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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Sunday 8th January 2012

Before I began this daily blog I used to irregularly write about psychoactive substance use in the ‘Substance Abuse News’ pages of the Phantastica section of this site. One topic that I wrote about on more than one occasion was the outbreak of anthrax amongst heroin users, initially in Scotland but later in England and Germany.

By the time the outbreak was officially declared to be over, in December 2010, there had been 119 cases and 14 deaths. Health Protection Scotland (HPS) set up a National Anthrax Outbreak Control Team (NAOCT) and has now published a report detailing the outbreak, the response to it and making recommendations for dealing with any possible future anthrax infections resulting from contaminated heroin.

I find it hard to read the report without being outraged at the contempt it demonstrates for the lives of heroin users. I’m not in any way impugning the concern shown by all those individuals involved in treating patients or in the investigation of the causes and measures to bring it under control. But it is very clear that they were working against a background of a lack of official interest in the wellbeing of drug users.

Starting at the end, the report concludes that, as far as can be ascertained, the anthrax spores entered a batch of heroin in Turkey, possibly during its production, as a result of contamination by material from an infected goat. A former director general of the Scottish Crime and Drug Enforcement Agency (SCDEA) has described videos he has seen of heroin production as showing ‘a horrible and unhygienic process’. In his view, we should be surprised that such outbreaks aren’t a more frequent occurrence.

So, at the start of the supply chain, we have confirmation that heroin in its pure form is anything but pure. There can be no doubt that if heroin was a legal substance its import, in its present form, would not be permitted under safety legislation. But, because it is an illegal substance, governments can set aside all the legislation on product safety and pretend it has no responsibility.

Going back to the very beginning, the first patient presented to the Victoria Infirmary in Glasgow on 7th December 2009 with a soft tissue infection. Such infections are quite common with around a third of injecting drug users (IDUs) having one annually. It was not until 17th December that lab cultures were found to be, probably, anthrax and samples were sent to Porton Down in Wiltshire. To its credit, Porton Down didn’t waste any time and the infection was confirmed as anthrax the following day.

By the 21st December there were two more confirmed cases and five possibles and it was realised that a full scale outbreak was occurring. NHS Greater Glasgow and Clyde set up an Outbreak Control Team (NHS GG & C OCT) that later became the National Anthrax Outbreak Control Team (NAOCT) when cases began appearing in other parts of Scotland.

Just to give an idea of what happens when a product is found to pose a health risk this story from last October says that, following the identification of E.coli in shellfish, immediate action was taken to shut off the supply of possibly contaminated products. And that is what you would expect; immediate action to prevent anyone else being exposed to risk.

Except if the risk is from an already illegal product. The obvious course of action was to issue warnings to heroin users and to make uncontaminated supplies available to IDUs. Instead the NHS GG & C OCT relied just on a publicity campaign to make IDUs aware of the possibility of anthrax infected heroin being supplied to them.

The NAOCT very soon concluded that ‘all heroin circulating in Scotland at the time had to be
considered as posing an anthrax infection risk’. And what did it do about this widespread risk? According to the report ‘users were therefore advised that the best way to minimise the risk of anthrax infection was to avoid taking (illicit) heroin at all’.

Didn’t I read somewhere that ‘Heroin is highly addictive and larger and more frequent doses may be needed to feel 'normal'’? Yes, I did on the ‘Know the Score’ website, which is the Scottish Government backed drugs information service.

This story on the NAOCT’s report (well worth a read) quotes Gareth Balmer, project manager of Addaction Dundee, as saying "heroin users don't use heroin for fun; it's a physical and psychological dependency...we felt as drug workers it was insulting people to say: 'There's possibly anthrax in your heroin; my advice is to stop using.' I was surprised I didn't get punched in the face."

There is, of course, an alternative to heroin but at the time of the outbreak there was a shortage of methadone and a six month wait to get onto the formal substitution programme.

To be fair to the NAOCT the report says ‘The substitution of illicit (street bought) heroin with officially supplied (or prescribed) heroin was suggested as a control option’ but goes on to say that it was realised that a policy decision would need to be taken by the Scottish Government and rather than appear critical of the government it ‘decided that consideration of such a measure was outside its remit and expressed no view on its merits or otherwise’.

It should also be said that, of the 13 confirmed and 1 probable deaths in the outbreak, 11 deaths had happened by the end of January 2010 so a temporary move to heroin prescription that could only happen after approval from the Scottish government and, probably, consultation with the UK government and the UN would have had little impact on the death toll.

So what you come back to is the very simple conclusion; if heroin is produced in such unhygienic conditions that users can be killed as a result of those conditions then it is morally repugnant for any government to turn its back on that situation and adopt what seems to be a ‘serves them right’ attitude. I’ve met relatives of people who have died from using illegal drugs and it certainly doesn’t serve them right.