Multiorgan failure from 1-benzylpiperazine ingestion – legal high or lethal high?

INTRODUCTION: 1-benzylpiperazine (BZP) is synthetic stimulant. It was legal and openly sold in New Zealand before October 1, 2008. Two cases of life-threatening toxicity associated with BZP use are reported in detail in this article. CASES: Case one describes an adult female who developed status epilepticus, hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, and renal failure associated with a BZP ingestion. Case two developed a similar pattern of toxicity from the combined use of BZP and 3,4-methylenedioxy-N-methylamphetamine. Both cases required prolonged hospital care but survived. DISCUSSION: There have been reports of deaths associated with the combined ingestion of BZP and 3,4-methylenedioxy-N-methylamphetamine. The effects may possibly be synergistic when co-ingested. Case one suggests that BZP alone has the potential to cause serious sympathomimetic toxicity.