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New recreational drug has its first casualty in UK

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.334.7600.927-a (Published 03 May 2007) Cite this as: BMJ 2007;334:927

Piperazines were developed to treat worm infestations in animals. But they've become a popular recreational drug because in the right blend they mimic the high induced by ecstasy (methylenedioxymethamfetamine). An 18 year old girl became the first reported casualty of this new drug in the United Kingdom when she collapsed in a London nightclub. She fitted for 10 minutes but made a full recovery after treatment with benzodiazepines. Toxicological analysis of her blood found benzylpiperazine, and nothing else. She had bought the tablets from a dealer thinking they were amphetamines or ecstasy.

The piperazines have an undeserved reputation for safety, writes one commentator (pp 1411-3). This case report may be the first in the UK, but many other cases have probably been misdiagnosed. Doctors have yet to catch up with the new recreational drugs and could easily mistake piperazine poisoning for the more familiar amphetamine poisoning. The symptoms are similar and include nausea, vomiting, hypertension, agitation, and seizures.

Benzylpiperazine became illegal in the UK in March this year. Other piperazines are widely sold as legal alternatives to controlled drugs. Doctors should expect more cases of poisoning. They should also be aware that routine toxological screens don't detect piperazines.

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