Mephedrone and the ACMD: lessons from BZP and New Zealand's 'Class D' experiment?

Witnessing the media frenzy around mephedrone yesterday I was struck by the similarities with the situation that emerged around the last legal stimulant to achieve any real youth market penetration, namely BZP. BZP (Benzylpiperazine) was reviewd by the ACMD and, following their recommendation, brought within the Misuse of drugs Act just before last Christmas, but had been effectively removed from the 'legal high' market after the MRHA clarified that it was covered by the Medicines Act in 2007. There was never the level of media frenzy over BZP that we are now witnessing with mephedrone, probably because it was neither as popular nor (from the relatively little we know) as risky, and specifically was not directly linked to any deaths. Some journalists did their best to whisk up some hysteria (check out this joker in the Guardian for example), but it never really got any full blown drug-panic momentum.

But at the time the BZP issue was emerging (around 2006), Transform, aware that the drug would soon be under consideration, produced a briefing and submitted it to the ACMD. Central to that briefing was a consideration of New Zealand's policy on BZP, where a unique experiment was underway in which a new piece of legislation had been added to the conventional ABC system, in the form of a new 'restricted list' or  'Class D' as it came to be known, within which drugs would be legal for sale under certain conditions. This was, to our knowledge the first time that a non-medical stimulant drug widely used on the party scene, had been legally regulated for commercial sale anywhere in the world.

Since the briefing was written the situation in New Zealand has changed, and there are also obvious differences between the situation with Mephedrone and BZP. None the less, it was interesting to see David Nutt (who was sitting on the ACMD when we submitted our BZP briefing) suggesting the New Zealand Class D model in the Guardian CiF today. With all this in mind we thought it was worth revisiting the discussion and recommendations from the 2006 BZP briefing, as they seem pertinent to the current debate around mephedrone (not least since the ban on BZP arguably created the space in the market into which mephedrone emerged).

BZP as sold in 2006 

To note - the briefing was produced in October 2006, and some of the information is out of date (more up to date reviews of BZP have emerged). Also, whilst a Class D might be useful as a short term measure it  is not a long term solution and comes with its own problems (potentially further muddying public understanding of drug risks for example). If you want to know what Transform are advocating see here (it isn't prohibition, it isn't a Class D, and it certainly isn't powerful stimulants being sold without any regulation online as plant food).

The full 2006 BZP briefing, with references, is available here, the discussion and recommendations section is copied below:

Discussion:

Piperazines are psychoactive drugs and clearly not without risks. However, the assessments that have been done suggest that the risks are relatively low (see safety appendix), arguably on a par with or less than khat, another legal stimulant (in this case plant based) recently considered by the ACMD  - for which classification under the MDA was not recommended.

Whilst the demographic profile of khat use (largely limited to traditional use amongst the male Somali community) is very different to that of piperazines (mostly used in the party / club / dance music scene) some of the same conclusions apply.

Costs of prohibiting piperazines would include:

• Potential for the creation of an illegal market for drugs that have an established market and level of demand
• Profits being diverted from legitimate, taxed and legally liable producers/retailers into the hands criminal gangs and unregulated dealers
• Increased risks/harm to users from drugs of unknown strength and purity, sold without any health and safety information
• Removal of potential harm reduction gains achieved by diverting recreational users away from more dangerous illegal drugs such as amphetamines (including methamphetamine) and MDMA (ecstasy) and its analogues.
• Criminalisation of users, mostly young people
• An increase in enforcement costs to police, customs, courts, prisons and probation services

Are there potential benefits to prohibiting piperazines?

Benefits of such a move would seem to be primarily political (i.e. demonstrating ‘tough on drugs' credentials).

A deterrent effect from such a prohibition is possible, but doubtful given that there is already an established demand for these drugs, and those deterred would likely substitute back to other illegal equivalents. Such a deterrent effect is poorly supported by evidence. The Science and Technology Select Committee recently concluded that:

“We have found no solid evidence to support the existence of a deterrent effect, despite the fact that it appears to underpin the Government's policy on classification. In view of the importance of drugs policy and the amount spent on enforcing the penalties associated with the classification system, it is highly unsatisfactory that there is so little knowledge about the system's effectiveness.”

The Government presented no evidence in their response to contradict this position. Piperazines (primarily BZP) have been prohibited in a number of countries including the US and it would be useful to examine what effects this had on patterns of use, and knock on effects on the use of other drugs. Transform is not aware that any such research has been undertaken.

There would be no prospect of reduced crime and social disorder, since there is none currently associated with the use of piperazines. According to the New Zealand EACD:

“ there is no reported criminal behavior associated with the use of BZP & TFMPP, as they are moderately priced and have a lower dependence potential than illicit amphetamine” (page 6)

Can we leave the market to self regulate?

The third alternative is to leave the market as it is. This is clearly not a long term tenable situation, even if producers of UK products (from New Zealand) and UK retailers put in place a voluntary code of practice. Although current UK retailers seem to be acting more responsibly than in the past (with, for example, magic mushrooms), there is no guarantee this will be the case for all retailers, and experience with unregulated ‘legal high' markets in the past does not inspire confidence. The New Zealand EACD report states that:

“Because there are many new substances that could appear on the market in this way, the challenge for public health practitioners and regulators is how to respond to these new substances in a way that promotes the public health while protecting individual rights. They are generally of lower potency and price than of illicit amphetamines and methamphetamine, and they are commercially packaged, labeled with the major ingredients and their strengths. The distributors would argue that this is a responsible approach to a demonstrated demand for the effects given by these substances.

When first distributed, this was an approach that allowed users to exit the illicit market with its inherent risks and the often poor quality drugs. Substitution of illicit with Piperazine is occurring, mostly amongst users who are afraid of the damage to their lives that a conviction would bring and who also wish to normalise the transaction required to purchase their choice of recreational substance. However, being unregulated at this time, they are being promoted within the free market, which has the generation of profit as the driving force. This can as easily lead to market saturation as can the imperatives driving the black market. Unlike either novel foods or new medicines, these products are being marketed without adequate scientific safety assessments because there is no need for the distributor to seek regulatory pre-market approval from a regulatory agency.” (p.8)

What would be the benefits of introducing appropriate regulation of the market and licensing of producers and vendors?

The idea of having a ‘restricted list' separate from, or a ‘Class D' in addition to the main drugs legislation (i.e. the ABC classification system under the MDA 1971) has many advantages over the status quo:

• It would create an enforceable legal structure allowing effective state intervention and control of production, supply (availability), promotion and use. This is not possible under the minimally regulated existing market, any existing regulatory options (medicines Act, food supplement regulations), or under the unregulated criminal market that classification under the MDA would inevitably create.
• It allows for full risk assessment of each drug as the basis for tailored penalties/restrictions rather than as a part of the blunt and malfunctioning instrument that is the ABC classification system.
• This form of legislation is significantly more flexible than current arrangements under the Misuse of Drugs Act and would allow for restrictions to be changed rapidly in light of new research, emerging trends or changing conditions.
• It removes virtually all the risks inherent in criminal markets; separating consumers from the wider criminal market (which in the case of Dutch cannabis policy is suggested to have kept down levels of use of more dangerous drugs) and offering harm reduction benefits from the availability of drugs of known content, strength and purity, and supplied with health and safety information
• Harm reduction through diversion away from use of more dangerous drugs.
• Harm reduction in terms of reducing the risk of young people being branded with the stigma of a criminal record.

The wider debate over classification and prohibition / regulation

Inevitably perhaps, proposals for a ‘restricted list' and or ‘Class D' will be seen by some as a ‘back door to legalisation' of cannabis and perhaps other drugs, a sentiment aired during the policy debate in New Zealand. The NZ legislation passed, however, following an intelligent public and parliamentary debate and engagement with all the relevant parties.

Transform's position on the current prohibition of drugs is well documented. We believe the enforcement led approach has been spectacularly counterproductive – failing to deliver any of its stated policy goals, maximising harms associated with dug use, creating a crisis in the criminal justice system and fuelling crime at all scales, at home and in producer and transit countries. We believe that drug policy should be led by evidence of effectiveness, established harm reduction principles and public health science. This inevitably leads to the conclusion that regulated markets (with different regulatory models depending on the drug) offer better outcomes than absolute prohibitions, on all key policy indicators; crime, social nuisance, public health, welfare of young people and value for money expenditure.

We are not alone in this view of prohibition:

“Prohibition doesn't work, as the US found out many years ago.”

John Reid MP Labour (now Home Secretary in charge of drugs policy):

Jeremy Vine programme, BBC Radio 2, 11.11.04

…"we can prohibit, regulate or leave it to the market. Prohibition does not work - it drives the activity underground…”

“Only ideological extremists favour a free-for-all where only the laws of the market hold sway. So the third option is regulation - and regulation with as much emphasis on the quality of the debate as the policy outcome. 'Better regulation' has to mean government engaging people in the decisions that affect their lives and doing so in new and better ways”.

Tessa Jowell MP Labour: 'Grown up politics for an adult world' The Guardian 21.11.04

The Piperazine issue offers a real opportunity to do the right thing, not necessarily the politically expedient one. These are drugs that have yet to attract the attention of a media hungry for drug scare stories (although the first murmurings are beginning to be heard in Ireland), so currently there is little political capital to be made from a high profile crackdown. There is some breathing room in which to address this issue before it gets out of hand. Intelligently handled this need not be a political minefield, and sold as a pragmatic public health intervention to better control a potentially risky substance and keep criminals away from the trade, regulatory options need not be perceived as ‘soft' either.

Important lessons can be learnt from the recent UK experience with fresh magic mushrooms. Whilst there has been well founded criticism that class A is not the appropriate classification for magic mushrooms (or psychedelics more generally), the situation with magic mushrooms was considerably different from that which we are facing with piperazines. Fresh magic mushrooms were legal because of anomaly in the law, rather than because they were a new ‘legal high'. Furthermore they were potentially creating a new market and demand for psychedelics that did not already exist, whereas piperazines are entering, and potentially displacing, existing demand for illegal stimulants (amphetamines and ecstasy) on the party scene. The ban on fresh mushroom sales has been effective at closing down the retailers and returning the market to its previous position, with lower levels of use and production returning to informal harvesting and small scale illegal sales of naturally growing UK mushrooms, that are rarely prosecuted. If there has been a knock on effect in terms of users moving to other drugs (legal or otherwise) this is impossible to quantify, however likely. This ‘success' (at least from the Home Office's point of view) is far less likely to occur following a similar move with piperazines, as has been discussed above, and as was concluded by the NZ Expert Advisory Council.

Similarly lessons can be learnt form the different approach taken with khat, which was rather more pragmatically left unclassified following a thoughtful and thorough investigation and report from the ACMD (unlike magic mushrooms, where policy alternatives received only the most cursory of consideration).

Piperazines probably lie in a similar risk spectrum to these drugs and if we have a choice between prohibition under the Misuse of Drugs Act (magic mushrooms, ketamine, GHB), and leaving things as they are (khat), surely the option of regulatory models, which have demonstrable advantages over both, must now be seriously considered. This is likely to remain a live issue as new ‘legal' drugs continue to emerge into the recreational market but are not covered by the UN drug conventions (Kratom, Fly-agaric mushrooms, peyote cactus, salvia divinorum and nitrous-oxide all potentially warranting consideration).

The ongoing debate around the ABC drug classification system has been brought into sharp relief by the recent Science and Technology Select Committee report, which concluded there was a poor scientific basis in support of its efficacy as either a public health tool or criminal justice deterrent. Even though the Home Office has now reneged on its promise to have a thorough review of the classification system (despite the fact that this idea was welcomed by everyone in the drugs field including the ACMD, and specifically requested the Science and Technology Select Committee) it is hoped that possibilities for the classification system to include a ‘Class D' - offering the possibility of licensed sales of some lower risk drugs - will feature prominently in this ongoing discourse.

The recent ACMD report ‘Pathways to Problems' has recommended that alcohol and tobacco be specifically brought within the remit of the ACMD. Such a move will raise many difficult questions about the historical legal anomalies between legally regulated and totally prohibited drugs. There may well exist possibilities for including alcohol and tobacco in a new ‘restricted' category (which, in effect, they already inhabit, albeit under separate legislation), and also for moving other misclassified (e.g. some psychedelics) or unclassified drugs (e.g. khat) into the new regulatory system. Transform would welcome a debate on these ideas within the ACMD, given that they have now very publicly opened the door for such a discussion.

Transform welcomes the recent shift in approach to the drugs issue, away from heavy handed enforcement towards public health and harm reduction as the guiding principles, and the development of effective regulatory models for some of the less harmful drugs currently in a legal grey area is inevitably going to be an important part of this process. Piperazines, a fairly marginal issue from Transform's perspective, could offer a useful opportunity to experiment with regulation whilst the stakes remain low, rather than leaving the market to self regulate, or opting for another expensive and counterproductive crackdown.

Recommendations

• Initiate an official consultation as part of a formal engagement between the relevant Government agencies (including the Home Office, the Department of Health and the Treasury and key stakeholders including drug services, police and enforcement, NGOs, user groups, producers and retailers) to consider the three key choices for going forward regarding policy and legislation on recreational piperazines (status quo, regulation, prohibition). The possibility for a ‘Class D' or ‘restricted list' for lower risk drugs along the lines of the New Zealand model should specifically be included in the consultation.
• That the ACMD produce a report that considers the information available on piperazines, clarifies the legal status and knowledge on of the various substances in question, and makes recommendations on ways forward, in line with similar recent reports on cannabis, khat, methamphetamines etc.
• The ACMD should be specifically required to consider the models brought into New Zealand law, and make direct contact with colleagues on the New Zealand EACD, to discuss their findings and recommendations.
• In the short to medium Transform recommends the establishing in of a new ‘Class D' within the MDA to enable the licensed sale of certain drugs under the direction of the ACMD.

NZ drug warrior pwned by Dihydrogen Monoxide hoax

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The story of new stimulant drug BZP in New Zealand has been a fascinating insight into the clash between public-health pragmatism and drug war politics. After a brief flirtation with efforts to sensibly license and control BZP production and sale, the rabid drug war ideologues have mounted their moral high horses and organised an evidence-free cavalry charge, winning the day for blinkered ignorance.

How informed are these ban-mongers? Well, not very. And here's the proof. (warning: *incoming pwnage*)

One of the chief cheerleaders for bringing BZP within the ineffectual clutches criminal law is New Zealand National Party politician (and former Play School presenter) Jaqui Dean. New Zealand blogger Micheal Earley (and friends) thought they'd see how much Dean really knew about drugs by deploying the Di-hydrogen Monoxide hoax - seeing if he could get her to call for the prohibition on water on the basis that it was a dangerous drug.

First, a brief bit of background:

The particular interest for drug law reformers was that in New Zealand BZP had been placed in a new Class D (appended to the UK-like ABC drug-harm / penalty hierarchy, or US style I-IV drug sheduling system) which allowed it to be legally manufactured and sold under license. The general idea was that it was considered a low risk drug (specifically: relatively safer than other comparable illegal stimulants - 8 million doses consumed in NZ with no deaths) and that bringing it within the existing ABC system of criminal penalties would increase overall harm, both to users and to wider society. The new Class D, established specifically to deal with BZP, offered a regulatory option for control - a sensible mid point between total prohibition and unregulated free markets (something UK ministers know all about).

Unfortunately Dean and her fellow drug warriors, sniffing out an opportunity for some old-school drug war posturing and opposition point scoring, look to have successfully pushed for the drug to get well and truly prohibited after all. Excellent. Now all the kids can go running back to those lovely crystal meth dealers.

Enter blogger Micheal Earley (with accomplices Ben Smith and Will Seal) who contacted Dean suggesting ...

As a strong advocate for the health and wellbeing of the young people of New Zealand, and a firm supporter of your action to ban BZP, I also call for you to ban Dihydrogen Monoxide. In many cases of drug/party pill overdoses reported in New Zealand and overseas, Dihydrogen Monoxide is considered to be one of the contributing factors, and as such, should be classed in the Misuse of Drugs Act. I look forward to your reply and ask you to take strong action.

and

That anybody is able to obtain ten lites of something as potentially dangerous as di-hydrogen monoxide, legally, is proof that the current government is doing nothing to solve this binge culture and that in fact the statistics have got worse as the years go by.

The DiHydrogen Honoxide hoax, is described on its very own Wikipedia page (which Jaqui Dean's in-depth research failed to uncover) thus:

Dihydrogen monoxide (shortened to DHMO) is a scientific name for water that is relatively unknown to most of the public, used in hoaxes that illustrate how the lack of scientific knowledge and an exaggerated analysis can lead to misplaced fears. "Di" meaning two, and "Mono" meaning single, describes how water is made up of two hydrogen atoms and one oxygen atom The hoax involves listing strictly negative effects of water, such as erosion or drowning, attributing them to "dihydrogen monoxide", and then asking individuals to help control the seemingly dangerous substance.

It was apparently created by Eric Lechner, Lars Norpchen and Matthew Kaufman, housemates while attending UC Santa Cruz in 1989, revised by Craig Jackson in 1994, and brought to widespread public attention in 1997 when Nathan Zohner, a 14-year-old student, gathered petitions to ban "DHMO" as the basis of his science project, titled "How Gullible Are We?"

Demonstrating the familiar rationality-free drug warrior dedication to ridding the world of evil (sounding) drugs, Dean took the bait, writing to NZ Associate Minister of Health Jim Anderton:

his reply was concise and humiliatingly to the point:

Laughably enough the National Party had previously mocked a NZ Green Party politician caught out by the same hoax.

Many will be aware that this is but the latest installment in a long and distinguished history of drug-war pomposity mocking highjinkery. Lest we forget the immortal Brass Eye drug panic special, featuring David Amess MP describing the terrifying 'bisturbile cranabolic amphetamoid' ... 'made up psychoactive chemical' CAKE:


Of course it's all to easy to laugh at how easily certain tough talking politicians can be lured into making fools of themselves over the drugs issue. But this isn't a joke: these people perpetuate disastrous policies creating havoc and suffering across the globe. It would be more funny if it weren't so tragic. The moral of this story? Drug war politics is all about populist posturing and opportunism. It has nothing, zero, absolutely zip, to do with with science or rational evidence-based policy making.

thanks to Micheal Earley and Snoop.co.nz

more on the UK BZP 'panic' here and Transform's detailed 2006 BZP/piperazine briefing is here.

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.

DRUGS ON THE INTERNET!!

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.

DRUGS ON THE INTERNET!! (refrain)

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.