For Bethany Clark, the poison tasted nothing like it. There was no bitter taste or astringent burning sensation at the back of the tongue. Anyway, she thought casually, the free shots she and her friends were drinking at the dorm bar in Laos it was probably diluted with water – she didn't notice a strong taste of vodka through the veil of Sprite she mixed it with.
In all, Clarke remembers drinking about five of these shots while sitting with her best friend Simone White and a crowd of other people at happy hour at a hostel. CCTV footage shows the group laughing in the warm air of an outdoor bar in the city of Vang Vieng as green and red lights dance over their shoulders.
By the evening of the next day they were in the hospital. Soon after, White was dead.
Clark describes the terrible effects of these drinks in brutal, prosaic detail. They woke up with what they assumed was a painful hangover. A tour bus ride where the symptoms worsened, ending with White vomiting and Clark collapsing and hitting her head. The debate is whether it was food poisoning, a hangover or a virus. Someone in the group finally decided it was time to look for a hospital. As they waited in the room, there was a gradual, gradual realization that something was wrong, that White was getting worse. I hear her breathing turn into short sighs. The news that her brain is swollen presses into her skull. Finally, her life support system was turned off.
“It was November 21st, which is a year ago, they turned the machine off,” said Clarke, who is originally from the UK but lives in Brisbane. “To be honest, it was just a nightmare.”
White, also British, was one of six tourists who died from poisoning in Laos in 2024 after drinking drinks contaminated with methanol, a cheap and deadly analogue of ethanol. In places where liquor is readily available on the black market, poorly regulated, expensive relative to income, or inaccessible due to legal and cultural taboos, it is increasingly making its way into the alcohol supply chain—with disastrous consequences. The lethal dose is 30 ml. Just 10 ml can cause irreversible blindness.
Quick Guide
What is methanol poisoning and how to recognize it?
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What is methanol poisoning?
Methanol is a poisonous form of “industrial alcohol” that is very difficult to distinguish from ethanol, an alcohol that can be drunk. It is sometimes added to alcohol as a cheap filler. Methanol itself is not toxic, but during its metabolism in the body formaldehyde and formic acid are formed. These toxic compounds make the blood acidic, affecting the nervous system, organs and brain. About 20-40% of untreated cases are fatal. Even a small amount can be dangerous: 30 ml (less than a glass) can be a lethal dose.
How do you know?
Symptoms of methanol often do not appear until 12 to 24 hours after ingestion. Symptoms include vomiting, loss of balance, impaired judgment and drowsiness, which progress to vision changes (blurred vision, tunnel vision, snowballing or blindness), hyperventilation, seizures, coma and death. Unlike a hangover, the symptoms of methanol use usually get worse over time.
Although labeled alcoholic beverages are sometimes contaminated with methanol, the greatest risk comes from alcohol that is unlabeled, sold on the dark market, or sold at very low prices.
What to do if you suspect this?
Anyone who suspects methanol poisoning should go to hospital immediately. If hospitals are not immediately available, a person should drink uncontaminated alcohol because ethanol stops methanol from turning into toxic compounds, says Dr. Knut Eric Hovda, an international expert on methanol poisoning. Beer, wine or spirits are fine. Although ethanol is an effective antidote to methanol, it is difficult to dose correctly over time, so receiving proper medical care as soon as possible is still critical.
Bethany and at least six others survived, one of whom was left blind by the toxin's effects on the optic nerve and is now alive. awareness campaign about the dangers of methanol. Their case has received widespread publicity, but experts say it is just one manifestation of a huge global problem happening largely out of sight, unmonitored and unreported.
“This is a hidden crisis,” said Knut Erik Hovda, a physician and professor at the University of Oslo and an international expert on methanol poisoning outbreaks. “It's huge and people forget about it – it keeps just disappearing and then reappears somewhere else when you let your guard down.”
This month the UK government issued travel warnings to a further 11 countries where travelers face the risk of methanol poisoning, citing an “increase in deaths and serious illness”. These additions bring the total number of countries on the warning list to 38. However, methanol poisonings have occurred throughout the world. The data was collected by a team from Oslo University Hospital and Doctors Without Borders (MSF). documented suspected cases of methanol poisoning in nearly 80 countries. The database covers more than 1,000 cases of poisoning, 41,000 poisonings and 14,600 deaths.
These documented cases were “just the tip of the iceberg,” Hovda said. Many outbreaks are never identified or reported as methanol poisoning. In countries where alcohol is prohibited or taboo, victims may be reluctant to seek treatment. Methanol poisoning can be difficult to detect, with symptoms sometimes not appearing until a day or two after consumption, so people don't attribute their illness to the drink. In addition to the characteristic blindness and vision changes that sometimes occur, symptoms of vomiting, dizziness, and hyperventilation can resemble other illnesses, confusing health care providers. “We call it the great copycat,” Hovda said. And in hospitals around the world, outbreaks are so sporadic that institutional knowledge about methanol is quickly disappearing.
The problem is also compounded by misconceptions about methanol, including that poisoning only occurs through homemade alcoholic beverages. While unlabeled liquor is a definite risk factor, a number of recent outbreaks have also been linked to contamination of official alcohol supply chains, where methanol is added to sealed bottles of liquor and ends up on the mass market.
In Sao Paulo, BrazilIn the early hours of August 31, 27-year-old elevator maintenance technician Rafael dos Anjos Martins Silva and four friends bought two bottles of gin, coconut water and energy drinks from an unlicensed manufacturer.
They drank at Silva's house and when the night was over they went home. Silva slept the entire next day; That evening he woke up vomiting and severe abdominal pain. Soon after this he lost his sight.
His parents rushed him to the hospital. “He was screaming and moaning in pain,” said his mother, Helena dos Anjos Martins, 46. Before they even reached the hospital, her son became unresponsive. “His last breath was in my arms,” Martins said.
Silva fell into a coma and spent 53 days in hospital before going into cardiac arrest and dying on October 23. This is one of 16 confirmed deaths and 46 methanol poisonings in Brazil this year, well above the historical annual average of about 20 cases. Police found methanol in a bottle of gin but are still trying to trace the cause of the outbreak. The operation in Sao Paulo linked some cases to clandestine distilleries that purchased methanol from gas stations.
Silva's case was one of the first to be reported at a time when hospitals across the country are grappling with the problem. shortage pharmaceutical ethanol used as an antidote. “Brazil has failed my family,” his mother said. “Brazil has not given this the importance it should have had from the beginning.”
Part of the tragedy of mass deaths from methanol is that while poisonings are difficult to identify, they are relatively easy to treat.
“If I contact you early enough, I can be sure that you will be out of my hospital within a few days and will be completely fine,” Hovda said. There are two effective antidotes: fomepizole, which is the best clinical treatment but often costs more than $1,000 (£750) per dose. Or – oddly enough – alcohol, which interrupts the process of converting methanol into toxic formic acid, allowing it to be gradually released from the body. Hovda recalls how, during one outbreak in Kenya, they put 35 men in a row in a room and served them alcoholic drinks every two hours. Five went blind before treatment, but all survived.
Methanol toxicity can cause brain damage, blindness and death within days. This means hospitals, health care workers and governments must be prepared with trained personnel, antidotes and warnings to the public about contaminated supplies. And while awareness campaigns have primarily focused on the risks to Western tourists, the largest death toll by far has been among local populations – typically those who are poor or disenfranchised.
There have been nearly 10,000 deaths due to methanol poisoning in Iran over the past two decades, according to the MSF database – an ongoing public health crisis that has barely made international headlines. Another 6,500 cases have been reported in India, where outbreaks are affecting the rural poor. Some of last year's largest outbreaks occurred in Türkiyewhere a series of poisonings killed more than 160 people.
There, taboos and high prices work in tandem to create the perfect environment for an outbreak. Under President Recep Tayyip Erdogan, whose AK Party often appeals to Islamic models of morality, the Turkish government has increased taxes on alcoholic drinks and banned alcohol advertising. Ozgur Aybas, head of the Turkish shopping platform Tekel (wine drinks), said via WhatsApp: “Nowhere in the world is the tax on a product higher than the price of the product itself. Here it is three, five, even 10 times higher. Under these conditions, is it surprising that people sell, provide or produce illegal alcohol?”
A bottle of raki, an anise-flavored spirit similar to ouzo, can cost £28 in a grocery store – a high price in Turkey, where the minimum monthly wage is around £470. This is out of reach for most people and a parallel market of illegal sellers is thriving.
“We are no longer shocked when we see on the news that 10 people died in a restaurant,” says Gökhan Genç, a 36-year-old Ankara resident. “It has become normal.”
