Is This The Most Dangerous Drug in Britain?

Rene Saunders had been planning the night out for a fortnight. The 22
year-old was well liked and made friends easily, a regular face in his
hometown of Shrewsbury. The Dreamscape organization was holding a rave at
the Bath and West Showground in Sheppeton Mallet, Somerset, and along with
about twenty of his friends, he had planned to make the trip south, heading
off to a surfing competition in Newquay later. On the evening of July 25
1998, he got into his white Vauxhall Cavalier, picked up three of his
friends and headed down the M5 to Somerset. He was playing a track called
‘Sensation’, one of his friends remembers over and over again. If he was
going to die, he told her, he wanted it to be on a night like this, when he
was having fun.

Rene was training to be a drug counselor at Shrewsbury College of Art &
Technology. He had been through it all himself, you see, bad problems with
speed & ecstasy. But all that was behind him, or was about to be. Before
leaving home, he had told his mum this was the last time he was ever going
to take drugs.

By early afternoon the next day he was lying dead near Yeovil District
Hospital, the first British victim of a new drug, 4-MTA. In its street form
4-MTA looks like a generic paracetamol, a white tablet with a vertical line
scored across one side. It is this marking that has earned such pills the
nickname ‘Flatliners’. In fact, certain 4-MTA pills in Holland bear the
imprint of a five-pointed star, but the name – thanks to a morbid
association with the flatline which appears on the heart monitor of a dead
hospital patient has stuck.

The term appeared in the national media in November last year, following the
death of a young soldier, Steven Evans, who had taken a 4-MTA flatliner. It
was touted as a new kind of ‘super ecstasy’, being sold in clubs alongside
other powerful MDMA variants such as DOB (33 times the strength of
ecstasy-although this just means that the drug manufacturer can produce 33
times as many from the same initial quantity) and ‘Mitsubishi’ (MDMA tablets
marked with the three diamond logo resembling that of the car manufacturer).
In fact, 4-MTA bears only superficial similarity to MDMA, and its reputed
strength is a largely secondary issue. It actually affects the brain in a
manner radically different to MDMA, while mimicking some of its effects.
But when combined with alcohol, cocaine or any of the other club drugs is
potentially lethal.

Testimony given by Rene’s friend Keith Ducket at the inquest into the death
of Rene Saunders: “You take one [4-MTA tablet] and you don’t really get a
buzz of it at all, you just feel normal. If you keep on taking them they
sort of level off, go high a bit and then feel normal. It keeps on getting
higher and higher. You don’t realize what’s happening to you. You think
you’re normal but you’re not. On an ecstasy tab the feeling is that you go
up and then you come down so it’s finished. You might take another one or
not. With flatliners you go up and you level off but after a while because
you’ve levelled off you think you’ve come back down again. Every time you
take another one you go higher and higher and higher without even realizing
it.”

With Hindsight, the death of Leah Betts in November 1995 marked a watershed
for ecstasy culture in Britain. The image of the policeman’s daughter dying
in hospital, appeared night after night on TV screens and day after day on
the front pages of newspapers, cause politicians to demand action. Police
forces across Europe began working together on a new plan of attack against
ecstasy manufacturers. If they could not close all the routes of supply,
maybe they could act before the drug was made. The first move was against
PMA, an industrial chemical used as a ‘precursor’ in the manufacture of
MDMA. Existing restrictions on the distribution of PMA – warehouses
stocking the chemical need a special license and are obliged to inform the
police when purchasing large quantities – came into force both here and, by
late summer 1997, in Holland. Indeed, during this period, PMA was taken off
the market almost completely.

Ecstasy producers decided to switch to the drug’s close chemical cousin.
The home office, however, ever eager to close loopholes, issued a list of 36
‘MDMA – variants’ they planned to ban last August, including
4-methylamphetamines, or 4-MTA.

Unknown to just about everyone at the time, 4-MTA had already been
implicated in the deaths of at least three people, one in Holland in June
and two in Britain: the first Rene Saunders, and two weeks later in
Plymouth, Steven Evans. Even before the cause of death in at least on e of
the cases had been determined, the National Criminal Intelligence Service
(NCIS) – a Home Office agency which monitors the manufacture and
distribution of illegal drugs – issued press releases warning about 4-MTA.

The story of Steven Evans made national headlines after the inquest after
his death towards the end of November 1998. The front-page lead in the
Express was typical: Victim of New Ecstasy! Here was an archetypal drug
death story the tabloids could latch onto: He was a soldier with a ‘bright
future’, an ‘exceptional sportsman’ and had just been given a clean bill of
health by army physicians. On August 8 he had gone out to Claire’s Nightclub
in Torquay where he took an unknown number of tablets. He and his friends
then went to the Monastery Club until the early hours of the next day before
driving back to Plymouth. He had a fit at the flat of his girlfriend Keri
Gunningham, and died in front of her. Less widely reported was the cocktail
of drugs found in his body found along with the 4-MTA: MDMA, ketamine,
cocaine and methadone. A post-mortem found that the cocaine had reacted, or
potentiated, with the 4-MTA. The verdict: death due to non-dependant abuse
of drugs.

An exchange between Rene’s friend Kelsey James and the coroner at the
official inquest into the death of Rene Saunders:

Kelsey James: “He was shaking really badly in the back of a car. I grabbed
his arms and held them from the front passenger seat to make him sit up.

We had a bottle of water in the car and gave him sips of it… we wrapped Rene
in a rug so he couldn’t move.” Coroner: “Why didn’t you call for help?”
James: “We had all just come out of a rave. We had seen him like this
before… he was perhaps worse than we had seen him. I don’t know. I don’t
know.”

As anyone who has ever bought an E will know, determining what’s actually in
it is virtually impossible. There have been at least five types of pills
described as flatliners on the drug market since there first appearance in
1991, but the police only began finding 4- MTA in them in the late summer of
1997 – just around the time when MDMA precursors were impossible to get hold
of.

”We’re seeing the same pattern of criminals trying to produce these drugs
[4-MTA & DOB] as we saw with ecstasy,” says Gail Kent, the press officer at
NCIS. “They’re trying to get hold of the precursors used to make them.
That’s what we’re finding when we raid the factories.” The NCIS are now
moving to place restrictions on the sale of precursor chemicals used to make
4-MTA and DOB – chemicals currently used in the manufacture of paint and
wallpaper.

NCIS is also worried about the high ratio of deaths to seizures: 3 in just
20 batches on 4-MTA (there are no official figures for the numbers of
tablets seized, but it’s likely to run into the hundreds of thousands).
There have yet to be any seizures of DOB in Britain, says Gail Kent, though
there is evidence that labs busted by police have been preparing to make it.
It is also believed that 250 000 tablets of DOB stopped on the
French/Belgian border were bound for Britain.

UK forces seem to have been caught by surprised by the NCIS’s warning about
the potentially lethal effects of 4-MTA. One of the deaths NCIS refers to
was in Derby. “It was not due to flatliners,” said a police spokesman. “We
do not have a problem with them in this area.” Sources in two different
local police forces spoke of their feeling that NCIS were ‘whipping up’ the
story. NCIS say they are simply being proactive, though this doesn’t
explain why they waited until nearly four months after the first deaths
before they informed the press. Their sudden announcement in November may
have been prompted by a huge seizures of 25 000 tablets of 4-MTA in London.

4-MTA was originally developed in 1969 by American scientist Dave Nichols of
Purdue University Indiana, who explains that, “We first synthesized in
attempts to identify new types of treatments of depression” The drug works
in a similar way to Prozac – by releasing serotonin in the brain, thus
increasing one’s sense of well-being. But whereas Prozac causes serotonin to
be taken into the brain, 4-MTA induces a serotonin release, which is neither
reabsorbed nor destroyed.

“The consequence is that one would expect that brain levels of serotonin
would go very high following administration of 4-MTA,” says Nichols, adding
that there is something known as ‘serotonin syndrome’ – an adverse reaction
to extremely high levels of serotonin – which he believes the drug can
cause. “The syndrome consists of restlessness, shaking, increased reflexes,
shivering and tremor and can lead to seizures, coma and death.”

4-MTA also takes much longer than MDMA to work (there is no lab data, but
anecdotal evidence places it at around two hours), so the recreational user
might take another couple of pills before the effects of the original one
kick in. Medically, virtually nothing is known about 4-MTA “We have a few
studies on rats,” says Nichols. The toxicology expert at Rene Saunders’
inquest had to undertake his own detective work just to detect it in
Saunders’ blood.

The hearing into Rene’s death is held in the town hall at Wells in Somerset.
There are two rows of chairs in the back of the small courtroom for
witnesses and four seats for the press. All are filled.

Proceedings are conducted by the coroner, Nicholas Rheinberg. The officer
in charge of the investigation, DC Paul Thomas, is called to the stand,
followed by Rene’s mother Shannette Lappage, two friends of Rene’s and the
pathologist all interwoven with statements taken by police at the time.
Slowly, the circumstances behind Rene’s death are revealed.

They arrived at the Bathe West showground at around 10:30pm parked up and
queued for about five minutes to get in. It wasn’t unusual for Rene to take
between 8 and 10 tablets each weekend, and at some point he found a dealer.
It might have been the same one Gareth Rowse found. Gareth gave evidence to
the police the afternoon of Rene’s death, despite their severe misgivings
about his state of mind – at one point during the interview he tried to
break into a police car. Confronted just minutes later, he apologized saying
he didn’t know what he was doing. “They [the pills] make you do things that
seem completely sensible,” Gareth told them. His speech kept cutting out as
his eyes rolled to the back of his head, DC Thomas reported to the inquest.

Gareth had bought some flatliners from a Scouser with a ‘weathered look’.
Rene was seen talking to the same dealer later on. After taking the pills,
Gareth felt nauseous and tried to make himself sick. At the same time Rene
was complaining of stomach cramps and was also feeling ill. Someone gave
him a sweater shortly after midnight because he said he was cold. By 1am he
was lying on the ground. He told several of his friends he had taken seven
flatliners. At 5am, one said, “Rene was not his usual self, he was very
huggy. He was also attempting to pick things up which weren’t there.” At
6:35am he was, “Shaking, sweating and looking a mess.” At 7am the rave ended
and he was helped out to the car ‘unable to stand’. Between 7 and 8am ‘his
face was drawn like an old man’. By 9:30am ‘he was stretching and clutching
the air as if moving an item one side to another.’

Keith Duckett decided he had better drive as Rene was in no fit state. All
their friends had agreed to meet at a nearby little chef. As their car
neared Podimore services at the junction at the A37 and A303, Keith started
having trouble with the clutch. He decided to pull over. Rene didn’t seem
to be getting any worse and it was already a beautiful day. So they spread
a blanket out in the grass by the side of the road, left messages on their
friends’ mobiles and waited for them to turn up.

Keith Duckett answers a question from Rene’s mother at the inquest: “We’ve
all had mixed emotions about it. I do feel really guilty for not
telephoning an ambulance and I wish I had. I’ve lost a really good friend.”
As he walks past her back to his seat his face crumples, he clasps her on
her shoulder and chokes out, “I’m sorry”.

Rene’s body, said the pathologist Dr Charlotte Fisher, looked like it had
been in a house fire, all dusky coloured. She told the coroner it was very
unusual to see a body like that. You usually get that in the extremities of
the body, but not all over. His brain was in fine shape – unlike most
ecstasy victims, who often die from hypopyrexia, where the brain swells
unnaturally. His heart, too, was in good shape, as were his lungs, which
were full of air. He hadn’t been unconscious for long before he died. “I’
ve got a healthy body”, she had concluded, looking a little bemused. “There
is no natural cause of death in the post mortem.”

His death had indeed come quickly. Someone had given him a cup of tea
around midday and he seemed to come round a little, starting to speak
coherently. Then he started to go blue. Someone called an ambulance. A
crew spent 30 minutes trying to revive him. He was pronounced dead at
Yeovil District Hospital that afternoon. It is believed he died from
arrhythmia (irregular beating) of the heart after taking flatliners. There
was no other explanation. “It seems we’re breaking new ground here,” said
the coroner, recording a verdict of accidental death due to an overdose of
4-MTA, the only drug found in Rene’s body. He also called for the drug to be
made illegal, probably unaware that the Home Office intend to classify the
4-MTA as a class–A drug under the Misuse of Drugs Act 1971- which also
outlaws LSD, cocaine and MDMA – from the beginning of this year.

The recent publicity surrounding 4-MTA has caused a split among those who
sell it, both surreptitiously in Britain and legally in Holland. Barry (not
his real name), who is close to a major London dealing ring, says, “Everyone
I know said they wouldn’t touch them because of the publicity. I wouldn’t
do it anyway – I’m not going to sell E’s that someone is going to die from.
As long as I’ve got some kind of morals I wouldn’t do it.” Further sources
suggest that several other major dealing rings have refused to buy pills
containing 4-MTA, and only those with gangland links are likely to be
selling them. Availability so far seems to be confined to the Southeast and
the West Country. There have been no reports of significant seizures of
4-MTA flatliners in Manchester, for instance, even though most of the
dealers there have gangland connections.

British police believe that the 4-MTA pills originate in Holland. Whereas
the standard of chemistry behind the drug scene in Britain is pretty low, in
Holland they take it much more seriously. But like the UK dealers, the
Dutch smart-drug shops are split on the issue of 4-MTA. ‘I think it’s risky
stuff,’ says a spokesman for Conscious Dreams, one of the biggest smart-drug
distributors in Holland. “We contacted some specialists that said nothing
was known about its effects on humans. It works rather dangerously. People
don’t want to use it.”

The story is somewhat different at their main rivals, The Shamen, who are
based in Arnhem. “There are a lot of commercial interests involved,” says a
spokesman. “People who stock 2CB-2 [another chemical cousin of MDMA, itself
a variant of 2CB, recently banned by the Dutch authorities] want to sell it
instead of 4-MTA. But if you use 4-MTA under special circumstances then it’
s okay.”

They handed out a leaflet with each pill sold, warning the user not to take
it with alcohol, amphetamines or MDMA, and to drink lots of water. They
sell around 10 000 pills each month, he estimates. So who makes it?

‘A large pharmaceutical company’, he replies, before going quiet. “They also
sell normal medicines. They don’t want this link between MTA and their
other products to be known.”

There is no evidence of any link in the Dutch pharmaceutical registers I
consulted, but a spokesman at the Department of Health in Holland admitted
he was not unfamiliar with the rumors. ‘We’ve heard that as well’, he said.
“But we can’t confirm it.” Gale Kent at NCIS is even more circumspect. “I
wouldn’t want to comment on that.”

Outside the courtroom in Wells, the local press and news agencies are moving
in for quotes in the event, the death of Rene Saunders, will make only brief
news story in The Guardian. No other national covers it.

Keith Duckett spots Rene’s mum, Shannette, and they embrace warmly for a
second. Shannette tells local TV that her Rene was “Like a bottle of pop,
always bubbling.” She speaks clearly without anger. She doesn’t blame the
rave. If she was young she might be doing it. She tells parents, they must
help their kids if they’re on drugs and kids should know what they are
taking.

“Is the camera off?” she asks the film crew. “Can’t be seen having a
cigarette on TV.”

Rene’s mum also called for ecstasy testing kits to be made available on the
NHS. But the test she is talking about wouldn’t really help, since it only
identifies the presence of MDMA. And as police forces grow more canny about
different recreational drugs, the chemists are always trying to stay one
step ahead of them.

But there is a more personal issue involved here. The strongest image from
Rene Saunders’ inquest was of a person after person describing Rene as ill:
shaking, sweat pouring off him, unable to speak or talk. And no one helped
him because he was often like that. His friends shouldn’t blame themselves.
Hindsight invokes terrible feelings in such cases, but they couldn’t have
known he was dying. Many of us have been in similar situations, wondering
whether to call an ambulance for a friend who always gets too out of it –
and then deciding not to.

After the inquest, I drive back to Bristol with the local BBC journalist who
interviewed Keith Duckett. Keith told him he was off drugs, this time for
good. It was, perhaps, a decision which went someway towards making an
amends for his friends death. But, at the same time, a large part of his
life had gone missing. Without the drugs, things just weren’t the same.
And he still hadn’t found anything to take their place.