Anthrax team raises heroin supply issue

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Friday 6th January 2012

Article taken from The Herald.

A REPORT into an anthrax outbreak which killed 14 heroin addicts suggests officials should consider prescribing the drug during any future contaminations.

The National Anthrax Outbreak Control Team (NAOCT) claims the Scottish Government could "usefully give this aspect further consideration" as guidance on the issue would be helpful for Outbreak Control Teams (OCTs) and addiction services.

Report author Dr Colin Ramsay, chairman of NAOCT, said prescribing heroin was suggested as a control strategy during the year-long outbreak – which began in Glasgow in December 2009 – but NAOCT considered the suggestion to be outwith its remit.

He added it was now relevant for consideration by Government officials, but a Government spokeswoman last night said it has "absolutely no such plans".

Dr Ramsay said: "Supplying (prescribed) spore-free heroin to all heroin users in Scotland was suggested as a control strategy.

"The NAOCT considered this suggestion was highly controversial and it would require high level Government consideration from a drug policy perspective.

"The NAOCT therefore considered this issue to be outside the competence of the group and made no recommendation on the matter. The NAOCT expressed no opinion on the merits or risks of advocating such a control measure.

"However, the NAOCT recognised it would be helpful to have definitive guidance on whether or not such an option would be practical as an emergency risk control measure in a future outbreak involving illicit heroin or other drugs.

"It was therefore considered relevant Government departments could usefully give this aspect further consideration and provide guidance for future OCTs."

The outbreak was the largest of its kind in the UK for more than 50 years and saw 119 patients in Scotland being classed as anthrax cases. It was also the first outbreak associated with heroin use anywhere in the world.

Dr Ramsay said: "The illicit nature of the heroin supply considered responsible for transmitting the infection, together with the illegal drug trafficking trade, limited the options for intervention and made control of the outbreak very difficult.

"Conventional options normally available to an outbreak control team to enforce eradication of a contaminant at source, or to remove contaminated material from supply, were not available in this situation."

He added: "As long as there is an illicit drug trade, the risk of further such outbreaks will continue; opportunities for their primary prevention are likely to remain limited."

The outbreak began when an injecting drug addict presented at hospital with a severe soft tissue infection in December 2009. A few days later, the infection was linked to anthrax.

A total of 208 expected cases were then seen over the next year, with 119 confirmed, probable or possible cases.

The report concluded the anthrax came from contaminated heroin, likely imported from Afghanistan or Pakistan, with an infected animal hide used to transport the drugs the most probable cause.

A Scottish Government spokeswoman said the report and its recommendations, which also included improving capabilities for identifying anthrax and better advice for drug users, were now being considered.

She said: "As with all outbreaks and public health incidents, it is essential we capture the experience and learn lessons from it. We will consider the recommendations contained within this report and respond accordingly."

Asked if that meant considering the prescription of controlled drugs during any future outbreaks, she replied: "We have absolutely no such plans."

The report which Health Protection Scotland, published on behalf of the National Anthrax Outbreak Control Team (NAOCT), describes the epidemiology of the outbreak, the investigations undertaken by the NAOCT and actions taken to manage the situation. The report also details lessons learned from the outbreak, from the challenges of diagnosis and clinical management of a new presentation of anthrax to managing effective communication with a hard to access vulnerable group of drug users.

The report is available at: http://www.hps.scot.nhs.uk/pubs/redirect.aspx?id=50107