Ecstasy-related deaths: How do we successfully debunk some of the myths in this area?

Recently I didn't get enough time to do the usual ecstasy section of my Year 12 presentation at a school I was visiting. I apologized for not being able to cover the information but made it clear that they could come up to me during the break and ask me anything they wished on the topic ... A couple of students took me up on the offer and the resulting discussion blew me away - some of the things these young people believed to be true about ecstasy were frightening, particularly around ecstasy-related deaths! Since then I have made it a point of approaching Year 12s at each of the schools I have visited to ask them some simple questions around the drug to see whether these beliefs were held more widely - unfortunately they were!

Of all the drugs I discuss in schools I think ecstasy is the most difficult one to deal with effectively. If you are speaking to a group of young people who have never used the drug and they don't know anyone who has taken it, your job is made a little easier. Providing information on the harms associated with the drug is far more likely to be accepted by this group. If you have a group of students who have used the drug themselves, however, or have friends or older siblings or family members who have, it becomes so much harder. The truth is that most people who take this drug for the first time have the most amazing experience of their life - of course, that's not true for everyone (some become extremely nauseous, some actually vomit, while others feel nothing or fight the effect and of course, deaths can occur) but talk to most ecstasy users and the vast majority of them will tell you that they loved the experience and couldn't wait to try it again! It's also important to remember that the people around them who took the drug are usually having exactly the same kind of experience. There is not death and destruction around them - people are having a great time and for most users, they rarely, if ever, see a person experiencing great problems with the drug.

When it comes to alcohol, most young people (whether they drink or not) have seen the negative effects for themselves. They have seen people vomit, they may have experienced a hangover and a surprising (and frightening) number have actually seen someone they know be treated by medical professionals or even taken by ambulance to a hospital due to their alcohol use. It's the same for cannabis - an easy way in to talk about the harms is to discuss the things they may have seen in their friends who may use the drug. These harms may include mental health issues such as paranoia and anxiety, 'greening out' or 'whiting out' (smoking too much or drinking alcohol at the same time and having a very nasty and scary effect as a result) and of course, legal problems. When it comes to ecstasy, most experiences are overwhelmingly positive - most haven't seen people get sick and very few have had a friend or even a person they know of die ... certainly more young people are finding themselves in legal difficulties with ecstasy, primarily because of drug detection dogs, but for most school-based young people who do use ecstasy the perceived positives far outweigh any of the negatives ...

But it's the mythology around ecstasy-related deaths that worries me the most. Here are some of the beliefs that the young men and women I have recently spoken to have in this area:

• Those who have died taking ecstasy were all first-time users - deaths only occur if you haven't had any experience with the drug
• People don't die from ecstasy - those who died (first-time users) had pre-existing conditions and that's what caused the death
• If you have a pill or capsule that contains MDMA (the substance you want when you buy ecstasy) then it is safe

Let me make it very clear - none of these statements are true!

Over the years I've heard the last two statements many times (admittedly not usually from secondary school students) but it is the first one that concerns me the most. Interestingly almost every young person I spoke to about this topic this week believed this to be true - they honestly thought that if you had taken the drug once and you survived the experience, then that was it, you would be fine! One young woman described the first time of taking the drug as a "test" to see whether you were "allergic" to it or not! I then asked her what her friendship group did to prepare for this 'allergy test' and what would they do if something went wrong and she said that they would only ever do one capsule the first time and they always made sure that one of their friends didn't take anything so that they could look after the person ... I suppose you have to see a positive in that they at least were thinking about the possible risks but truly I find this frightening!

The sad part is that I can kind of see where this is coming from ... if you look at how ecstasy-related deaths are reported inevitably a parent or relative will make a statement to the media claiming that the drug use was completely out of character. They go onto say something along the lines of that the young person who had died had made a foolish decision, one they had never made before and it had taken their life and they usually finish off the statement by issuing a warning of some kind for others not to make the same mistake. Now I'm certainly not going to say that the families have got it wrong here and accuse their dead child of being a regular ecstasy user but if you look at the evidence we have, it is certainly not first-time users who usually die ... A 2009 study MDMA-related fatalities in Australia found 82 deaths over a 5-year period, with the majority being male (83%) with their median age being 26 years. Unfortunately, the deaths covered by the media usually involve the very young, preferably female who comes from a 'good family' with everything to live for - reinforcing the myth that it is 'drug naïve' teens who are most likely to die ...

There are no easy answers here - ecstasy is a really difficult drug to deal with in terms of prevention. I have struggled for many years to come up with some simple messages in this area that can be given to young people that are useful, as well as accurate and credible. It is important to acknowledge that ecstasy deaths are rare, but they do happen and when they do, there is often no simple explanation as to why one person who took a pill died and those that were partying with them that night took exactly the same pill from the same batch had no negative effects whatsoever. That's a difficult message to sell and simply saying 'You're playing Russian Roulette' is not going to cut it with teens!

If young people choose to use ecstasy they need to be aware that there is always the risk that something could go wrong - death is unlikely but it is possible. This apparent increasing belief that once you've taken ecstasy and nothing goes wrong you're in the clear for the rest of all time is deeply concerning. Always acknowledging that taking a pill could be potentially dangerous just before a user puts it in their mouth is important - their guard is up. When you down a pill, confident that you are somehow immune to the negative effects, if something does go wrong you're not going to be far less prepared. Myths like this contribute to growing numbers of users, particularly younger ones, taking greater risks. That scares me ...