This outbreak could easily happen again, and on a significantly larger scale

Sheriff Edward Bowen

Sheriff Bowen said: "Each of these deaths represents a wasted life; a tragedy for all who died and those close to them.

"But they represent only one episode in a very large tragedy which deserves to be addressed with as much vigour and commitment as any external threat to our national security and well-being."

The sheriff's report calls for wider publicity to be given to the dangers of injecting drugs.

He said: "There is every reason to suppose that a similar outbreak could occur without warning.

"The dangers of heroin as a highly addictive drug are well known.

The first deaths occurred in April 2000

"What also deserves to be well publicised is that injecting heroin, particularly directly into muscle, involves a significant risk of introducing a deadly bacteria into the body."

The sheriff said he was worried about the way the outbreak, which involved 23 fatalities from a total of 42 cases in Strathclyde, stretched the public health laboratories.

He said: "This outbreak could easily happen again, and on a significantly larger scale. Lurking in the background is the threat of bio-terrorism."

Sheriff Bowen's report rejected criticisms, levelled by relatives of some of those who died, at the way addicts were treated by hospitals.

He said there was no evidence that quicker intervention could have prevented a fatality in most of the cases.

The FAI was heard at Glasgow Sheriff Court

He also held back from criticising police and hospital staff who dealt with the drug users who became ill, saying addicts were "a difficult group to deal with and treat".

But he said there appeared to be shortcomings in the distribution of information from the experts who examined the infection to staff on hospital wards.

"I am not wholly convinced that the information was disseminated to the extent which it might have been.

"I stress that in no case did such an absence of knowledge affect the outcome, but it might have done."