Methanol Poisoning: The Pointless Loss of Young Lives, and A Wider Problem in Southeast Asia
On 11 November 2024, two 19-year-old Australian backpackers, Bianca Jones and Holly Bowles, booked themselves into the Nana Backpackers Hotel in the town of Vang Vieng in central Laos. Two days later, just as they were scheduled to check out, they were instead found to be seriously unwell and taken to hospital by hostel staff. Jones died in the northern Thai town of Udon Thani on 21 November, followed by Bowles the following day in Bangkok. The six killed by methanol poisoning included 28-year-old Simone White, a British lawyer, two unnamed Danish women, aged 19 and 20, and an anonymous 56-year-old American man.
Vang Vieng lies on the Nam Song River, 80 miles north of the Laotian capital of Vientiane. It is surrounded by limestone mountains and caves. Following its “discovery” by Western travellers in late 1990s, it has built up a reputation as a hedonistic party capital, facilitated by its location along the Banana Pancake Trail backpacking route, which straddles Thailand, Laos, Cambodia, and Vietnam. It became renowned for its parties and for river tubing, which entails floating on the water on inner-tubes of tractor tyres. The most recent guests at Nana Backpackers Hostel had been greeted on the evening of their arrival with free shots of Lao Tiger vodka, mixed with Coke Zero. These shots are believed to have contained methanol, although details of the exact source are lacking.
Toxic amounts of methanol can be found in many domestic and industrial products, including antifreeze, paint strippers, varnish removers, photocopier fluids, de-icing fluids, window cleaning solutions, and windshield washer fluids.
Methanol is designated as a “toxic alcohol”, being unfit for human consumption. In its unmodified form, however, it is not particularly toxic. The adverse health effects of methanol are caused by the products of its metabolism in the human body, whether ingested, inhaled, or absorbed through the skin. When taken by mouth, methanol is absorbed within 30 to 60 minutes of ingestion, depending on the presence or absence of food. It is oxidised by the enzyme alcohol dehydrogenase in the liver into formaldehyde, which in turn is converted by aldehyde dehydrogenase to formic acid, a potent metabolic toxin. Formic acid is further broken down into carbon dioxide and water by yet another enzyme, the more formidable-sounding 10-formyl tetrahydrofolate synthetase. Drinking as little as 25 ml of methanol can be fatal.
Following methanol ingestion, irritation of the gastrointestinal tract causes nausea, vomiting, and abdominal pain, while depression of central nervous system function leads to drowsiness, confusion, headache, dizziness, and unsteadiness, and can progress to seizures and coma. After a latent period of 6 to 24 hours, optic nerve damage causes blurred vision, visual hallucinations, and eventually blindness. Meanwhile, the build-up of formic acid lowers blood pH (metabolic acidosis), with a deleterious effect on the function of many body systems. Diagnosis can be difficult as the symptoms are non-specific, and is confirmed by detecting raised blood levels of methanol and formic acid.
Methanol poisoning can be treated by either of two possible antidotes. Both ethanol and fomepizole (4-methypyrazole) inhibit the action of alcohol dehydrogenase and thereby block the conversion of methanol to formaldehyde. The body can then safely dispose of any remaining methanol. Antidotes must be given early and are usually administered intravenously, although drinking strong alcoholic drinks may buy time when antidotes are not readily available. Once severe acidosis sets in, haemodialysis has to be relied upon to remove methanol and its metabolites from the bloodstream.
Methanol poisoning has been reported on many occasions from Southeast Asian countries, as well as from India and Iran and elsewhere in the world. In these countries, legitimate alcohol (ethanol) may be costly, unavailable, or proscribed by culture or religion. Cheaper methanol, which is clear, colourless, and flavourless, may thus be mixed with alcoholic beverages, including spirit-based drinks (cocktails) and even brand-name alcohol. Illegally distilled grain spirits-bootleg alcohol-often contain methanol. According to an MSF (Médecins Sans Frontières) database, Indonesia has reported the highest number of poisoning episodes in the last two decades. In June 2024, at least 57 people died in the southern Indian state of Tamil Nadu after ingesting methanol.
Although primarily a problem of low-income communities, methanol poisoning can also affect travellers from affluent nations, despite being well-known to both tourism operators and embassies. Bargain-seeking holidaymakers in locations where cheap and readily available alcohol fuels non-stop-partying are particularly at risk. Travellers must beware of the possibilities of tampering and counterfeiting, and should only buy alcoholic drinks, if they must, in sealed bottles and cans from reputable shops, bars, and hotels, avoiding homemade brews, freebies, and super-cheap liquor from dodgy outlets. Once again, innocent lives, by no means for the last time, have been tragically lost to the scourge of methanol.
Ashis Banerjee