the mouth, extreme alertness, pruritus, confusion, agitation, tremor, extrapyramidal symptoms (dystonia, akathisia), headache, dizziness, anxiety, insomnia, vomiting, chest pain, hallucinations, paresthesia, tachycardia, hypertension, palpitations, collapse, hyperventilation, sweating, hyperthermia and problems with urine retention. The more severe toxic effects include psychosis or adverse psychiatric events, renal toxicity, respiratory failure, hyperthermia, serotonin syndrome, rhabdomyolysis and seizure. Blood benzylpiperazine concentrations have been measured either to confirm clinical intoxication or as part of a medicolegal death investigation. Risk of fatality Ingestion of piperazine derivatives alone rarely causes death. A retrospective study carried out at an Auckland emergency department found that BZP presentations only made a minor contribution to their overdose database, with most cases not producing any significant toxicity. One death has been attributed to ingestion of BZP alone; in this case its blood concentration was measured to be 8 mg/L. Combined with alcohol or other illicit drugs, such as TFMPP and MDMA, multiple deaths have been reported. A combination of BZP and MDMA ingested by a 23-year-old DJ nearly resulted in death. He was put into an induced coma, and later recovered. In another case in Zurich in 2001, a 23-year-old who had taken BZP and MDMA died from a massive cerebral edema 57 hours after hospital admission. Addictive effects BZP has not been found to be physically addictive in humans. Most users of BZP say they could stop, but do not want to. Studies undertaken on animals have indicated that BZP can substitute for methamphetamine in addicted rats, although it is one-tenth as potent and produces correspondingly weaker addictive effects. Legal status BZP is banned in Australia, Austria, Canada, Denmark, Estonia, France, Germany, Greece, Ireland, Italy, Japan, Malta, Poland, Sweden and the United States BZP is not controlled under any UN convention, so the compounds themselves are legal throughout most of the world, although in most countries their use is restricted to pharmaceutical manufacturing and recreational use is unknown. Australia BZP is banned in all Australian states. Victoria, the last state in which it was legal, changed its classification on 1 September 2006, when BZP and piperazine analogs become illegal in the federal schedules, which are enacted by all Australian states and territories. Canada In Canada, Benzylpiperazine and salts of benzylpiperazine are classified as Schedule III controlled substances under the Controlled Drugs and Substances Act. European Union Benzylpiperazine was the subject of a European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)