Feature: Anthrax-Tainted Heroin Takes Toll in Europe, Prompts Calls for Emergency Public Health Response

European heroin users are on high alert as the death toll rises from heroin tainted with anthrax. At least eight people have died -- seven in Scotland and one in Germany -- since early December, and another 14 Scottish heroin users have been hospitalized after being diagnosed with anthrax. Meanwhile, drug reform and drug user activists are reporting a cluster of nine suspicious heroin-related deaths in Coimbra, Portugal, although it is unclear at this point whether they are linked to anthrax-tainted heroin.

http://www.stopthedrugwar.org/files/anthraxspores.jpg
anthrax spores
The Scottish government has responded by urging heroin users to stop using and to seek drug treatment. That advice has not gone over well with drug users and public health and harm reduction advocates, who are demanding an emergency public health response.

The first four Scottish deaths were in Glasgow, but after one person died in Tayside and one in the Forth Valley earlier this month, Health Protection Scotland epidemiologist Dr. Colin Ramsay said: "The death of this patient in NHS Forth Valley indicates further geographical spread of the cases, meaning that heroin users all across Scotland need to be aware of the risks of a potentially contaminated supply. I would urge all users to stop using heroin immediately and contact local drug support services for help in stopping. If any heroin users do notice signs of infection, for example marked redness and swelling around an injection site or other signs of serious infection such as a high fever, they should seek urgent medical advice."

The French government has also reacted, with the General Directorate for Health issuing a statement Tuesday warning that contaminated heroin may be circulating in France and other European countries. Noting the rising death toll, the statement said "the likeliest source is heroin contaminated by anthrax spores."

Heroin users should be alert, the French statement said, because heroin contaminated with anthrax is indistinguishable from other heroin. "There is no outward sign or color enabling the user to tell whether the heroin has been contaminated by anthrax, and contaminated heroin dissolves or is used in the same way as uncontaminated heroin," it said.

Anthrax is a potentially lethal bacterium that exists naturally in the soil and can also occur among cattle. It is also a potential bio-terror weapon.

The vast majority of heroin consumed in Europe comes from Afghanistan, and while so far evidence is lacking, speculation is that anthrax spores may have been present in bone meal, an animal product sometimes used as a cutting agent. Another possibility is that containers used in the heroin production process were contaminated with anthrax spores. And, given fears that Al Qaeda and its Taliban allies could resort to biological warfare against the West and given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out.

"The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group, and a member of INPUD (the International Network of People who Use Drugs). "People are scared -- you can be sure of that -- but I think they're more afraid of withdrawing. The Scottish government's advice was for people to stop using heroin, but that won't happen."

Instead, Miller said, heroin users are doing what they can to protect themselves. "Users feel there's not much they can do personally and, as usual, they feel isolated," he said. "A lot are looking up the effects on anthrax on the net and passing on information to people with no internet access. We think the powers that be should put out information on how to spot signs if someone has been in contact with access. Basically, mate, the Scottish government wants little to do with it."

The Scottish government's response so far has drawn a harsh rebuke from the United Kingdom's harm reduction and public health community. In a Tuesday letter to the Scottish government, the International Harm Reduction Association, the drug think tank Release, the Transform Drug Policy Foundation, the UK Harm Reduction Alliance, and individual public health experts called on the government to put in place an emergency public health plan to deal with the crisis.

The letter said the government's advice to heroin users to stop using and enter treatment was "reckless in light of the fact that waiting times in Scotland for opiate substitute treatment (OST) are the longest in the UK. Many of those accessing services are informed that it is a condition of their treatment to engage with the service for a minimum period of time, before they will be entitled to a prescription offering an alternative substitute medication, usually methadone. In some areas of Scotland we have been informed that waiting times for OST can be up to 12 months."

[There is another potential issue with methadone, as well. The antibiotic drug Cipro, used to treat anthrax, interacts with methadone, leading to the possibility of methadone overdoses.]

Given the reality of treatment shortages and delays, it is "unacceptable" for the Scottish government to just tell users to stop or to go to treatment that isn't there, the letter said. "It is clear that this kind of approach can only lead to the death of more vulnerable people."

Instead, the Scottish government must immediately implement a public health plan that includes rapid access and low-threshold prescribing of alternatives to street heroin, the letter-writers advised. They recommended prescribing dihydrocodeine, a synthetic opiate approximately twice as strong as codeine. It is sold in the US under brand names including Panlor, Paracodin, and Synalgos.

"Such an approach will go some way to prevent any more loss of life and will provide greater protection to the public as a whole," the letter said. "Failure to adopt such a policy would mean that the Scottish state would be failing in its duty to its citizens."

Joep Oomen of the European Coalition for Just and Effective Drug Policies (ENCOD) had another suggestion. "The only decent reaction to this kind of episode is to immediately open facilities where people can test their heroin and where they can use in safe conditions, supervised by people who can help if anything goes wrong," he said.

"Hopefully, in the longer term, because of these incidents, authorities will start to see the need for introducing heroin maintenance programs, not as a trial for a limited group of people, but as a permanent service for all those who cannot abstain from heroin for a longer period of time," he added.

Ultimately, said Oomen, prohibition is the problem. "Adulteration is a practice that belongs to the illegal market," he said. "It happens because the people who control the heroin market have no interest at all in the health of their customers."

Dr. Sharon Stancliff of the US Harm Reduction Coalition agreed with her colleagues' assessment of the Scottish government's response. "Telling people to stop is not useful information," she said. "Maybe some occasional users will have a glass of wine instead, but if people are sick and treatment is limited, telling people that heroin is bad for them isn't going to have much impact," she explained.

"At this point, the European harm reduction people should be getting the word out, and the medical people over there need to be on the alert," she added.

Stancliff said she had seen no sign of heroin contaminated with anthrax on this side of the Atlantic, but she was worried. "I hope the DEA is out there buying heroin to see what's in it," she said. "If there is any hint of it here, physicians should be alerted by the Centers for Disease Control as they were with levamisole-tainted cocaine."

If the anthrax-contaminated heroin is coming from Afghanistan, as most heroin consumed in Europe does, US heroin users may catch a break. Most heroin consumed here is of Mexican or Colombian provenance.

But on the other side of the Atlantic, adulterated heroin is killing drug users.

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Link to International Harm Reduction Association is incorrect

The link to the International Harm Reduction Association is incorrect.

borden's picture

ihra.net

Thanks, that should have been ihra.net, not ihra.org. It is fixed now.

David Borden, Executive Director
StoptheDrugWar.org: the Drug Reform Coordination Network
Washington, DC
http://stopthedrugwar.org

Jean Boyd's picture

Harsh

If insulin was tainted with anthrax, it would be big news all over the world. Emergency depots would be set up everywhere to ensure diabetics safe injections. This is an example of the disdain and disregard for human life when it comes to drug addiction. There is little consideration of the fact that heroin users would be considered "normal" if not for prohibition. I guess this is why the authorities in Scotland are not providing the much needed opium derivative to citizens as it would eliminate their scapegoats. Since the Scottish authorites do not care for this group of people, I no longer care for the Scottish authorities.

anthrax laced heroine

Why not supply these drug addicts with the anthrax vaccine instead of spending gov'tfunds supporting their drug addiction with free drugs? Cost wise the shots would be cheaper then supplying drug addicts with a temporary fix. The government would go broke trying to support their drug habit! I do empathize with those with herioune addictions but supplying them with free drugs is not the answer.

kg's picture

Re: Bio-attack cannot be completely ruled out.

"...given the Taliban's role in the Afghan opium and heroin trade, a bio-attack cannot be completely ruled out."

No, it cannot be completely ruled out, but I think it would be highly - almost exceedingly - unlikely.

Think about it; ostensibly some portion of the Taliban and Al Qaeda's funding comes from this opium and heroin trade. It would be counter-productive for them to attack their customer base. Kill off the customers - no more customers and no more funding.

Not to mention that the customer base would be a less-than-desirable target for terrorism. When a terrorist organization plans and executes an act of terrorism, the target is going to be a high-profile target that generates the maximum amount of publicity. How much publicity would an attack on a country or countries' hard drug users generate?

While such an attack cannot completely be ruled out, I feel it is so unlikely that it should be considered, researched, then dismissed for more likely causes.

Jean Boyd's picture

This is a Bio-Attack

One reason the Taliban would poison the opium supply would be because of the CIA competition in the Heroin trade. However, there are many hands the opium-heroin passes before it gets to the street. Heroin tainted with anthrax is as much of an "attack" as any previous anthrax poisoning. And like previous attacks it is impossible to know who is behind the grevious assaults.

Advice - harm reduction

Advising users to smoke the drug, and not inject it

(if they are unable to stop taking it) would be sensible.
While this would not completely guarantee against infection by a contaminated batch, it would substantially reduce the risk, compared with injecting.
It should still be made clear that not using is the only safe option.
However, hell is likely to freeze over before addicts stop using because someone tells them that their heroin might kill them! And the chances a viable alternative being offered are about equally likely, especially in Scotland at the moment!

The lack of useful advice, and wider coverage, highlights the degree of care and concern for people in these unfortunate circumstances. Users refer to this (prevailing and occasionally deserved) attitude as DJS - Dirty Junkie Syndrome - I.e. "All addicts are evil, devious, deceitful, unworthy and undeserving scum of the earth, and ideally should be shot on sight, and any resources devoted to their plight are wasted."

David Dunn's picture

Smoking vs. anthrax

The anthrax-infected heroin hasn't decreased use, whether people are injecting it or chasing [smoking] it," said Tam Miller, chair of Chemical Reaction, an Edinburgh drug user group…"

If smoking doesn't decrease use, then apparently smoking doesn't kill the anthrax spores. If that's the case, then the next source that terrorists could do would be to lace marijuana with anthrax spores. That would impact a large number of Americans.

Yet, as long as hemp is still classified as a Schedule 1 drug in the Controlled Substances Act, isn't this tantamount to Congress authorizing terrorists to lace marijuana with anthrax spores?

The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government.

— Thomas Jefferson

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