Bad Policy to Blame for Scotland Botulism Outbreak, Not Just Contaminated Heroin

heroin spoon

The recent outbreak of wound botulism among heroin users in Scotland may be due to contaminated drugs, but the true cause goes far deeper.

Since the turn of the year, Scotland has witnessed a handful of wound botulism cases among injecting drug users (IDUs), causing alarm among drug users, service providers and health professionals. As of February 6, one person had died and four remained hospitalized in Glasgow due to the illness, according to The Evening Times, with Public Health England confirming that there has been one case south of the Scottish border.

It is currently unclear if there is any cross-border link between the cases.

Wound botulism among IDUs occurs due to the injecting of contaminated drugs into the skin or muscle and cannot be spread from person to person. Spores of the bacterium Clostridium botulinum enter the body via a wound and go on to germinate, causing paralysis, and death in 5-10 percent of cases (see here for a full list of symptoms).

The most prominent theory as to why this outbreak has occurred came from The Evening Times which claimed late last month that a newly-released dealer had dug up an old stash of heroin they had buried prior to serving a three or four year sentence. An anonymous source told the newspaper: "We think he's got a few ounces. It depends how he's cutting it but traditionally you'd get about 240 tenner bags from an ounce. I don't think this is the end of it yet. I think we'll get other cases before it ties off."

The source added that it's highly likely the dealer is unaware their batch is contaminated. 

Though the immediate source of the outbreak may have been identified, the root causes go far deeper, entwined in drug laws that put vulnerable IDUs at greater risk.

By following a prohibitionist line, governments do little more than amplify the harms associated with drug use, leaving people with no option other than to expose themselves to a potentially fatal pot luck scenario when buying, having no knowledge of what may have been put into the product.

There are countless examples from around the world of the dangers in this, but one need only look to recent events in the UK for evidence. On top of people unknowingly buying contaminated heroin in Scotland, four people lost their lives over the Christmas period when buying what they thought was MDMA. Instead, the pills had been heavily laced with PMMA, a drug with similar effects though one that can kill at far lower doses

If steps were taken to diminish the role of the black market for drugs, these consequences could be significantly mitigated against.

Not only does prohibition increase the uncertainty around what's contained in a substance, it is also extremely detrimental to drug users -- particularly IDUs -- seeking help. The widely propagated stigma born out of prohibition and associated with heroin use marginalizes the IDU population from the rest of society. Those suffering from an injecting-related illness or infection may not go to a health professional out of fear that they may be discriminated against, or worse, criminalized. 

The Scottish government has made strides in recent years to tackle health problems among the IDU community, increasing harm reduction provision across the country and putting in place a national naloxone program which has helped reduce the number of opioid-related fatalities. What's more, in the face of the botulism cases, Glasgow Drug Crisis Centre increased efforts to divert heroin users away from injecting toward smoking the drug by offering foil.

It is arguable, though, that handing out foil is a relatively minor step and that more could be done through exploring initiatives such as rolling out prescription diamorphine, a move that would reduce the dangers of the black market tremendously. 

Until there is an equal emphasis placed on reforming drug laws, problems such as the botulism outbreak will continue to surface from time to time. Prohibition is one of the final barriers to ensuring that the harms associated with drug use are minimized to the greatest degree. There is no way around it; it must be knocked down.