MANY QUESTIONS LEFT UNANSWERED

Issues Surrounding Designer Drug Use Remain Cloudy

Everything about Allen Ho's death makes for a powerful story.

Over the course of his high-profile inquest, the city has heard repeatedly
how he collapsed at an underground rave, which was held in a hot, stuffy
parking garage with no lighting and insufficient fire exits.

It's not known how much Ecstasy Mr. Ho took, but it is clear that when a
friend stumbled across him at 3:30 a.m., he had already succumbed to
terrible convulsions.

But while Mr. Ho's inquest has turned underground raves into dinner-table
conversation, it has also created a false view of designer drug fatalities
in the province. (The term "designer drugs" has come to include substances
such as Ecstasy and GHB.)

It's easy enough to trace the way that came about. When the coroner's
office saw Ecstasy-related deaths in Ontario jump during the past year, it
decided to hold an inquest into the drug.

Mr. Ho's case was eventually chosen as a representative case, but the other
deaths were also to play a significant part.

What actually happened -- during a remarkably adversarial hearing that was
more trial than public inquiry -- is that those other deaths were
introduced, and then largely ignored. Mr. Ho's death, as it turned out, was
hardly representative at all.

The statistics presented to the coroner's jury concerned 13 Ecstasy-related
deaths, encompassing one in 1998, nine in 1999 and three that occurred
earlier this year. What was most striking about the cases is the range of
circumstances and substances involved.

To begin with, seven of the deaths involved cocktails of drugs, including
heroin, cocaine, and methadone. The most reliable conclusion to be drawn
from the deaths, in fact, might be that users need to be warned against
taking more than one powerful drug at a time.

Furthermore, it's questionable whether those seven cases should be labelled
Ecstasy-related deaths at all. One witness explained that it's not possible
to know which drug in the cocktail caused death, so they could just as
easily be grouped under heroin-or cocaine-related deaths.

Only three of the 13 deaths had any connection with raves, and only one,
Mr. Ho's, involved an underground rave.

Three of the deaths occurred at home, and two at bars in small Ontario
cities. Another user was found in a park, and yet another at a construction
site.

The deaths evoke a drug that can be found in a variety of circumstances.
What they don't show is any evidence that Ecstasy and raves are any more
deadly a combination than Ecstasy and other environments.

For those who have followed coverage of Mr. Ho's inquest, that could be a
difficult point to accept. But it's reinforced by three additional deaths
involving Ecstasy that occurred over the May 24 weekend in the Oshawa and
Ajax areas.

According to Dr. Jim Cairns, Ontario's deputy chief coroner, none of the
three had any connection with raves. (The deaths occurred separately, and
tests to see whether other drugs were present should be available in
several weeks.)

There is another set of numbers that shows a broader view of local designer
drug use. It was supposed to be discussed at Mr. Ho's inquest, but
curiously was not introduced as evidence at all.

Those numbers come from a study of designer drug admissions at the
emergency department of St. Michael's Hospital. It shows that, of 62 such
admissions on weekends last year, 40% involved the drug GHB, and only 18%
involved Ecstasy.

The study showed patients coming from two big downtown clubs -- where raves
are occasionally held -- but also from bars and parties.

Frequently, when witnesses at the inquest tried to talk about drug use in
venues other than raves, they were shut down. That was typified by an
unpleasant exchange in which a witness attempted to discuss drug use in
downtown bars.

"We're just dealing with raves and Ecstasy here," snapped coroner's counsel
Paul McDermott.

Furthermore, testimony repeatedly showed just how poor most rave-related
information is.

Instead of presenting reliable data about the age of ravers, and the
percentage of them who may be taking drugs, experts proffered a series of
bad guesses, proving only that such numbers should always include a proviso
explaining how they were arrived at. Indeed, while it is now received
wisdom that designer drugs are targeted at the city's "early teens," the
St. Michael's study showed patients' average age to be just over 22. Among
the 13 dead, ages ranged from 17 to 28, with nine cases over the age of 20.

There is still no accurate, broader picture of designer drug use in
Toronto. At times, witnesses did refer to Ecstasy use in venues from
nightclubs to homes to bush parties.

And David Collins, of the Toronto Harm Reduction Task Force, told the jury
that while Ecstasy use may have once been the province of ravers, it has
now spread to an older, thirtysomething demographic.

But it's important to know those things for certain: If they're right, then
a central point of Mr. McDermott's case -- that raves and Ecstasy have a
particular connection -- may be long outdated.

Why is poor and missing information, and a lack of context, such a
potential problem?

For one, it means that, to prevent more designer drug deaths, education
efforts may have to be targeted not just at the rave community, but much
farther afield.

(In fact, it could be argued that cracking down on raves means dispersing a
group of people that knows far more about safe designer drug use than any
other group).

It means that continual reference to Ecstasy and other designer drugs as
rave drugs is misleading, and that, in future, the coroner's office should
dispense information much faster about the circumstances surrounding
designer drug deaths, so they can be put in context.

The jury's recommendations, which are non-binding, are expected mid-week. A
good legacy for Allen Ho might be a critical look at the information his
inquest did provide, and an understanding of how much we still need to find out.