Why are pills so strong right now?

“It confirms what we've known for the past couple of years,” observes Dr Adam Winstock of the Global Drugs Survey. “Pills are definitely getting stronger”. In a new report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), findings show a "recent resurgence in use of MDMA in Europe and increased availability of high-strength MDMA tablets and powders". In 2005, pills contained around 80MG of MDMA. Now, the average sits at around 150MG, but new pills popping up have tested upwards of 250MG.

Last month a young woman died in Manchester after taking one of these apparent super strength pills. Reports say it was a ‘Mastercard’: big and red with a groove down the middle, to make it easier to snap in half. Another collapsed in the same city after taking a 'Lego' pill. Every year or so, particular strains of pills make the headlines because of their potency: UPS pills, Blue Ghosts, Partyflocks, causing mass panic. Pill Report, an online forum for testing and reviewing drugs, is inundated with warnings to stay away from particularly shaped and coloured tablets. The media tells us it’s not pure MDMA at all, but anything from LSD to high doses of caffeine. It’s confusing and information is convoluted. It’s hard to know what to believe, and importantly how to stay safe.

MDMA has certainly proved its longevity, and it isn’t going anywhere. We spoke to Dr Winstock about the facts, myths and tips that surround the party drug.

Why are these pills getting stronger?

Dr Adam Winstock: It’s easier to make good quality MDMA and that's because there's new pre cursors available, with new synthetic roots. The way governments would previously try and restrict the manufacture of MDMA was to reduce access to precursor chemicals, and they did that pretty successfully, but about 2-3 years ago, a new precursor chemical was developed that’s easy to make, which is still unregulated.

In terms of why pills are getting stronger, we spoke to some people in Holland and they put it down to manufacturers wanting to break into a market.They want to differentiate their products, so that’s why we see physically bigger, stronger pills. It’s maybe a way of getting a reputation. It’s about getting their brand noticed in a really crowded market place. But they're mistaking big doses for what people want, and it's not. If everyone knew that each pill they bought had 100mg of MDMA, then they could break it in half and take 50, or whatever. Now we wind up with pills that look the same, big and small, but you end up with some that are 250-300MG.  

Are they as strong as they were in the 90s?

Dr Adam Winstock: Pills in the 90s were just made of MDMA when quality distributors came along. They were about 80-100mg. Pills have never been as strong or as consistent containing MDMA. But in the 80s and 90s, people certainly weren't bucking pills out with 200mg.

Increasingly people are purchasing powder though, because it works out cheaper buying a gram than a few pills at seven quid each. It makes better sense if you're a drug dealer. 

Are these strong pills being cut with other things, like PMMA?

Dr Adam Winstock: Most of the time no, because MDMA is pretty easy and cheap to make, so why would you bother? There are occasions where there will be pills floating around that have something else in them. Some pills might not have MDMA in them and may contain methylone, ethylone or butylone.

For the past 12-18 months, pills flogged as MDMA are going to have something psychoactive in them, and most likely to have MDMA and MDMA alone. I'm sure there are dodgy, unscrupulous people who may have a whole batch of something nasty they want to get rid of, but actually dodgy and nasty stuff is as difficult to knock up as quality MDMA. At festivals where pills and powders being sold, some may have ALPHA PVP, which is a very potent, long acting stimulant drug. People are taking that in the belief that it was MDMA powder or a pill. People were becoming aggressive, confused and psychotic. The fact is that you can't differentiate one crystalline stimulant powder from another. Crystal meth looks really similar to MDMA powder, but a drug dealer is obviously going to get more money flogging crystal meth than MDMA.

What's the average dose of these super strong pills?

Dr Adam Winstock: The average MDMA dose is about 120-150MG, but there were pills floating around in the Netherlands last year that actually had 330MG. That's the highest dose pill that I've been made aware of.  A fair number floating around have 250MG in. While 250MG might not be far off the dose taken over an entire night, if you take that dose all at once, most people will find it really unpleasant. They'll come up too strongly, they'll vomit, become confused and hallucinate. If you talk to clubbers in Holland, one thing that is putting them off MDMA is that high dose MDMA just isn't nice. I think people believe the purest drug is the nicest and it’s just not true. Most people need to work out what their optimum base is. Some people like coming up and feeling that rush even though they might be sick and throw up, other people don't like that.

Are they coming exclusively from The Netherlands?

Dr Adam Winstock: Yes, they remain one of the biggest manufacturers in the world. They’ve got access to big labs, there’s a history with great dealing networks. It’s a nice centrally placed European country for easy access, with fairly liberal drug policies.

Are the prices fluctuating? How does the UK compare to elsewhere?

Dr Adam Winstock: About nine quid was the average last year, and about 35 quid per gram of MDMA. The price is going up year-on-year. Pills four or five years ago were averaging at a fiver. The cheapest are in the Netherlands where it’s four euros a pill and 24 euros a gram. The most expensive were in New Zealand, where it was almost 30 euros a pill and 260 euros a gram.

The average amount taken by UK users was 0.42 grams per session: the average around the world is 0.28, so the UK looks like the heaviest users.

“Is 2016 a good year to start taking MDMA? If you're going to take MDMA for the first time, you need to be better educated”

There have been reports of pills with grooves in them for snapping in half. The young woman who died recently in Manchester was said to have taken one. Is this the market responding? Can this be trusted to determine dosage?

Dr Adam Winstock: Most MDMA deaths are not related to dose. Bigger doses don’t tend to be positive experiences, but there actually isn't that much of a relationship between high dose and death. This happens a lot with young people. Think of the most well publicised deaths over the last three or four years, like Jordan Chambers or Ann-Marie Cockburn’s daughter. They're all teenagers and tend to be first time users. They’ll be using high doses because they don’t know any better. There's something about adolescence and high doses that’s intrinsically dangerous. Young people haven't learnt how to take drugs yet. It's easier to overheat, to dehydrate, and maybe take other things. High dosage and inexperience is a really bad cocktail, and a bit more education would be sensible.

So should people actually be weary of ones with certain nicknames? Or is it more the shape and texture?

Dr Adam Winstock: There will probably be other Mastercard pills out there that actually aren't that high a dose of MDMA. A good kind of Mastercard with 90MG in it could come out, then within two months of that, there would be 50 different pills out there all with different doses that look exactly the same. People should never believe brand names on a pill, because drug manufacturers aren't daft. If everyone’s got Blue Rolexes and there's a rumour going around that they’re lovely, they’ll jump on it. It's not really difficult to change a pill press, so people will knock out what sells well. There’s nothing more reliable than talking to the person actually dealing it.

What’s most important is the quality of the press. By that, I mean the harder the pill is pressed, the longer it'll take to come up. Some pills are really crumbly, and people will be set in their ways thinking whether that’s a good or a bad thing. It will dissolve very quickly in your stomach and you will come up very quickly, while a pill which is hard pressed will take more time to break down. People will think it’s rubbish and take more, when it’s not. This is far more important than the colour or shape. It would be much nicer if pills were scored into four, but there’s really no relationship, so just to keep track.

Do you think the lack of education is the biggest concern? Is now the best time to uptake on MD?

Dr Adam Winstock: Is 2016 a good year to start taking MDMA? If you're going to take MDMA for the first time, you need to be better educated. So high quality drugs make good quality education more important than ever. The challenge is that the government aren’t a very credible source of this information. They can’t turn round and say ‘Look guys, most of the drugs we’ve banned aren’t really that bad, so here’s how to use them safely’.  For MDMA, at the Global Drugs Survey, we’ve got the Highway Code, curated by the 80,000 participants in our survey. That gives advice on how to get the most out of taking the drug. 

What do you think is missing in the conversation about drugs today?

Dr Adam Winstock: One of the things we have in our survey is about drug-related pleasure, and that's what most conversations on drug use simply don't have. It's not all about reducing the harm, it's also about accepting people want to have a bit of fun. Young people, naive users will go 'more drugs, more fun', and that’s not the case.

What information about drugs can people trust – the government, the media?

Dr Adam Winstock: If by some miracle the government plan worked and removed all MPS from people’s availability, then people would just go back and use traditional drugs. Then we could have a campaign for how to use them better. Global Drug Survey promote safe drug use, and the most reliable information for those who take drugs is other people who use drugs. We package information from people who like taking drugs to distribute to others. People might not want to listen to us, but they will to those who drop pills all the time. We tell them: here's what 3,000 MDMA users reckon you should take to have a good time. 

There’s a low number of MDMA-related deaths, but has there been an increase in the past few years?

Dr Adam Winstock: I don't think there's been an increase in deaths, I think it's been pretty static at around 30-40 a year. What the drug survey spotted was an increase in people seeking emergency medical treatment on MDMA and we've seen that year-on-year. The thing we're noticing is young women who are much more vulnerable. Women are twice as likely to end up in A&E as men and I'm still not quite sure why that is. 

How else can people keep themselves safe?

Dr Adam Winstock: Buying a pill shouldn't be like going to the pub, buying a round and saying cheers, and everyone going off. Someone should take some; wait and everyone can see how they react. It won’t protect everyone, because people will respond differently, but it will be easier to track.

You need to start your evening out straight because if you've already been out doing coke, you're a bit pissed and you take your pill, it's just much more difficult to know what's going on. MDMA is best enjoyed on its own, or gently augmented by small amounts of other drugs or alcohol. Stay with good friends and you can look after each other. Usually if someone feels strange, it isn’t going to be serious, so just take them for fresh air and a cold drink. Reassurance a lot of the time can be all they need.