A Tragic Footnote

It looks as if the mystery of the hitherto unexplained deaths of some heroin addicts in Dublin, Glasgow and the north of England…

It looks as if the mystery of the hitherto unexplained deaths of some heroin addicts in Dublin, Glasgow and the north of England in recent weeks is just about unravelled. Investigators in Scotland appear to have established that a species of bacterium known as Clostridium - possibly Clostridium novyi, a less familiar member of the species whose number include the lethal causative agents of botulism, gas gangrene and tetanus - must have contaminated the batch of heroin which some heroin addicts injected into their muscles. It seems reasonable to infer that this highly toxic bacterium was also the cause of the deaths among addicts in Dublin and England. Clostridial bacteria are ubiquitous in the environment and, because they can survive for long periods in the form of spores, they can be found in almost all soils, especially those which may contain traces of animal and human excrement. A few spores, should they find themselves in an environment with little or no oxygen, (as when injected into a muscle) can quickly become active bacteria releasing some of the most potent toxins known to man.

It is unlikely that the source of the contamination of the batches of heroin used in these tragically fatal cases can ever be established. But the doctors treating affected addicts will be relieved to know what they may be dealing with in these potentially lethal cases. Early and high-dose treatment with certain antibiotics can save lives. There will, therefore, be some relief among the addicts themselves, their families and the health services which must care for the affected individuals. But, tragic as these recent deaths have been, it is important to realise that, in the annual statistics of deaths due to heroin (clean or contaminated), they will make virtually no difference. People will go on dying as a result of taking heroin: there have been eight deaths in Dublin from the use of contaminated heroin, but there were 86 inquests in Dublin last year where the cause of death was found to be drug-related. The Clostridial contamination cases can make only a tragic footnote to so appalling a national toll.

The current contamination episode, regrettable as it is, must not be allowed to distract anyone from the overall picture of heroin addiction and the devastating effects it is having not only on those areas of social deprivation where it is most rampant, but on the nation as a whole, in terms of crime, ill-health and, until quite recently, political inertia and incompetence, not to mention denial. The current review of the National Drugs Strategy must result in the provision of vastly greater resources to deal with not only the heroin epidemic but with the prevention of further deterioration of the situation. Those areas of urban Ireland which have been socially, recreationally and educationally deprived for three or more decades past must now be positively discriminated for with an input of resources to remedy their social, infrastructural and political neglect. And everyone must recognise that this will take years to achieve. Treatment and rehabilitative services for individual addicts and for whole communities must be provided and improved with speed and generosity. There is a long and expensive road to travel before the nation can reclaim its reputation as a caring society.