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POP TILL YOU DROP

We're a risk-taking culture, say drug experts, and new laws restricting the sale of party pills will not stop their use.

The timing was perfect.  The day the Press ran a front-page story on an 18-year-old admitted to hospital after taking 10 party pills, the government's health committee proposed a new drug classification to regulate the sale of low-risk drugs.

The decision won a wave of approval.  Teenagers at emergency clinics, dairies advertising "energy pills", suburban outlets selling party pills have outraged whole communities.  Even some in the industry have complained about a cowboy mentality that sees pills sold to any age without any advice.

According to Ross Bell, executive director of the NZ Drug Foundation, a new classification that restricts age and regulates supply is a sensible step.  "Although we can't regulate against personal stupidity, we can regulate against unsafe marketing practice and ensure that the consumer is given sufficient information about the risks and effects of party pills."

But legislation will only go so far.  The young woman who went into seizures after taking 10 pills will still be able to take 10 pills, even after a new classification.

Professor David Fergusson at the Christchurch School of Medicine and Health Sciences says it is a complicated debate that has been completely botched.

"It's completely predictable - young people between 18 and 25 are at their peak potential for taking risks.  There is probably good reason to regulate sale, supply and delivery, but if laws aren't reflected in people's belief system, they will never work.  Look at cannabis - if you pass a law saying no smoking of cannabis and most people ignore it and police don't enforce it, it's not really a law, is it? If young people don't believe [in these proposed regulations] and parents give them freedom and they have purchasing power, the law will be completely irrelevant to how young people take drugs."

Fergusson points to the panic surrounding nitrous oxide ( nos ).  Unlike other inhalants such as sprays and cleaning fluids, nitrous oxide has little effect on critical body function ( the main risks result from woeful misuse, such as filling a rubbish bag with the stuff and putting it over your head ).  It has been used as a recreational drug since the 1700s, and its harmful effects, says Fergusson, are "close to zero".  This year, it was recognised as falling under the Medicines Act.  It is now illegal to sell it or even possess it without reasonable excuse.

"The fervour did more harm than the actual drug.  Everyone learnt about it."

And enforcement is an issue.  A walk through Christchurch on a Friday night shows that the trade in nos is still alive and laughing.

Are party pills a health risk?

The active ingredient is benzylpiperazine ( BZP ), a synthetic central nervous stimulant originally developed to treat cattle parasites.  Users describe feelings of euphoria, energy and heightened senses.  BZP became popular in the dance-rave scene of Europe as a positive alternative to alcohol or illegal drugs.

"That scene was rarely associated with alcohol.  One or two beers maybe, but because alcohol makes you dehydrated and because it interferes with your dancing, that concept of getting plastered just wasn't there," says emergency medicine consultant Dr Paul Quigley.

On its own and in restricted quantity, there are few negative effects.  There is no evidence of physical dependence and there have been no fatalities ( the death of a European woman in 2001 was found to be related to Ecstasy, and not BZP as initially claimed ).  But taken in large quantities, or taken with alcohol or other drugs, legal or illegal, it can cause symptoms of extreme agitation.

Christchurch naturopath Michael Woods stresses that drugs like BZP react differently in different people.

"They are not for everybody - this is the dilemma with drugs in general.  My suspicion is that there's a group of people who are vulnerable to that stimulation, who will react badly.  And if you haven't eaten well, if you're dehydrated or tanked up on caffeine or sugar all day, and you go out at night and take party pills, then there could be problems.  It's a gamble."

At Auckland City Hospital, the number of those arriving with BZP overdose symptoms rose from three in 2002 to 23 in 2004.  Of these, five had taken other illegal drugs, 10 had consumed alcohol, three felt better before they saw a doctor.  In the end, two needed relaxants and one vomited and was admitted with reflux oesophagitis.  In the same year, 809 were admitted with problems of excess alcohol.

Dunedin and Waikato hospitals see an average of up to one a week with overdose symptoms, with most having also had alcohol.  Christchurch averages one a day, with most occurring in the weekends.  Again, although seizures and anxiety are consistent with BZP toxicity, many of those appearing at A&E clinics are either not sure what pills they have taken or have taken party pills alongside alcohol.

At Wellington Hospital, BZP barely figures - drug presentation is 99 percent dominated by alcohol.

Shouldn't we be campaigning against the local bottle store rather than the suburban party-pill outlet?

"Our binge-drinking culture interferes with our recreational drug problem," says Quigley.  "The combination is not good.  You will always get users who are stupid users, who mix drugs or who have a dangerous attitude, who'll take 12 tablets when you're supposed to take two.  And when they say my friend gave me two red tablets, you have no idea where it was cooked up."

We are, says Fergusson, a risk-taking culture.  "We'll get stuck into stuff with greater vigour than other cultures, and we'll pay the bill for it.  Look at the wowser tradition - six o'clock closing made drinking very difficult.  There was a lot of law-breaking; sly grogging was almost a virtue.  We have an essentially anti-prohibitionist tradition and people will try to subvert drug rules.  This is a waste of time.  If you take a moral position, you might as well say it should not be available at all."

Last year, the Expert Advisory Committee on Drugs concluded that there was insufficient information on which to recommend banning BZP.  They did, however, suggest partial control through a classification controlling its manufacture and sale.  Dr Ashley Bloomfield, Chief Advisor Public Health: "In the absence of research, it was felt there was enough community concern for there to be some regulation.  It's a substance that alters the mind, and other substances like that, such as alcohol, we do regulate."

Bell says there should be restrictions on the sale of BZP, but there must be a rational basis for such rulings.

"If you make drug policy in response to short-term community concern or political opportunism, you run the risk of having bad drug policy.  We're not pro-drug - we believe in the golden rule that young people shouldn't do drugs, because they're at a vulnerable age when drugs will have an impact - but we want to make sure we use evidence and science when developing drug policy."

Good legislation, he says, helps people make good decisions.  And to make good decisions, we need information.

"Government agencies should be addressing this," says Woods.  "You can't just legislate all these things all the time.  Education has got to play a key role."

Legislation is not the only answer.  Recreational drug use isn't going to go away.  As Bell says, if we see less BZP on the streets, it will be because chemists have come up with something else.  And whatever the latest concoction, it will come down to education as to how many end up at A&E.