Brittany Flannigan died of a suspected ecstasy overdose after she attended a concert at the House of Blues in Boston.
The next weekend Mary "Shelley" Goldsmith, a 19-year-old honors student from Virginia died of an apparent overdose after she went to an electronic dance music club in Washington, D.C.
The deaths sparked a spate of rumors -- not only in the EDM community but among cops and even in the media -- that "bad" ecstasy was being passed around and killing young people.
Even the New York Times got on-board the bad-ecstasy train.
It paraphrased psychiatrist Julie Holland, who works with the pro-ecstasy group Multidisciplinary Association for Psychedelic Studies, as saying "the drug itself is not a cause of death."
That MDMA couldn't kill on its own is an outright falsehood disproved by several autopsy reports and studies.
The Times also paraphrased Holland as saying ecstasy is "easily contaminated with other, more dangerous substances and easily counterfeited," a statement that fuels many ravers' beliefs that only "bad" or "fake" ecstasy should be feared.
The New York Daily News says even Boston cops believe a "a bad batch of 'molly' is being sold in the Northeast after the synthetic drug was blamed for a rash of overdoses."
When we asked Holland if her words to the Times were accurately reported she said "not exactly." She emphasized that dancing "for hours on end" made ecstasy dangerous in rave settings. She also blamed the overdoses on other drugs parading as E. (More on that later).
In any case, the damage is done. Many E users truly think they're safe so long as they use the real deal. The advent of the powdered type of ecstasy known as "molly" might have exacerbated the notion of safe E, because the word connotes molecular purity. That's even though experts say molly is no more "pure" or safe than older, pill forms of MDMA.
"Molly is marketed as pure MDMA, but what our chemists are telling me is that it's rarely pure," says DEA spokeswoman Sarah Pullen. "Molly is just MDMA with a new name."
Even Holland, who says she believes ecstasy can be safe when it's pure and it's used in a clinical setting supervised by a doctor like herself, admits that "the recreational model is inherently dangerous."
But she buys into the myth that bad ecstasy is causing these deaths and says that, on the street, "you have no idea what it is" you're buying. Which is true.
The myth of bad ecstasy has been propagated by organizations such as DanceSafe, which encourges "harm reduction" measures for ravers, such as moderate dancing and healthy water and electrolyte intake -- both legitimate concerns when it comes to real MDMA.
The group encourages E buyers to get their pills tested for adulterants, as if there's a difference in safety between adulterated and non-adulterated MDMA.
But here's the truth: Ecstasy with poisonous additives is practically unheard of. In 2010, when 23-year-old Anthony Mata died following a rave at the Cow Palace in San Francisco, authorities seemed convinced that his dose might have been spiked with rat poisoning. Not so, said the local coroner's office: It was merely MDMA that killed him.
And while the likes of Holland and the DanceSafe crowd correctly blame dancing, overheating and, in some cases, over-hydrating (drinking too much water) for the deaths attributed to just MDMA, the drug can kill just by its toxicity alone.
It doesn't necessarily need the dancing or the overheating.
See more on how else ecstasy can kill on the next page ...
According to a summary of a 2011 study published in the journal Forensic Science, Medicine and Pathology ...
MDMA is associated with causing death by a number of mechanisms, including hyperpyrexia, cardiac arrhythmia water intoxication and liver failure.
Researchers found that 13 of the 59 ecstasy-related fatalities they examined were attributable to the drug's toxicity; 22 of the deaths involved multiple drugs, including MDMA; and 24 cases involved MDMA-related "trauma."
A 2010 report on the 2009 Together As One New Year's Eve rave in Los Angeles published by the U.S. Centers for Disease Control examined 18 emergency room visits and one death related to MDMA:
10 of the 18 had used alcohol, and five had used other drugs. Three patients were admitted to the hospital, including one to intensive care. A tablet obtained from one of the patients contained MDMA and caffeine, without known toxic contaminants.
The well-publicized death of 15-year-old raver Sasha Rodriguez in Los Angeles was also attributed to ecstasy alone.
The coroner's office said she died of "complications of ischemic encephalopathy due to methylenedioxymethamphetamine intoxication" -- brain death and organ failure.
Una McCann, psychiatry professor at the Johns Hopkins School of Medicine, told us:
The vast majority of MDMA deaths are related to malignant hyperthermia. The drug leads to increased temperatures. Vigorous activity in a hot, unventilated crowded room exacerbates this significantly (although the drug itself can lead to malignant hyperthermia in the absence of raves). By the time friends and colleagues realize that the bizarre behavior being exhibited by their friend is not just being "high," it is often too late to reverse the damage.
She acknowledged "there are a few other ways that people die after taking MDMA," including the ischemic encephalopathy and organ failure experienced by Rodriguez and other fatalities.
Although there are many reports of ravers dying from ecstasy toxicity and overheating, Marc Futernick, director of emergency services at California Hospital Medical Center, who has seen dozens upon dozens of ecstasy overdose patients as a result of the hospital's proximity to the L.A. Coliseum and Sports Arena, acknowledges that E can shut you down even without the overheating seen at packed parties.
He remembers one patient who experienced "kidney failure." "She didn't arrive with a high temperature," Futernick said. "But she arrived with a profoundly altered mental status."
Futernick observes that after huge raves, which sometimes attracted more than 100,000 people, were shut out of the L.A. Coliseum and Sports Arena in 2011, he has yet to see any additional fatalities from an ecstasy overdose.
At the same time the size of East Coast parties, like Electric Zoo, is starting to approach the scale we've seen in Southern California and Las Vegas in recent years, and the big Eastern cities are now starting see the kinds of overdose deaths that have have been a problem in L.A. and Vegas.
See also: Death, Money and Megaraves.
"I think it's a shame that each city is learning this lesson one by one," Futernick said.
Another argument MDMA apologists will put forward is that the ecstasy young people have been taking is either not ecstasy at all, or that they're overdosing because they had multiple drugs in their systems.
Holland calls such close MDMA relatives as PMA and methylone "counterfeits."
The pro-E crowd is right on those points: Methylone, for example, was fingered in the death of 20-year-old Matthew Rybarczyk following a Governors Island rave in New York earlier this summer.
And PMA has been wreaking havoc in the United Kingdom for years. Both drugs have been peddled as ecstasy or molly. Holland:
A lot of times with a cluster of fatalities it has been PMA. The question is if there was a particularly bad batch.
There's no evidence we could find linking PMA to recent rave deaths, but Charles Grob, a professor of psychiatry and pediatrics at the UCLA School of Medicine and a longtime ecstasy expert, says he's "suspicious of PMA" and calls it "the most potent amphetamine known."
(Autopsies and toxicology tests on the East Coast victims have yet to be completed.)
Holland encouraged us to track PMA via a pill testing site known as EcstasyData.org.
Interestingly, the site's stats show the percentage of pills testing as "MDMA only" is at a six-year high. PMA seems to be a rare bird: It has only showed up three times in 13 years, according to the site.
The most recent case was in Ireland earlier this year. Before that, it showed up twice in the United States in the year 2000, according to the database. EcstasyData.org has dozens and dozens of pill tests that have come up as methylone, however.
The DEA's Pullen told us that agents have picked up PMA in recent years in the Southwest although, she added, "It's certainly not widespread."
New York DEA special agent Erin Mulvey told us there was some fear on the East Coast that both PMA and methylone were being smuggled into the United States from China.
Both drugs were first synthesized by Bay Area chemist Sasha Shulgin, best known as the "godfather of ecstasy."
There are many cases of multiple drug use among those who died following raves, and it's anyone's guess if it was the E in particular that did the victims in. But coroner's reports almost always blame the totality of the poly-drug use on a patient's demise.
The point here is that, for the most part, ecstasy can kill all by its lonesome. It doesn't need adulterants, which are most often caffeine, pseudoephedrine, acetaminophen and other relatively harmless fillers anyway (see EcstasyData.org for yourself).
Charles Grob of UCLA oversaw the first FDA-approved study of ecstasy, in the early 1990s, and he's been an early academic proponent of MDMA's possible suitability for use in psychotherapy.
But even during his research with patients in a controlled, supervised setting, doctors had to deal with two subjects who had "alarming blood pressure" reactions, he said.
At raves, Grob says, ecstasy use is problematic. He wouldn't recommend it:
The temperatures shoot up to 105, 106, the blood vessels start to clot, it leads to liver failure, kidney failure and death.
MDMA, he says, "can kill:"
I know someone who took MDMA and got into a hot tub. He did not survive. As a recreational drug I think there are very significant risks. There are these myths going around that molly is pure. That's how people felt about ecstasy back in the '80s. It can be quite dangerous.
[Added at 4:30 p.m.]: After we requested them last week, the L.A. County Department of Coroner today sent us two of its reports on high-profile rave deaths. We thought we'd share some of the information with you to shed light on what happens when ecstasy kills:
Twenty-year-old Michelle Yuenshan Lee died after attending Monster Massive at the L.A. Sports Arena in 2007.
According to the coroner's report she died from the "consequences of multiple drug toxicity." The drugs listed were MDMA and methamphetamine. (Ecstasy has been cut with meth, although meth is also a part of MDMA's chemical makeup).
However, no toxicology report was included with these conclusions, and the findings, made before 6-to-8 week toxicology results would have been completed, appear to have been based on a "history of ecstasy / amphetamine toxicity," as noted in the coroner's documentation.
We reached out to the coroner's office for further clarification.
She also was hyperthermic (overheated), suffered renal failure (kidney failure) and suffered "ischemic liver disease," according to the report dated Nov. 7, 2007.
According to a coroner's synopsis:
The decedent was found down and unresponsive by friends after attending a "rave" party. They summoned paramedics who transported the decedent to the hospital where she was admitted 10/28/2007 suffering with the artifacts of an ecstacy [sic] and amphetamine overdose. Over the next six days she never seemed to gain ground as she battled renal and respiratory failure and hypothermia which eventually overwhelmed her. Death was pronounced 11/2/2007.
The case of 15-year-old Sasha Rodriguez involved "complications of ischemic encephalopathy due to methylenedioxymethamphetamine intoxication," as mentioned earlier.
Notes on her autopsy say she suffered ...
... an altered level of consciousness, altered behavior with subsequent seizure ... Admitted to hospital in comatose state with ischemic brain damage ...
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Initial tests at the hospital showed she was "amphetamine positive," the autopsy says. (MDMA can test positive for this because it's a component of the drug). Later toxicology tests turned up MDMA.
The coroner's synopsis:
... On 6/27/2010 paramedics transported the decedent to the hospital with an altered level of consciousness and an increasingly combative demeanor after apparently taking the drug ecstasy at a 'rave' party. Upon arrival to the ER she suffered an apparent seizure event and was subsequently intubated and admitted in a comatose state. A urine toxicology screen tested positive for amphetamine. Her condition failed to improve, and on 6/29/2010 she was terminally extubated with death pronounced at 1655 hours. No reported pre-existing medical conditions.