Papers

Review of deaths related to taking ecstasy, England and Wales, 1997-2000

Fabrizio Schifano, senior lecturer, Adenekan Oyefeso, senior lecturer, Lucy Webb, research nurse, Mike Pollard, database officer, John Corkery, honorary senior research fellow, A Hamid Ghodse, chairman. 

National Programme on Substance Abuse Deaths, Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London SW17 0RE

Correspondence to: F Schifano f.schifano{at}sghms.ac.uk

The lack of data about the lethal consequences of taking ecstasy has led to high profile reports of deaths in the media and also the idea that ecstasy is safe. The United Kingdom accounts for most of the ecstasy tabletsnormally containing methylenedioxymethamphetamine (MDMA) or 3,4-methylenedioxyamphetamine (MDA)seized in the European Union.¹ The rate of deaths related to taking ecstasy in people aged 15-24 during 1995 and 1996 in England was 18 and between 1995 and 1997 in Scotland was 11.² The risk of using ecstasy varies between one death in 2000 first time users to one death in 50 000 first time users.²

The National Programme on Substance Abuse Deaths was established after the Home Office Addicts Index closed. We report all the information recorded in the programme's database between 1 July 1997 and 30 June 2000 about deaths in England and Wales related to taking ecstasy.³

	Participants, methods, and results

Top Participants, methods, and... Comment References

Deaths are included on the database of the National Programme on Substance Abuse Deaths if one or more psychoactive substances are directly implicated in death, if the patient had a history of dependence on or misuse of psychoactive drugs, or if controlled drugs are found during necropsy. The response rate from coroners in England and Wales was high (about 95%).³ We defined deaths related to ecstasy as a coroner's report including the text "ecstasy," "XTC," "MDMA," or "MDA."³

We identified 81 deaths related to taking ecstasy. Results of toxicological examination were made available in 75 cases; MDMA accounted for 68 (91%), MDA for 7 (9%), and opiates or opioids for 44 (59%) of these cases. In 26 (38%) cases, one or more drugs (mostly hypnotics or sedatives) had been prescribed to the deceased patient (table).

	Comment

Top Participants, methods, and... Comment References

Most people who died from taking ecstasy were white employed men in their late 20s, known to services as drug addicts, and died at home. Typically, the deceased took several different (prescribed and non-prescribed) drugs with ecstasy; the large number of people who also took opiates seems surprising but confirms previous findings and may explain why a high proportion of the victims were known to services.⁴ People may have taken ecstasy with other drugs to modulate the effectsecstasy had, at least, a facilitating role in causing death. A small proportion of people (6/81; 7%) died after taking only ecstasya previously doubted possibility.⁵ Toxicological tests could detect all drugs that had been taken in the 2-3 days before death and gave only limited information about which drugs had been taken on the last occasion. Deaths related to ecstasy occurred in two clusters (urban industrial areas in southeast and northern England); people died mostly at party times (weekends, summer, and at New Year).

Information about the incidence of taking ecstasy and other drugs and amounts taken is unfortunately lacking; the database of the National Programme on Substance Abuse Deaths (which is being extended to Northern Ireland and Scotland) will collect more information in futurefor example, the concentration of individual drugs in tissuesto obtain a better understanding of the role of other drugs in deaths related to taking ecstasy.

	Acknowledgments

Contributors: FS wrote the manuscript and coordinated the study. AO, LW, MP, and JC collected data and interpreted the results. AHG participated in interpreting the results. FS is guarantor.

	Footnotes

Funding: No additional funding.

Competing interests: None declared.

	References

Top Participants, methods, and... Comment References

1.	European Monitoring Centre for Drug and Drug Addiction. Annual report on the state of drugs problems in the European Union. Lisbon: EMCDDA, 2001.
2.	Gore SM. Fatal uncertainty: death-rate from use of ecstasy or heroin. Lancet 1999; 354: 1265-1266[CrossRef][Medline].
3.	Ghodse AH, Oyefeso A, Webb L, Schifano F, Pollard M, Jambert-Gray R, et al. Drug-related deaths as reported by coroners in England and Wales. London: European Centre for Addiction Studies, 2002. (Annual review 2001 and np-SAD surveillance report No 9.)
4.	Schifano F. Potential human neurotoxicity of MDMA ("ecstasy"): subjective self-reports, evidence from an Italian drug addiction centre and clinical case studies. Neuropsychobiology 2000; 42: 25-33[CrossRef][Web of Science][Medline].
5.	Giroud C, Augsburger M, Sadeghipour F, Varesio E, Veuthey JL, Rivier L. Ecstasy: the status in French-speaking Switzerland: composition of seized drugs, analysis of biological specimens and short review of its pharmacological action and toxicity. Schweiz Rundsch Med Prax 1997; 86: 510-523[Medline].

(Accepted 21 June 2002)