As the anthrax situation worsens and we get the first cases appearing in England (London and Blackpool) there is still a lot of confusion over the finer details of the outbreak, especially the lack of details ‘released’ on the routes of drug administration.
This has lead to anger from user groups, as Alan J from the National Users Network said on their Facebook page:
It would be most helpful if the HPA could give a breakdown of those infected by the contaminated heroin according to mode of ingestion…
Well, the information exists but for a number of reasons it’s only being distributed via word of mouth, possibly because Health Protection Scotland (HPS) are worried that the information may make people feel safe using routes that later turn out to also be a risk.
NOTE: As I’ve previously mentioned on this site, it seems that ALL possible routes of administration are risky when dealing with heroin infected anthrax. Please bear that in mind when reading the following information. The best harm reduction advice is still to try to stop using heroin, either via self detox or substitute prescribing.
The following is information is being verbally disseminated to drugs workers in Scotland and was sent to me by a senior worker who wishes to remain anonymous (but who I trust) the worker felt that the information should be made more widely available.
21 out of the 23 people who have died injected into muscle, there is reason to believe one of the other two missed a vein, and the last I’ve already talked about above. There have also been cellulitis, necrotising fasciitis and gut bacteria present in abscesses associated with the anthrax infection, suggesting underlying untreated infection, poor hygiene and poor injecting practice (i.e. licking the needle before injecting). All of this increases the risk of fatality as the immune system is already compromised.
Things to avoid when injecting;
Filters are unlikely to stop anthrax spores, there is a better chance of filtering out spores using the purpose made filters as they may be able to filter particulate matter to a small enough size. Anthrax spores will last a long time in a filter and can survive extremes of heat and cold, so dispose of filters after a single use.
There is minimal risk through intimate or sexual contact. Although there is a potential risk from touching skin lesions, especially open wounds. Avoid contact with leaking or dried out wounds of abscesses, keep them covered, clean up spillages with bleach or other suitable diluted disinfectant.
I think some of this information is not already out there and I hope it proves useful.
Again I would like to make it clear, as also mentioned in this text, that this does not mean smoking is a safe route of use for anthrax infected heroin. Inhalation anthrax leads to death in a far higher percentage of users than wound anthrax.
The Scottish Drugs Forum as released guidance for workers on how to deal with the Anthrax outbreak, this is essential reading for all workers (and users).
Nigel Brunsdon is the owner of Injecting Advice. He’s been working in harm reduction since the 1990’s, previously a frontline needle programme worker he now splits his time between photography and developing online resources for drugs workers and users.