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For Bethany Clarke, poison tasted like nothing. There was no bitter aftertaste, no astringent sting at the back of the tongue. If anything, she thought in passing, the free shots she and her friends were drinking at a hostel bar in Laos had probably been watered down – she wasn’t detecting a strong vodka flavour through the veil of Sprite she had mixed it with.
All in all, Clarke remembers drinking about five of those shots, sitting with her best friend, Simone White, and a crowd of others at the hostel’s happy hour. CCTV footage shows the group laughing in the warm air of the open bar in the town of Vang Vieng, green and red lights dancing over their shoulders.
By the next evening, they were in hospital. Shortly afterward, White was dead.
Clarke describes the awful aftermath of those drinks in blunt, matter-of-fact detail. Waking up, with what they assumed were grinding hangovers. A tour-bus ride where those symptoms grew worse, ending with White vomiting and Clarke fainting, hitting her head. The debate over whether it was food poisoning, a hangover, a virus. Someone in the group finally deciding it was time to find a hospital. The gradual, creeping realisation, as they waited in the ward, that something was badly wrong, that White in particular was getting sicker. Hearing her breathing shift to short gasps. The news that her brain was swelling, crushing into her skull. Finally, her life support being turned off.
“That was 21 November, so a year ago, that they turned the machine off,” Clarke, who is from the UK but living in Brisbane, said. “It was honestly just a living nightmare.”
White, also British, was one of six tourists who died in the 2024 Laos poisoning, after consuming drinks contaminated with methanol – a cheap, deadly relative to ethanol. In places where spirits are easily available on the black market, poorly regulated, expensive relative to income, or inaccessible because of legal and cultural taboos, it is increasingly finding its way into the alcohol supply chain – with catastrophic consequences. A lethal dose is 30ml. As little as 10ml can cause irreversible blindness.
What is methanol poisoning and how do you recognise it?
ShowWhat is methanol poisoning?
Methanol is a poisonous form of 'industrial alcohol' that is very difficult to distinguish from ethanol – the alcohol that can be drunk. It is sometimes mixed into drinking alcohol as a cheap filler. Methanol is not toxic itself, but as the body metabolises it, it produces formaldehyde and formic acid. These toxic compounds turn the blood acidic, attacking the nervous system, organs and brain. About 20-40% of untreated cases are fatal. Even a small amount can be dangerous: 30ml, less than a shot glass, can be a deadly dose.
How do you recognise it?
Methanol symptoms often do not manifest until 12-24 hours after ingestion. Symptoms include vomiting, loss of balance, impaired judgement and drowsiness, escalating to vision changes (blurriness, tunnel vision, 'snow' or blindness), hyperventilation, convulsions, coma and death. Unlike a hangover, methanol symptoms will typically grow worse over time.
While labelled spirits are sometimes contaminated with methanol, the highest risk comes from alcohol that is unlabelled, hidden-market, or very cheap.
What should you do if you suspect it?
Anyone who suspects methanol poisoning should seek immediate attention at a hospital. If hospitals are not immediately accessible, the person should drink uncontaminated alcohol, as ethanol halts methanol's conversion into toxic compounds, says Dr Knut Erik Hovda, an international expert in methanol poisoning. Beer, wine or spirits will work. While ethanol is an effective antidote to methanol, it is difficult to correctly dose over time, so getting proper medical care as soon as possible is still crucial.
Bethany and at least six others survived, one of them blinded by the toxin’s attack on the optic nerve, and she is now campaigning for better awareness of the dangers of methanol. Their case was high profile, but experts say it is just one manifestation of an enormous global problem, occurring mostly out of the spotlight, untracked and unreported.
“This is a hidden crisis,” said Knut Erik Hovda, a doctor and professor at the University of Oslo, and an international expert on methanol poisoning outbreaks. “It’s huge, and it’s forgotten – it keeps just disappearing, and then it crops up again in a different place, when you have your guard down.”
This month, the UK government issued travel warnings for 11 additional countries where travellers face the risk of methanol poisoning, citing “a rise in cases of death and serious illness”. Those additions brought the total number of countries on the warning list to 38. But methanol poisonings have struck around the world. Data compiled by a team from Oslo university hospital and Médecins Sans Frontières (MSF) has documented suspected methanol poisoning incidents from almost 80 countries. The database covers more than 1,000 poisoning incidents, 41,000 poisoned people and 14,600 people dead.
Those documented cases were “only the tip of the iceberg”, Hovda said. Many outbreaks are never identified as methanol poisoning, or are not reported. In countries where alcohol is illegal or taboo, victims may be reluctant to seek treatment. Methanol poisoning can be tricky to identify: symptoms sometimes don’t set in until a day or two after consumption, so people don’t connect their illness with the drink. Other than the distinctive blindness and vision changes that sometimes occur, the symptoms of vomiting, dizziness and hyperventilation can resemble other illnesses, leading medical professionals astray. “We call it the big imitator,” said Hovda. And in hospitals around the world, outbreaks are sporadic enough that institutional knowledge of methanol quickly fades.
The problem is also being compounded by misconceptions about methanol – including that poisonings happen only through home-brewed liquor. While unbranded spirits are a definite risk factor, a number of recent outbreaks have also been linked to contaminated official alcohol supply chains, where methanol is being added to sealed bottles of spirits and finding its way on to the mass market.
In São Paulo, Brazil, in the early hours of 31 August, the lift maintenance technician Rafael dos Anjos Martins Silva, 27, and four friends bought two bottles of gin, coconut water and energy drinks from an off-licence.
They drank at Silva’s house, and when the night ended, went home. Silva slept through the entire next day; that evening, he woke up vomiting, with intense abdominal pain. Shortly afterwards, he lost his sight.
His parents rushed him to the hospital. “He was screaming, moaning in pain,” said his mother, Helena dos Anjos Martins, 46. Before they even reached the hospital, her son had stopped responding. “His last breath was in my arms,” said Martins.
Silva fell into a coma and spent 53 days in hospital before suffering a cardiac arrest and dying on 23 October. His is one of 16 confirmed deaths and 46 poisonings from methanol in Brazil this year – well above the historical annual average of about 20 cases. The police detected methanol in the bottle of gin, but are still trying to trace the origin of the outbreak. An operation in São Paulo has linked some of the cases to clandestine alcohol factories that had bought methanol from fuel stations.
Silva’s case was among the first to emerge, at a time when hospitals across the country were facing a shortage of pharmaceutical ethanol used as an antidote. “Brazil failed my family,” said his mother. “Brazil didn’t give it the importance it should have at the start.”
Part of the tragedy of mass deaths from methanol is that, while the poisonings can be challenging to identify, they are relatively simple to treat.
“As long as I get hold of you early enough, I can make sure you walk out of my hospital within a couple of days and 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) a dose. Or – counterintuitively – alcohol, which interrupts the body’s process of converting methanol into toxic formic acid, allowing it to gradually be released by the body. In one outbreak in Kenya, Hovda recalls setting up 35 men in a row in the ward, and serving them an alcoholic drink every two hours. Five were blind before treatment started, but all survived.
Methanol toxicity can cause brain damage, blindness and death within days. That means hospitals, health workers and governments need to be prepared with trained staff, antidotes and public warnings about contaminated supply. And while awareness campaigns are primarily focused on risks to western tourists, the biggest death toll by far is among local populations – typically those who are poor or disenfranchised.
About 10,000 people have been recorded as killed by methanol poisoning in Iran over the past two decades, according to the MSF database – a rolling public health crisis that has barely touched international headlines. Another 6,500 were recorded in India, where outbreaks are hitting the rural poor. Some of the biggest outbreaks of the past year have been in Turkey, where a series of poisonings have killed more than 160 people.
There, taboos and high prices work in tandem to create a perfect environment for an outbreak. Under President Recep Tayyip Erdoğan, whose whose AKP party often makes appeals to Islamic models of morality, the Turkish government has increased taxes on spirits and banned advertising of alcoholic beverages. Ozgur Aybas, the head of the Turkish Tekel (liquor) stores platform, said via WhatsApp: “Nowhere else in the world does the tax on a product exceed the price of the product itself. Here it is three, five, even 10 times higher. Under these conditions, is it really surprising that people sell, provide, or produce illegal alcohol?”
A bottle of raki, an anise-flavoured spirit similar to ouzo, can cost £28 in a grocery store – a high price in Turkey, where the monthly minimum wage is about £470. For most people, it is out of reach, and a parallel market of illicit sellers is thriving.
“We’re not shocked any more when we see in the news that 10 people died in a restaurant,” says Gökhan Genç, a 36-year-old Ankara resident. “It’s become normalised.”
