On 13 May 2000, Vidyya first brought you the stories of several mysterious drug deaths among heroin users in Scotland. Since then there have been similar deaths in Ireland and England. Experts now believe the deaths may have been caused by the anaerobic bacteria, Clostridia.
Researchers are working to find the cause of the illness. "We are exploring
all potential etiologies," said 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
To date, 14 have died and 15 others have taken ill in Glasgow, Scotland.
In Dublin, Ireland 8 have died and 15 taken ill under similar
circumstances. All are heroin users that have injected the drug into their
muscles or just below the skin, rather than into their veins. Officials in
London report that seven have died in England and Wales under similar
circumstances since April 24th. They are currently reviewing their case
files to determine if a link to the Scottish outbreak exists.
The Public Health Laboratory Service, England's version of the US
Centers for Disease Control and Prevention (CDC), is working with the
Scottish and Irish authorities to provide testing and support. "If in fact it is
Clostridia, 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."
Media reports have attempted to link this outbreak to a series of deaths
among heroin users occurring in San Francisco in June of 1999. Those
cases were attributed to black tar contamination of the drug. "Clearly, the
heroin in Scotland and Ireland is also contaminated with something, but
we can't link this to the San Francisco outbreaks," Duerden said.
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
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
"We have established a protocol that laboratory cultures from these
individuals will be reviewed for 10 days to insure that all bacterial
possibilities are explored," Duerden said.
"We have been trying to warn the public that there may be contaminated
heroin on the streets. We have made appeals through the media, sent
outreach workers into areas we believe there may be drug users that don't
have access to the media, and posted notices in national papers and
clinics," Browne said. "We have had more than 200 heroin users turn up
for treatment of their addiction since all the publicity began."