What's in a drug?

Hopefully all our readers had a good holiday and are looking forward to a prosperous 2007. Sadly this won't be happening for a group of heroin users in London and the south east who have recently died in a cluster of heroin-related deaths. The London deaths have been blamed on 'contaminated' heroin while those in Essex have been attributed by the police to an extra strong batch. But what does contamination mean?

The powder drugs like heroin, cocaine and amphetamine are especially susceptible to having all manner of substances cut into them to bulk out the weight and increase profits. But there is a degree of urban mythology about just what these substances are. We hear much talk of ground glass, brick dust and strychnine being added to heroin, for example. But the forensic evidence does not support this and in any event it makes no economic sense from a dealer's point of view. If you want your customers to come back for more, why sell them stuff that will kill them in an instant?

Most of the adulterants for heroin will be powdered paracetamol, other opiate alkaloids, and sometimes diazepam plus sugars for extra bulk. These substances can cause health problems if injected, but are unlikely of themselves to result in death.

More likely the contamination will be bacterial in nature and what happened recently in the south-east may be similar to clusters of heroin deaths in Scotland and Ireland in 2000. In these cases, users became infected with spore-forming organisms like Clostridium novyi type A. How heroin becomes infected in this way is unclear, but there have been suggestions that heroin could be contaminated by being buried in soil prior to sale.

What is abundantly clear however is that users cannot tell if they are about to inject heroin which is either full of bacteria or of a strength their bodies cannot cope with. From a harm reduction perspective, smoking rather than injecting heroin is a better option for those not ready for the treatment journey, but there should also be a greater political will to see medically prescribed heroin made more widely available in a bid to reduce heroin deaths whatever the cause.

http://news.bbc.co.uk/1/hi/england/essex/6235009.stm
http://news.bbc.co.uk/1/hi/england/london/6207655.stm