International Journal of Drug Policy RSS feed: Current Issue. The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world. Electronic usage: An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 9,932* * Figure is an average based on full text articles downloaded monthly via ScienceDirect between August 2008 and March 2009 http://www.ijdp.org/?rss=yesElsevier Inc.en © 2009 Elsevier B.V. All rights reserved. International Journal of Drug Policy0955-3959211January 2010 © 2009 Elsevier B.V. All rights reserved. healthpermissions@elsevier.comhttp://www.ijdp.org/article/PIIS0955395909001339/abstract?rss=yesThe Commission on Narcotic Drugs (CND) was formed in 1946 as the United Nations’ central policy-making body in matters relating to drugs: it “analyses the world drug situation and develops proposals to strengthen the international drug control system to combat the world drug problem.” (CND website, http://www.unodc.org/unodc/commissions/CND/01-its-mandate-and-functions.html accessed 09.10.09). It is the form that this analysis takes, and the information upon which it is based, which provide the objects of discussion for this editorial. Taking as our starting point a resolution on the improvement of data relating to the production, trade in and use of drugs, endorsed at the 52nd CND in March 2009, we will examine one of the most commonly used, reported and reviewed report on the “world drug situation”—the UNODC's annual World Drug Report. We consider two issues: first, does the data produced by the UN drug control agencies satisfy the requirements of quality and validity within the limits of the framework it currently uses? And secondly, does the framework, even in the unlikely circumstances that it could be made to work perfectly, provide the international community with the kind of map it needs in order to facilitate an effective social and governmental response? The answer to these questions is bound up with what the “world drug problem” is taken to be. Many discussions at CND assume that the “problem” is transparently obvious—“drugs”. Things, as ever, are not so simple.Mapping the world drug problem: Science and politics in the United Nations drug control systemChristopher Hallam, David R. Bewley-Taylor10.1016/j.drugpo.2009.10.007International Journal of Drug Policy 21, 1 (2010)2009-11-16International Journal of Drug Policy2009-11-16211S0955-3959(09)X0007-1Editorial13http://www.ijdp.org/article/PIIS0955395909001133/abstract?rss=yesAbstract: Highly active antiretroviral therapy (HAART) has dramatically improved health outcomes among people living with HIV/AIDS. However, significant rates of HIV-related morbidity and mortality have persisted among HIV-positive injection drug users (IDU) globally. To date, research as well as programmatic and policy responses have failed to adequately address barriers to HAART access and adherence among IDU both in developing/transitional and developed countries. A review of existing literature suggests that this is due to a shortage of context-specific evidence and an overemphasis on individual-level and behavioural variables. We propose a conceptual shift away from understanding suboptimal HAART adherence as determined predominantly by individual factors modifiable through individually focused interventions, towards a greater acknowledgement of the influence of social and structural factors such as stigmatization and social exclusion, unstable housing environments, the organization of health care systems and the continued prohibitionist approach to illicit drug policy. Globally, the future of a successful HAART treatment approach for HIV-positive IDU relies largely on a more careful consideration of these social and structural barriers that IDU face and, importantly, on a serious commitment to effect social and structural changes that will foster conditions which allow IDU to enjoy the full benefits of HAART.Social and structural determinants of HAART access and adherence among injection drug usersAndrea Krüsi, Evan Wood, Julio Montaner, Thomas Kerr10.1016/j.drugpo.2009.08.003International Journal of Drug Policy 21, 1 (2010)2009-09-14International Journal of Drug Policy2009-09-14211S0955-3959(09)X0007-1Commentary49http://www.ijdp.org/article/PIIS0955395909001182/abstract?rss=yesAbstract: Over the past five years, the release of cohort studies assessing the link between cannabis and psychosis has increased attention on this relationship. Existing reviews generally conclude that these cohort studies show cannabis has a causal relationship to psychosis, or at least that one cannot be excluded. Few studies have evaluated the relative strengths and limitations of these methodologically heterogeneous cohort studies, and how their relative merits and weaknesses might influence the way the link between cannabis use and psychosis is interpreted. This paper reviews the methodological strengths and limitations of major cohort studies which have looked at the link between cannabis and psychosis, and considers research findings against criteria for causal inference.Cohort studies that assessed the link between cannabis and psychosis were identified through literature searches using relevant search terms and MEDline, PsycINFO and EMBASE. Reference lists of reviews and key studies were hand searched. Only prospective studies of general population cohorts were included. Findings were synthesised narratively.A total of 10 key studies from seven general population cohorts were identified by the search. Limitations were evident in the measurement of psychosis, consideration of the short-term effects of cannabis intoxication, control of potential confounders and the measurement of drug use during the follow-up period. Pre-existing vulnerability to psychosis emerged as an important factor that influences the link between cannabis use and psychosis.Whilst the criteria for causal association between cannabis and psychosis are supported by the studies reviewed, the contentious issue of whether cannabis use can cause serious psychotic disorders that would not otherwise have occurred cannot be answered from the existing data. Further methodologically robust cohort research is proposed and the implications of how evidence informs policy in the case of uncertainty is discussed.Assessing evidence for a causal link between cannabis and psychosis: A review of cohort studiesJennifer A. McLaren, Edmund Silins, Delyse Hutchinson, Richard P. Mattick, Wayne Hall10.1016/j.drugpo.2009.09.001International Journal of Drug Policy 21, 1 (2010)2009-09-28International Journal of Drug Policy2009-09-28211S0955-3959(09)X0007-1Reviews1019http://www.ijdp.org/article/PIIS0955395909000565/abstract?rss=yesAbstract: Background: Genital ulcer disease (GUD), including syphilis, is an important cause of morbidity in low and middle income (LMI) countries and syphilis transmission is associated with HIV transmission.Methods: We conducted a literature review to evaluate syphilis infection among drug users in LMI countries for the period 1995–2007. Countries were categorized using the World Bank Atlas method [The World Bank. (2007). Data and statistics: Country groups. Retrieved online October 18, 2007 at http://go.worldbank.org/D7SN0B8YU0] according to 2006 gross national income per capita.Results: Thirty-two studies were included (N=13,848 subjects), mostly from Southeast Asia with some from Latin America, Eastern Europe, Central and East Asia, North Africa and the Middle East but none from regions such as Sub-Saharan Africa. The median prevalence of overall lifetime syphilis (N=32 studies) was 11.1% (interquartile range: 6.3–15.3%) and of HIV (N=31 studies) was 1.1% (interquartile range: 0.22–5.50%). There was a modest relation (r=0.27) between HIV and syphilis prevalence. Median syphilis prevalence by gender was 4.0% (interquartile range: 3.4–6.6%) among males (N=11 studies) and 19.9% (interquartile range: 11.4–36.0%) among females (N=6 studies). There was a strong relation (r=0.68) between syphilis prevalence and female gender that may be related to female sex work.Conclusion: Drug users in LMI countries have a high prevalence of syphilis but data are limited and, in some regions, entirely lacking. Further data are needed, including studies targeting the risks of women. Interventions to promote safer sex, testing, counselling and education, as well as health care worker awareness, should be integrated in harm reduction programs and health care settings to prevent new syphilis infections and reduce HIV transmission among drug users and their partners in LMI countries.Syphilis in drug users in low and middle income countriesLara S. Coffin, Ashley Newberry, Holly Hagan, Charles M. Cleland, Don C. Des Jarlais, David C. Perlman10.1016/j.drugpo.2009.02.008International Journal of Drug Policy 21, 1 (2010)2009-04-10International Journal of Drug Policy2009-04-10211S0955-3959(09)X0007-1Reviews2027http://www.ijdp.org/article/PIIS0955395909000632/abstract?rss=yesAbstract: Background: This study evaluates whether the instauration of a heroin prescription trial (‘NAOMI’) generated an impact on the occurrence of crime and disorder in surrounding areas. The clinical trial was initiated in Vancouver and Montreal in 2005, with the aim of assessing the benefits of heroin-assisted treatment (HAT) in Canada. While experiences from other jurisdictions where HAT trials have been implemented clearly demonstrate substantial crime reduction effects for trial participants, there is overall concern that HAT clinics – similar to other interventions aiming at problematic street drug users – may induce a ‘honeypot’ effect, leading to increases in crime and/or disorder problems in the vicinity of interventions. It has been argued that HAT clinics will attract undesirable behaviour associated with cultures of street drug use and thereby produce negative impacts on the community.Methods: This study examined the incidence of crime and disorder in the Vancouver and Montreal sites before and during the NAOMI trial (2002–2006), using police calls for service and arrest data. Data were analysed by autoregression analyses.Results: The analysis suggested that most indicators remained stable during the pre- and implementation phase of the NAOMI trial in both sites.Conclusion: While the attribution of observed crime and disorder trends to the specific clinical interventions in Montreal and Vancouver is difficult and many extrinsic factors may play a role, this study has not generated any clear evidence from institutional police data to suggest increases or decreases in community-based problems associated with HAT programs in Canada.A heroin prescription trial: Case studies from Montreal and Vancouver on crime and disorder in the surrounding neighbourhoodsBenoit Lasnier, Serge Brochu, Neil Boyd, Benedikt Fischer10.1016/j.drugpo.2009.04.003International Journal of Drug Policy 21, 1 (2010)2009-05-18International Journal of Drug Policy2009-05-18211S0955-3959(09)X0007-1Research Papers2835http://www.ijdp.org/article/PIIS0955395908001692/abstract?rss=yesAbstract: Background: Despite the proven effectiveness of methadone treatment, the majority of heroin-dependent individuals are out-of-treatment.Methods: Twenty-six opioid-dependent adults who met the criteria for methadone maintenance who were neither seeking methadone treatment at the time of study enrollment, nor had participated in such treatment during the past 12 months, were recruited from the streets of Baltimore, Maryland through targeted sampling. Ethnographic interviews were conducted to ascertain participants’ attitudes toward methadone treatment and their reasons for not seeking treatment.Results: Barriers to treatment entry included: waiting lists, lack of money or health insurance, and requirements to possess a photo identification card. For some participants, beliefs about methadone such as real or rumored side effects, fear of withdrawal from methadone during an incarceration, or disinterest in adhering to the structure of treatment programmes kept them from applying. In addition, other participants were not willing to commit to indefinite “maintenance” but would have accepted shorter time-limited methadone treatment.Conclusion: Barriers to treatment entry could be overcome by an infusion of public financial support to expand treatment access, which would reduce or eliminate waiting lists, waive treatment-related fees, and/or provide health insurance coverage for treatment. Treatment programmes could overcome some of the barriers by waiving their photo I.D. requirements, permitting time-limited treatment with the option to extend such treatment upon request, and working with corrections agencies to ensure continued methadone treatment upon incarceration.Why don’t out-of-treatment individuals enter methadone treatment programmes?James A. Peterson, Robert P. Schwartz, Shannon Gwin Mitchell, Heather Schacht Reisinger, Sharon M. Kelly, Kevin E. O’Grady, Barry S. Brown, Michael H. Agar10.1016/j.drugpo.2008.07.004International Journal of Drug Policy 21, 1 (2010)2008-09-22International Journal of Drug Policy2008-09-22211S0955-3959(09)X0007-1Research Papers3642http://www.ijdp.org/article/PIIS0955395909000589/abstract?rss=yesAbstract: Background: The availability of prison-based drug treatment has increased markedly throughout Europe over the last 15 years in terms of both volume and programme diversity. However, prison drug treatment faces problems and challenges because of the tension between ideologies of rehabilitation and punishment.Methods: This article reports on a study of four cannabis treatment programmes and four psychosocial drug treatment programmes in four Danish prisons during 2007. The data include the transcripts of 22 semi-structured qualitative interviews with counsellors and prison employees, prison statistics, and information about Danish laws and regulations.Results: These treatment programmes reflect the ‘treatment guarantee’ in Danish prisons. However, they are simultaneously embedded in a new policy of zero tolerance and intensified disciplinary sanctions. This ambivalence is reflected in the experiences of treatment counsellors: reluctantly, they feel associated with the prison institution in the eyes of the prisoners; they experience severe opposition from prison officers; and the official goals of the programmes, such as making clients drug free and preparing them for a life without crime, are replaced by more pragmatic aims such as alleviating the pain of imprisonment felt by programme clients.Conclusion: The article concludes that at a time when prison-based drug treatment is growing, it is crucial that we thoroughly research and critically discuss its content and the restrictions facing such treatment programmes. One way of doing this is through research with counsellors involved in delivering drug treatment services. By so doing, the programmes can become more pragmatic and focused, and alternatives to prison-based drug treatment can be seriously considered.Drug treatment or alleviating the negative consequences of imprisonment? A critical view of prison-based drug treatment in DenmarkTorsten Kolind, Vibeke Asmussen Frank, Helle Dahl10.1016/j.drugpo.2009.03.002International Journal of Drug Policy 21, 1 (2010)2009-05-08International Journal of Drug Policy2009-05-08211S0955-3959(09)X0007-1Research Papers4348http://www.ijdp.org/article/PIIS0955395909000425/abstract?rss=yesAbstract: Background: Area-level socioeconomic conditions are associated with epidemic rates of viral hepatitis and HIV amongst urban injection drug users (IDUs), but whether specific socioeconomic markers are uniformly related to IDU outcomes across different urban environments is unclear. We evaluated whether injection behaviour is differentially related to neighbourhood socioeconomic characteristics for IDUs in inner city vs. surrounding urban areas.Methods: The study population was 468 active IDUs on the Island of Montréal. Neighbourhoods were represented as 500m radius buffers around individual IDU dwelling places. High-risk injection behaviour (HRIB) was defined dichotomously. Relations between neighbourhood socioeconomic disadvantage (percentage households below low-income cutoff), neighbourhood educational attainment (percentage adults with university degree), and HRIB were assessed using multivariate logistic regression. Stratified analyses were conducted for inner city IDUs (n=219), and those in surrounding areas (n=249).Results: Similar proportions of IDUs in inner city and surrounding areas reported HRIB. Neighbourhood socioeconomic characteristics were not associated with HRIB for IDUs in surrounding areas. For inner city IDUs, those in socioeconomically disadvantaged neighbourhoods were more likely to practice HRIB (OR 4.34; 95% CI 1.15–16.35). Conversely, inner city IDUs residing in lower educational attainment neighbourhoods had a lower odds of HRIB (OR 0.41; 95% CI 0.21–0.80).Conclusion: HRIB did not vary according to urban environment but for inner-city IDUs was differentially related to socioeconomic markers. Associations between HRIB and neighbourhood socioeconomic disadvantage and lower educational attainment, positive and negative, respectively, indicate that adverse socioeconomic circumstances are not related to a uniformly greater likelihood of HRIB.Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, CanadaMélissa Généreux, Julie Bruneau, Mark Daniel10.1016/j.drugpo.2009.01.004International Journal of Drug Policy 21, 1 (2010)2009-03-02International Journal of Drug Policy2009-03-02211S0955-3959(09)X0007-1Research Papers4955http://www.ijdp.org/article/PIIS0955395909000553/abstract?rss=yesAbstract: Background: Following a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.Methods: In order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.Results: 77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR]=2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR=2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR=3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR=3.02, 95% CI: 1.65–5.54).Conclusion: The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for interventionAve Talu, Kristiina Rajaleid, Katri Abel-Ollo, Kristi Rüütel, Mati Rahu, Tim Rhodes, Lucy Platt, Natalia Bobrova, Anneli Uusküla10.1016/j.drugpo.2009.02.007International Journal of Drug Policy 21, 1 (2010)2009-04-23International Journal of Drug Policy2009-04-23211S0955-3959(09)X0007-1Research Papers5663http://www.ijdp.org/article/PIIS0955395909000474/abstract?rss=yesAbstract: Background: This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances.Methods: Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005–2006 were examined.Results: Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11–1.53) for Canadian boys and 1.55 (1.31–1.83) for girls, and 2.0 (1.73–2.31) for Dutch boys and 1.92 (1.62–2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR=.67; .46–.96).Conclusions: The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the NetherlandsBruce Simons-Morton, William Pickett, Will Boyce, Tom F.M. ter Bogt, Wilma Vollebergh10.1016/j.drugpo.2009.02.003International Journal of Drug Policy 21, 1 (2010)2009-03-23International Journal of Drug Policy2009-03-23211S0955-3959(09)X0007-1Research Papers6469http://www.ijdp.org/article/PIIS0955395909000607/abstract?rss=yesAbstract: Background: A supervised injection facility (SIF) has been established in North America: Insite, in Vancouver, British Columbia. The purpose of this paper is to conduct a cost-effectiveness and cost-benefit analysis of this SIF using secondary data gathered and analysed in 2008. In using these data we seek to determine whether the facility's prevention of infections and deaths among injecting drug users (IDUs) is of greater or lesser economic cost than the cost involved in providing this service – Insite – to this community.Methods: Mathematical modelling is used to estimate the number of new HIV infections and deaths prevented each year. We use the number of these new HIV infections and deaths prevented, in conjunction with estimated lifetime public health care costs of a new HIV infection, and the value of a life, in order to calculate an identifiable portion of the societal benefits of Insite. The annual costs of operating the SIF are used to measure the social costs of Insite. In using this information, we calculate cost-effectiveness and benefit-cost ratios for the SIF.Results: Through the use of conservative estimates, Vancouver's SIF, Insite, on average, prevents 35 new cases of HIV and almost 3 deaths each year. This provides a societal benefit in excess of $6 million per year after the programme costs are taken into account, translating into an average benefit-cost ratio of 5.12:1.Conclusion: Vancouver's SIF appears to be an effective and efficient use of public health care resources, based on a modelling study of only two specific and measurable benefits—HIV infection and overdose death.A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facilityMartin A. Andresen, Neil Boyd10.1016/j.drugpo.2009.03.004International Journal of Drug Policy 21, 1 (2010)2009-05-08International Journal of Drug Policy2009-05-08211S0955-3959(09)X0007-1Research Papers7076http://www.ijdp.org/article/PIIS0955395909000450/abstract?rss=yesAbstract: Background: The legislation on psychoactive substances has a role to play with regard to shaping social values and influencing the normalisation of drug use. In New Zealand from 2005 to 2008, benzylpiperazine-containing ‘legal’ party pills (BZP-party pills) were legally available for purchase, subject to controls around a minimum purchase age of 18 years, and prohibitions on free of charge distribution and advertising in certain media. This paper explores what their legal status communicated to young users.Methods: Interviews and group discussions with young people (n=58) who had used BZP-party pills in the preceding 6 months.Results: Data were collected between June and December 2006 via a series of interviews with individuals, ‘friendship’ pairs, and groups comprised of participants known to each other. Young people saw BZP-party pills as ‘safe’ and of good quality as they were legal/government sanctioned, but also thus of inferior strength, suggesting they could take more of them. However, after using them they often reviewed their view of their safety and quality due to varied experiences. Being legal for some people meant they could use the substances without breaking the law, or having to go to ‘dealers’. Their legal status also meant they were easily accessible and were seen to be ‘socially acceptable’, with some young people indicating they would be happy to discuss their use with their parents. However, social acceptability was, for some, a reason not to use them.Conclusion: These data provide a unique insight into the tension between positive and negative harm reduction messages relating to the legal nature of psychoactive drugs and as such begin to fill an information void in this area. The legal status of these ‘party pills’ conveys mixed messages to young people and whilst being seen as potentially safe and of good quality, this often leads to higher than ‘recommended’ doses being used. Nevertheless, not breaking the law or having to access BZP-party pills from ‘dealers’, and being able to discuss their use with their parents are all potentially positive harm reduction issues.“They’re legal so they’re safe, right?” What did the legal status of BZP-party pills mean to young people in New Zealand?Janie Sheridan, Rachael Butler10.1016/j.drugpo.2009.02.002International Journal of Drug Policy 21, 1 (2010)2009-03-25International Journal of Drug Policy2009-03-25211S0955-3959(09)X0007-1Research Papers7781http://www.ijdp.org/article/PIIS0955395909000437/abstract?rss=yesAbstract: Background: There is great need to sustain harm reduction programmes for opiate-dependent persons, given variable retention of opioid agonist treatment (OAT) enrolees. Resource challenges may lead some health organizations to discontinue such programmes, though just as programmatic evaluation may determine efficacy and cost-effectiveness so to does it aid in examining impacts of programme dissolution.Methods: This retrospective evaluation investigated impacts of the dissolution of a ‘Minimal Services’ (MS) harm reduction programme for substance-abusing OAT clientele at an urban U.S. Veterans Affairs Medical Centre. Targeted clinical data concerning treatment retention, substance use and service utilization was abstracted from medical records of MS-assignees (N=32) and a matched comparison group of standard OAT enrolees. Chart reviewers gathered data for a two-year period encompassing baseline, transitional, and dissolution study phases.Results: Relative to matched-controls, MS-assignees exhibited: (1) disproportionately poor treatment retention over the two-year period; (2) high and temporally stable rates of documented substance use across study phases, and (3) increased utilization of resource-laden VAMC services after MS dissolution.Conclusion: Collective results suggest MS programme dissolution was associated with adverse conditions for assignees and the larger treatment setting, and reinforce the need for pragmatic, humane treatment policies to facilitate retention of opiate-dependent persons.Dissolution of a harm reduction track for opiate agonist treatment: Longitudinal impact on treatment retention, substance use and service utilizationBryan Hartzler, Ann J. Cotton, Donald A. Calsyn, Rachael Guerra, Edward Gignoux10.1016/j.drugpo.2009.01.005International Journal of Drug Policy 21, 1 (2010)2009-03-12International Journal of Drug Policy2009-03-12211S0955-3959(09)X0007-1Short Reports8285http://www.ijdp.org/article/PIIS0955395909000486/abstract?rss=yesAbstract: Background: ‘Party’ pills containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) were sold legally in New Zealand until early 2008. Prospective studies of hospital emergency department admissions appeared to suggest that the harm from party pills was greater among South Island than North Island users. The party pill industry association (the Social Tonics Association of New Zealand or STANZ) claimed these differences were due to the voluntary code of practice adopted by their members in the North Island. The aims of this study were to examine differences in harm from party pills between North and South Island users in New Zealand, and to investigate possible reasons for any differences in harm, including the impact of industry self-regulation.Methods: A national household survey of BZP/TFMPP party pill use was conducted in New Zealand. Information on the ingredients of party pills was provided by the National Poisons Centre.Results: In a number of instances last year users of party pills from the South Island were more likely than last year users from the North Island to report harm from party pills. There were no differences between the North and South Island users with regard to the mean number of BZP/TFMPP party pills taken, mean total milligrams of BZP/TFMPP ingested or prevalence of use of other drug types in combination with party pills. A minority of users in the South Island reported using extremely high numbers of BZP/TFMPP party pills in a single session and using extremely high potency brands of party pills. Last year party pill users from the South Island were more likely than those from the North Island to be students.Conclusion: A number of factors may have contributed to the greater harm from BZP/TFMPP party pills among South Island users including a higher proportion of student users with higher consumption of alcohol and other drugs. Users from both Islands commonly exceeded the dosage of BZP/TFMPP recommended by STANZ suggesting the STANZ code of conduct was largely ineffective.Differences in harm from legal BZP/TFMPP party pills between North Island and South Island users in New Zealand: A case of effective industry self-regulation?Chris Wilkins, Paul Sweetsur10.1016/j.drugpo.2009.02.005International Journal of Drug Policy 21, 1 (2010)2009-04-09International Journal of Drug Policy2009-04-09211S0955-3959(09)X0007-1Short Reports8690