BBC News | SCOTLAND | Killer heroin report published

A report into the deaths of 23 drug users, who died after injecting contaminated heroin, has been published by a medical team in Glasgow.

Doctors investigating the outbreak, which also affected drug users in the Liverpool and Dublin areas, have drawn up 12 recommendations to prevent further deaths.

The report describes an "unprecedented outbreak of severe illness" among 60 users in Scotland, mostly in Glasgow, between April and August 2000.

It said that 23 users died as a result of taking the drug, some within hours.

Clearly in the future if there are one or two outbreaks this is the bacterium we will be homing in on.

Dr Syed Ahmed
All of the victims developed a serious abscess after they had injected into muscle or accidentally outside a vein.

But it is still not known how the heroin was contaminated.

Most addicts inject into their veins and oxygen in their blood kills the bacterium in the heroin.

But there is no oxygen in muscles, meaning the poison which would eventually kill them could grown unseen.

Greater Glasgow Health Board investigated the outbreak identifying the bacterium, clostridium novyi.

Dr Syed Ahmed: Future outbreaks
The health board's Dr Syed Ahmed said that this discovery will help them deal with future outbreaks.

He said: "This is the first ever outbreak anywhere in the world.

"Clearly in the future if there are one or two outbreaks this is the bacterium we will be homing in on.

"So it is possible we may be able to identify the organism sooner."

In many cases the clostridium novyi infection caused untreatable multiple organ failure, according to the clinical analysis of the outbreak which affected a 109 addicts in Scotland, England and Ireland.

Chemical weapons research

More than 40 people across the UK and Ireland are believed to have died after taking the drug.

A special police unit was established to deal with the spate of deaths and medical experts from the United States were called in to help track down the cause.

Doctors initially feared the illness, which caused severe inflammation of vital organs, was anthrax but ruled that possibility out after tests at the government's chemical weapons research centre.

Greater Glasgow Health Board said it could happen again, underlining the vulnerability of street heroin users - and the need for effective treatments.

The twelve recommendations made include improving communications between doctors and hospitals dealing with any further outbreak - and also the flow of information to users.

The recommendations are:

When there is no obvious cause of death of a known drug user, pathologists should be told immediately to enable necessary specimens to be taken

When there is a risk of serious or unusual infection, doctors should inform clinical microbiologists that patients are known drug users and discuss what specimens should be taken.

Information about any unusual infection in a drug user should be given to the local public health consultant who should inform the Scottish Centre for Infection and Environmental Health.

Tissue samples from living and post-mortem cases involving severe tissue infection should receive additional treatment.

Steps should be taken to ensure hospital laboratories are maintained with qualified staff to enable them to cope with such outbreaks.

A properly resourced prospective research study should be undertaken to ascertain the underlying incidence and nature of soft tissue infection.

Drug Action Teams should review arrangements for communicating information for those at risk from future outbreaks.

Health boards should review arrangements for receiving and treating drug users.

Drug Actions Teams should continue efforts to make drug users aware of the dangers of injecting.

In future similar outbreaks, there should be pro-active, consistent and open communication with the media.

The co-ordinating health board should use a pre-existing outbreak website to disseminate information, available and publicised on commonly-used search engines.

An international meeting should be convened to consider what lessons should be learnt from the outbreak and what could be done to prevent future incidents.

A Fatal Accident Inquiry (FAI) is due to open at Glasgow Sheriff Court next month into the deaths of 18 men and women from Glasgow who died from the apparently contaminated drug batch, which is now believed to have come from Afghanistan.


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