Monday, April 30, 2007

The anatomy of a drug panic

On Friday the Guardian ran a news article that came perilously close to the classic ‘new killer drug’ panic stories we are more used to seeing in the tabloids. It’s a hackneyed old journalist trick when reporting drug stories that risk bening a bit dull or are maybe too complicated for an 800 worder. The basic things to remember to do are:

  • Pre-decide your narrative arc: e.g. deadly new drug must be banned
  • (rotten) Cherry-pick all the worst sounding, most scarey bits of information from the source material
  • Especially look for facts that involve suffering, rape, and death (preferably of teenaged girls)
  • Ignore context, more positive/ambiguous harm assessments, and key facts if they don’t suit the drama of your ‘new killer drug’ story
  • Come up with a suitably high impact headline, preferably including one of the following ‘crazed’, ‘rapist’ , ‘kill’ or ‘death’
  • Try and mention that the drug can be bought...ON THE INTERNET!!

Here are some highlights for the Guardian piece in bold, with commentary. And theres some discussion afterwards.

Warning on legal dance drug that experts say can kill

· Health Loophole in law allows BZP to be sold as 'fertiliser'
· Report urges EU to consider imposing ban

Rupert Neate
Friday April 27, 2007
The Guardian

A dance drug described as "legal ecstasy" faces a possible Europe-wide ban after a report catalogued a number of deaths and serious injuries linked to the stimulant.

As we shall see ‘linked to’ in no way translates to ‘caused by’

Two people have died after taking the drug with ecstasy and it has been found during postmortems on two road accident victims in Britain.

Some key details missing here. The EMCDDA source document being cited notes that:

“In both cases BZP was quantified in blood and urine samples, but a number of other psychoactive substances were also found e.g. cannabinoids, cocaine, ephedrine, MDMA, ketamine, amphetamine, diltiazem and ethanol. Therefore, it could be assumed with a high level of certainty that the possible role of BZP in these cases was negligible”

and that

“In New Zealand, it has been argued (Candor Trust – road safety group) that party pills enhance driving and are, in fact, ‘saving lives’ because they provide a legal and safer alternative to controlled stimulants such as methamphetamine.”

Medical experts warn that benzylpiperazine (BZP) can cause convulsions, anxiety, abnormal heart rates, stomach pain and even death through over-stimulation of chemical pathways in the brain.

All drugs can have side potential effects – read the tiny print on that folded up bit paper in any over the counter or presciption medicine (In case of slow news day: list them in a headline for a ready made scare story on your product of choice). Paracetamol for example can kill, and unlike BZP actually has. I could equally unbalancedly have quoted the EMCDDA report saying BZP “is reported to produce arousal, euphoria, wakefulness, improved vigilance and feeling of wellbeing” (presumably the reason why people take it) and then not mentioned the negative/toxic side effects.

It can also be legally imported into Britain from foreign websites, mostly operating from New Zealand, where it is a multimillion-dollar industry and 20% of the population have taken the drug, which is sold under names such as Pep Twisted, Legal E, Nemesis and Euphoria.


Reported deaths in New Zealand from scary new killer drug that 20% of population have tried, with approx 8 million doses consumed : zero

If the assessment, which will be released in June, finds the drug to be dangerous it could be banned throughout the European Union. If the drug is not banned by the EU, the Home Office could add BZP to the list of substances controlled under the Misuse of Drugs Act.

Its very unclear what is meant by ‘dangerous’ here. All active drugs have risks and all drug are 'dangerous’ to some degree, indeed most 'can kill' if you try hard enough. But not all drugs are banned, most are strictly regulated to manage and minimize the dangers.

[the Lancet paper] describes the case of an 18-year-old who bought tablets from a dealer in a nightclub thinking they were ecstasy or amphetamines. She collapsed after taking five of them and appeared to have a seizure lasting 10 minutes. When she arrived at hospital her pupils were dilated, her heart was racing and her body temperature and blood pressure had plummeted. She was treated in hospital with tranquillisers and within 12 hours had recovered and was discharged.

The single case described in the Lancet is of a teenager who had unknowingly taken BZP, and furthermore had taken a substantial overdose. So technically this was an accidental 'overdose’ resulting from a ‘poisoning’, and in no way characteristic of informed BZP users who are capable, indeed likely, to exhibit rational overdose-avoiding behaviour if appropriate advice on dosage etc is given at point of sale or on the packaging. Note also that 12 hours later she was fine and went home apparently fully alive.

The Lancet also does not use the term ‘plummeted’ with regards blood pressure and body temperature opting for the less dramatic ‘she was apyrexial (35·9°C).’ (normal body temperature is 37) and reporting ‘a blood pressure of 150/51 mm Hg’. Whilst the systolic figure of 51 is low , 150 systolic pressure is technically in the ‘high blood pressure’ category (>140) if I remember my O'level biology correctly.

The paper says that standard medical tests may not pick up BZP, and warns it is potentially life-threatening.

Test don't pick it up because it is a new drug and not tested for yet. The Lancet quotes a 2005 New Zealand study of 80 BZP related emergency room admissions noting that ‘Three patients had potentially life-threatening recurrent seizures’. I took a look at the referenced paper, and it mentions that of the 80 admissions ‘Two displayed airway compromise and metabolic derangements that were potentially fatal.’ In the study the average patient experiencing adverse effects had taken 4.5 pills (a toxic overdose) and the majority were teenagers.

One of the report's authors, John Ramsey, a toxicologist at St George's hospital in London, told the Guardian: "We have no real idea how widespread the use of this drug is, as it is rarely reported. But it is quite clear it should be a controlled drug."

BZP is a controlled drug. As described earlier in the article it is controlled under the medicine act and is now illegal to sell. I assume he isn’t referring to it being ‘controlled’ by gangsters and criminal profiteers as are other drugs ‘controlled’ under the Misuse of Drugs Act’.

The Advisory Council on the Misuse of Drugs discussed the legal status of BZP in November but no action was taken.

It was a preliminary review to see whether more action was required. They agreed to look at the issue in more detail.

Phil Willis, chairman of the Commons science and technology select committee, said: "BZP gives the government the perfect chance to play new drugs with a straight bat. They should look into the harm they cause and give drug users proper information about the drug. It is then up to the criminal justice system to decide how illegal the drug should be based on criminality."

Despite the rather confusing last sentence, Phil is onto something here. The Government does indeed have the opportunity to choose the regulatory and legal framework for this substance that would minimize its potential harms. Unmentioned in the article is the fact that in new Zealand the Government established a new class D (appended to the UK-like A,B,C system) that allowed the drug to be sold under licensed conditions including:

- Where the drug can be sold (e.g. not near schools)
- Age of purchaser controls
- In what doses, strengths and quantities it can be sold (based on a risk assessment)
- How the product must be packaged
- How the product must be stored, and how much can be stored in each location What
- Information must be given to the customer at the point of sale (including information about possible interactions with other drugs and medication)

Interesting information that might have been useful for Guardian readers

The European report lists a series of deaths and serious injuries linked to the drug, including a 23-year-old Swiss woman who took BZP together with ecstasy and drank more than 10 litres of water. She died of hyponatraemia, or water poisoning.

So again 'linked', not 'caused by'. The best (worst) example the author can find is clearly a water toxicity death, not a toxic BZP death. The most thorough review of the drug has was produced by the New Zealand Expert Advisory Committee on Drugs (the equivalent of our ACMD), which goes unmentioned in the Guardian coverage. Commenting on this particular death the EACD notes that: “No linkage with the BZP was made and the death displayed all the characteristics of an ecstasy related death” adding that “Other than this one case, no other fatalities are known of, therefore BZP's known potential to cause death is low , or as yet unknown”

Originally designed as a cattle wormer, the drug is considered so dangerous by US authorities that it is classified as schedule one, the same category as heroin.

Schedule 1 is also the same catagory as - less scary drug - cannabis, indeed the US sheduling system is arguably even more riven with anomalies and bad science than our own. According to the EACD review, the DEA decision to put BZP in schedule 1 was in part based on the same water toxicity death, mentioned above, (the one with which ‘no linkage with the BZP was made’).

It should also be noted that the DEA scheduling decision was based on an error in assessing the drugs potency (overestimating it by 20,000%): The DEA initially claimed that:

“BZP acts as a stimulant in humans and produces euphoria and cardiovascular changes including increases in heart rate and systolic blood pressure. BZP is about 20 times more potent than amphetamine in producing these effects. However, in subjects with a history of amphetamine dependence , BZP was found to be about 10 times more potent than amphetamine. ” [ref]

The DEA then produced a revised BZP profile in 2004 stating:

“BZP acts as a stimulant in humans and produces euphoria and cardiovascular effects, namely increases in heart rate and systolic blood pressure. BZP is about 10 to 20 times less potent than amphetamine in producing these effects .”[ref]

The EMCDDA report also notes that BZP is one tenth the potency of amphetamines. Again unmentioned in the Guardian story.

The report also gives anecdotal evidence that BZP was used in an alleged drug-induced rape case in Britain.

A single piece of scary but unsubstantiated annecdata. The EMCDDA report says the following:

“there has been an alleged drug facilitated sexual assault case in which BZP and 1-(4-methoxyphenyl) piperazine (pMeOPP) were detected in a urine sample. The concerned individual declared to have taken pills called ‘PEP Love’”……. And that “No further details about the case are available.”

So it was an unspecified and alleged ‘sexual assault’, not specified as a ‘rape’, and the wording suggests the user took the pills voluntarily, and there are no further details, about the nature of the assault, whether charges were brought, or whether other drugs (including alcohol) might have been involved.

The authors of the report are concerned that many of the injuries caused by the stimulant may go unreported because it is not routinely tested for and clubbers are unlikely to tell doctors they have taken it.

This is a problem for all illegal or quasi-legal drugs

But despite several raids by the agency and police, including the seizure of 64,900 tablets from a car in London, online shops are still selling thousands of pills a day.


Finally this quote from a user at the end:

"But I would imagine the legal status and its availability is the main reason people take it."

Morphs into this more dramatic, almost viz-like, pull quote,

'Its legal status is a big reason for people taking it'

helping to back up what the author's apparently pre-decided narrative: this is a killer drug which should be banned.

Just to be clear about this. BZP use has risks, and given its relative newness on the party scene these risks are relatively poorly understood. However, there have been a number of published studies, and governmental reviews that describe what is known thus far. Almost any drug can kill if misused, but BZP, whilst being linked to a number of deaths, does not appear to be linked by way of direct toxic fatality – even following overdose – to any of them. It is evidently possible, but hasn't happened yet. Drug death stats are a minefield at the best of times, but given that BZP has been consumed by significant numbers of people (probably millions) over a number of years, this would suggest to me that compared to similarly placed drugs including ecstasy and amphetamines, it may be at least comparatively less risky.

From a harm minimisation perspective this raises important issues. If people are substituting BZP use for more dangerous illegal drugs, the net effect may be reduced harm (including the harm of a drug conviction). The fact that BZP appears to be fairly dose specific - with unpleasant side effects kicking in at a level only marginally higher than the active dose, (according to the EACD report; at 2.5 times the average dose) as well as following attempts to re-dose as effects ware off - may actually have a self limiting effect on use of the drug: it doesn’t appear to lend itself to patterns of binge use or problematic dependent use. If users are educated about the dangers and have clear safety and dose information available at point of sale or on the packaging potential harms can be reduced further.

Journalists find justification (and a self-congratulatory follow up story) when ‘clampdowns’ are announced in the wake of a decent media drug panic. But if the drug is brought within the Misuse of Drugs Act as this piece seems to be suggesting users may either return to potentially more dangerous drugs, or be buying BZP of unknown strength and purity with no safety information from a harm maximising illegal marketplace. Overdosing teenagers turning up in emergency rooms would seem more likely in this scenario. Bad reporting of drug stories can end up harming people by politicising descisions and making rational evidence-based public health interventions more difficult and less likely.

There are other options of-course. Whilst unregulated sales of the past are clearly unacceptable, the drug could be strictly regulated for sale from licensed vendors, with age of purchaser controls, in plain packaging, with appropriate safety information and warnings, and in units of known dosage – enabling users to make informed decisions and minimise risks. Something like this has, as mentioned, been tried in New Zealand with the class D idea. Maybe the Guardian should be covering that too – and its not like they are unaware of it. The author of this piece contacted me a couple of weeks ago, we had a long chat about all the points raised above, and he had read Transform’s briefing on piperzines produced last year, which discusses all this in detail. Unfortunately, the only detail he uses is in the Guardian online blog item on the same story where he references a scary stat about DRUGS ON THE INTERNET!! from the briefing.

I rate the Guardian. People take it seriously and much of the misinformation in this news piece will probably be cropping up in future coverage - (just watch out for more ridiculous references to date rape, car accidents, death, 'worming tablets' and 'fertiliser').

For the Guardian this was all very.....dissapointing.


Steve R said...

This may cast some light on the journalist. He is a student on a placement after winning a student journo competition. Nothing wrong with that, but you would think they should have someone checking over his work.

I wonder if his media degree has special course modules on sensationlism and moral panics.

mike said...

Gald someone is watching the papers with a critical eye!

BZP has been around for ages in new zealand...

20 mil consumed with no deaths so they say...
and worming tablets - dont they contain piperazine citrate or something, not benzylpiperazine???