It is now believed (at time of going to press) that at least 31 people have died as a result of a mystery infection that is currently attacking injecting heroin users. The infection, which was first identified in Glasgow in early May has claimed the lives of 16 users in the city, one in Aberdeen, eight in Dublin and (we think) eight now in England and Wales. Of these last deaths, six (we calculate) have been in the North West. Four we reckon in Manchester/Salford/Trafford and two in Merseyside. Another four are ill in hospital.

The course of the illness appears to be swellings or inflammation around an injection site, the appearance of abscesses of a type most injectors have experienced at one time or another, then in, severe cases, a rapid deterioration with worsening abscesses over a number of days with development of a septic-shock like syndrome requiring intensive care. A number of these cases have not responded to conventional medical treatments such as broad spectrum antibiotics.

A significant number of the victims have been women. And doctors are suggesting that this is due to the fact that women are less likely to use their arms and are more likely to inject into muscle (or under the skin) in the legs/groin areas. Thus they are either deliberately choosing IM or subcutaneous injections, or they are missing the vein and going into tissue accidentally. First theory was that citric was the source of the infection. Later this was replaced by the theory that deadly anthrax spores (a common disease in Afghanistan) had contaminated the heroin (South West Asian brown heroin). Some drug users in Scotland are favouring a conspiracy theory with someone high up in the distribution network that hates drug users putting infectious agents into the heroin. Though why someone who profits from the trade would wish to snuff its consumers remains to be explained.

The favoured current theory is that the culprit is a particular kind of anaerobic bacterium, a bug that thrives in a low oxygen environment. The theory goes that such bacteria, while harmless in the presence of oxygen rich blood or tissue, thrive in the conditions created where muscle or other tissue is killed off by the citric and it is this that produces the killer infection. The source of the bacterium was believed to be a particular batch of heroin from Afghanistan/Pakistan, imported via Amsterdam. The wide geographical spread that is now emerging suggests this theory needs revising.

There are a number of points that emerge from this. The first is a message to users.

1. Be even more careful than usual to make sure you get a hit if you are going intravenously.

2. Women injectors should be extra careful because their veins may be harder to hit

3. Skinpoppers and IM users beware. DON'T is the best advice. Smoke it if you can.

4. Cut down on the citric!

5. If you find swellings or inflammation around an injection site or are developing abscesses on a site, GET MEDICAL ADVICE QUICKLY. It will probably be nothing more than the usual stuff if you live round here. But better be safe than sorry.

Weird infections of this kind are not unusual among injecting drug users worldwide. It could be that by the time you read this article, the cause of the infection has been found and the epidemic is over. It is more likely than not to be one batch that is infected, and police and public health officials in England, Scotland and Ireland (with help from scientists from the Centre for Communicable Diseases in the USA) are working hard at tracing the heroin and the organism responsible. So let's not panic.

But other things come out of this. First, there is the attitude of the media. Most of the Ôheavyweight' papers (Daily Telegraph, Guardian etc) have covered the story in occasional detail. The popular press has been less interested, except when the anthrax scare with its overtones of biological warfare and killer diseases was running. Thirty one people killed by a contaminated drug. Compare the column inches and the TV interest in this story with the coverage Leah Betts death got. Leah Betts' death was a tragedy for her and her family. But all those twenty-eight heroin users had families. What about their families? What about their grief? The truth is that, as far as the media goes, the victims were just junkies. So who cares? Not nice middle class girls from Essex but people living in scuzzy housing estates in Glasgow and Dublin, poor people. So why bother?

Mind you, at least they've got some sense in Ireland and Scotland. The Irish are pumping more money into treatment to expand methadone places. While in Scotland, top Glasgow public health official, Dr Lawrence Gruer has called for a Swiss style experiment in which heroin is given to addicts under controlled conditions.

So what's Jack had to say about this outbreak? (Seeing as how he's in charge of drugs policy now and Mo Mowlam's got a permanent seat on the subs bench). Well, Jack's response was to lump all these deaths together with the fact that some theatrical bint's streamlined her nose with charlie and ended up with one big nostril. His startling and unhelpful conclusion was that the loss of an actress's looks and the deaths of 31 poor people just show us how bad drugs are. Oh, well done Jack! That'll comfort the relatives, help us deal with the crisis and make the rest of us think twice before we use Class A's. Isn't there some repressive third world regime somewhere you could get a job in?

Information taken from Scottish, Irish and English newspapers and Communicable Disease Report Weekly vol 10, no 22, 2 June 2000. Also checked with Communicable Diseases Consultant locally. Information checked up to time of going to press.