Vol. 6, No. 1349 - The American Reporter - June 8, 2000 PENTAGON, C.D.C. ENTER SEARCH FOR SOURCE OF TAINTED HEROIN THAT HAS KILLED 32 IN ENGLAND, IRELAND, SCOTLAND AND WALES American Reporter Staff Hollywood, Calif. LOS ANGELES -- Several weeks ago, the Internet tropical disease mailing list Pro-MED, to which this newspaper has occasionally contributed, first heard reports of an alarming number of deaths of unknown causes associated with the use of heroin by drug addicts in Glasgow, Scotland. Since that time, addicts have begun to die in Ireland, England and Wales while experts struggle to understand the origins of the disease that is killing them. Currently, the verified death toll is 32 in Ireland and the United Kingdom, according to official sources in those countries. Most recently, the Centers For Disease Control and the Pentagon have entered the investigation, according to this comprehensive report from Martin Hugh-Jones, a distinguished professor of veterinary medicine and contributor to ProMED and other medical journals who became interested when several of the deaths were attributed in the press to anthrax infections. Anthrax, a disease that originates in cattle and can spread to humans, has since been ruled out as a source of the unknown disease, he reports. This Mr. Hugh-Jones' June 7 report to ProMED: The number of confirmed cases in the Greater Glasgow area now stands at 33, with 15 deaths. Nineteen of those cases, including eight of those who have died, have been women. In Dublin, Ireland, 8 have died and 15 are ill with similar symptoms. Seven heroin injectors in England and Wales (places have not been revealed) have died since 24th April and are believed to be from the same cause(s). Greater Glasgow Health Board said microbiologists suspected the condition had been caused by a form of anaerobic bacteria -- the class of bacteria which includes the causes of botulism, tetanus and gas gangrene. The condition appears to affect heroin addicts who inject the drug into the muscle or under the skin, rather than into a vein. Victims suffer a septicaemia-type illness and need intensive care, but some have died from multiple organ failure within hours. According to Dr. Brian Duerden, medical director of the Public Health Laboratory Service in London, "The pattern of illness is one of localized infection at the injection site, followed by a systemic infection similar to a toxic shock reaction. It is highly suggestive of a Clostridia infection. If in fact it is ClostridiaD, it is very difficult to detect under normal laboratory conditions." To augment their investigation, officials from both countries called upon the CDC in Atlanta. "There has been excellent cooperation amongst the international community. Doctors are talking to doctors and that is what we need," said Maureen Browne, communications director of the Eastern Regional Health Authority in Dublin, Ireland. "The police forces of both countries have their investigations as well, but our concern is assessing and managing the public health risk." Officials ruled out anthrax as a potential contaminant early on. They also explored the possibility that citric acid, mixed into the heroin, may be the culprit. "The citric acid may certainly be contributory to the problem," Duerden said. "It causes localized tissue damage and necrosis at the injection site and may be establishing the ideal environment for a superinfection to grow, but the clinical signs clearly point to a bacterial infection." The patients hospitalized have all had white blood cell counts between 4,000 and 135,000, which would support the bacterial superinfection theory. However, these individuals have not responded to broad-spectrum antibiotics. Jai Lingappa was seconded to Glasgow from CDC [in] Atlanta and Kristy Murray to Dublin. [Editor's note: "Seconded" means that that the named officials of the CDC were sent in person to the cities mentioned.] Dublin newspapers carried a bleak message for heroin addicts. Large advertisements warned there could be contaminated supplies of the drug on sale and urged users to contact a doctor immediately if they noticed any unusual symptoms, particularly an abscess or swelling close to an injection site. Whether these measures will reach those who are most vulnerable, the thousands of addicts who inject heroin and are not in touch with any of the social services provided, is a cause for serious concern. One counsellor said yesterday: "If an addict needs heroin, he or she will inject." The crisis has focused a harsh spotlight on a problem which most Irish people would prefer to ignore since it hardly impinges on the more comfortably off sections of a society doing well in a time of economic boom. Ireland's addicts are the youngest in Europe, with an average age of 24, compared with 34 in the Netherlands. The overwhelming majority come from the most socially deprived areas of large cities, although senior police officers have recently expressed concern that the drug is becoming more available in rural areas. In Dublin alone there are 13,000 heroin-users, of whom 4,500 are on treatment programmes and 400 more are on waiting lists. That means that 8,000 addicts are not in touch with any of the social services offering some form of help. It is these young men and women who are most at risk from injecting contaminated heroin. As Anna Quigley, co-ordinator of the Dublin-based City Wide Campaign against Drugs, commented: "There's no point in telling an addict not to inject. If it were that simple, we wouldn't have a heroin problem." Some argue that what is needed is a much more radical approach which would take the supply of heroin out of the hands of criminal gangs. Father Sean Cassin, a member of the National Drugs Strategy Team, has argued that Ireland should follow Switzerland's example and prescribe heroin for young addicts. The Irish government's own task force has recognised -- and emphasised -- that the drugs problem cannot be solved in isolation from the underlying causes of social exclusion, poverty, unemployment, lack of recreational and other facilities throughout large areas of inner cities. Most heroin reaching Dublin and Glasgow comes through Amsterdam and usually originates in Asia. However, Europol, the EU police intelligence agency, has reported that South American gangs are increasing their flow of drugs into European markets. The two batches of heroin which were used by two of the victims and have been located by gardai [Irish police] from the Garda National Drugs Unit are understood to be in powder form. These samples are being sent to the US for examination. Garda sources said it seemed uncertain whether all the deaths could be attributed to a contaminated batch of the drug. An average batch of heroin will be used by at least 100 or 200 addicts, and it might be expected that any bacteriological contamination would be more widespread. After the Garda Commissioner appointed the drugs unit to uncover the source of the heroin used by the victims, officers visited relatives and associates but were able to trace only two samples of heroin which had been used. In both cases the heroin appears to have been of unusually high strength. The drugs unit officers discovered that in all cases the victims appeared to have been diluting or "cutting" the heroin with citric acid. In the meanwhile, American secret service agents have been called in to investigate the mysterious illness. Pentagon officials ordered the probe after reports that a deadly batch of heroin may have been contaminated with the killer disease anthrax. They fear Iraqi dictator Saddam Hussein could unleash devastating germ warfare on the West to get revenge for the Gulf War. Useful other sources: EuroSurveillance Weekly <http://www.eurosurv.org/update/> Drug Misuse in Scotland <http://www.drugmisuse.isdscotland.org/index.shtml> National Disease Surveillance Centre (Ireland) <http://www.ndsc.ie/> <A HREF="http://www.ctrl.org/">www.ctrl.org</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. Proselytizing propagandic screeds are unwelcomed. Substance—not soap-boxing—please! 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