Death by drug policy

When Anthrax is mentioned in the news it is normally in connection with a supposed terrorist plot. Last December though, an outbreak of the disease in Scotland was linked to a contaminated supply of heroin.

In total, it was estimated that the infection claimed 14 lives with approximately 119 other confirmed cases. Although the majority of those infected were from the Glasgow area, cases were also reported as far south as Kent and there was even one infection as far away as Germany.

Due to the fact that the outbreak was limited to heroin addicts, this story was largely overlooked by the mainstream media. A report investigating the incident was recently published though by the National Anthrax Outbreak Team (NAOCT) and some of its recommendations have been uncharacteristically progressive.

In one section of the report entitled ‘Alternative control measures’ it was suggested that providing addicts with prescribed heroin could have been used as a control strategy. This was dismissed though as ‘highly controversial and that it would require high level Government consideration from a drug policy perspective.’ The NAOCT therefore ‘considered this issue to be outside the competence of the group and made no recommendation on the matter.’

A government spokeswoman also dismissed this idea saying that, with regards to prescribing heroin, there were ‘absolutely no such plans.’

With this stance though, the government is once again acting in a brazenly ideological manner, as in most cases, the provision of heroin would have greatly hindered the spread of the disease and almost definitely saved lives.

Anthrax is most often found in animals abroad, particularly cattle, sheep and goats. It is a disease which is very rare in humans and most of those who catch it are involved in professions which handle animal hides such as slaughterhouse workers and butchers. The last known UK death before this outbreak occurred in Scotland in 2006 and involved a man who was manufacturing drums from animal hides.

Experts believe that the heroin could have been potentially contaminated in Turkey as the strain identified was closely related to that found in goats in the country. The UK’s top microbiologist commented that ‘In the UK there used to be problem with anthrax-infected imports, particularly wool from areas east of Turkey.’  How the substance actually became contaminated though remains a bit of a mystery.

One theory suggests that spores may have come from bonemeal which is sometimes used to cut heroin and this could have potentially come from diseased animals. Another explanation is that the equipment used to manufacture the substance could have been contaminated. Opium is often mixed with water and chemicals in a barrel before being heated over a fire. It has been suggested that these barrels could have been previously used to carry diseased meat.

In fact Professor Graeme Pearson, a former director general of the Scottish Crime and Drug Enforcement Agency (SCDEA) and now with Glasgow University’s Unit for the Study of Serious Organised Crime commented at the time that “I’ve seen videos of heroin production and it’s a horrible and unhygienic process. It’s surprising that this doesn’t happen more often.”

The provision of medical heroin by drug services would have therefore definitely helped lessen the spread of the disease. Of course no such provisions were made and the main advice given to addicts was to stop taking heroin or to try and switch to methadone.

At the time many drug workers were deeply critical of the official advice. Gareth Balmer, project manager of Addaction Dundee, a support centre said "heroin users don't use heroin for fun; it's a physical and psychological dependency. We have a constant supply of people who would like to access methadone, but 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."

Balmer also commented on the problems of opioid substitution: "if we could have got people access to methadone or Subutex [another heroin substitute] very quickly, it wouldn't have been a ridiculous message, but we were looking at six-month waiting lists and, in some parts of Scotland, a year." In Balmer’s opinion the outbreak had "brought home how behind we are in helping people access that treatment".

Patricia Tracey, from Glasgow Drug Crisis Centre, also commented that it was “unrealistic” to expect addicts to listen to public health warnings. She said that “users are concerned, but not concerned enough to stop using.”

It seems obvious then that the provision of prescribed heroin would have greatly reduced the spread of the disease as addicts would have been able to access a clean supply and would not have had to resort to the tainted street product.

Heroin addicts though remain one of the most stigmatized groups within society and the belief that addicts have only themselves to blame is still widespread. Until addicts are viewed as people with serious health problems, rather than criminals, there will be no progress and they will continue to suffer and die at the margins of society.