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Check Those Pills! Harm Reduction and Club Drugs [FEATURE]

[This article was written in partnership with Alternet, and was originally published here.]

With the holiday break coming up soon, millions of young Americans will be looking to party. And tens, perhaps hundreds of thousands of them will be looking to stimulant drugs, especially Ecstasy (MDMA), to help them dance to the throbbing beats far into the night. MDMA is a synthetic stimulant with a chemical structure related to both methamphetamine and mescaline. It's great at providing the energy for partying the night away with a psychedelic tinge. The new scene drug, Molly, is simply Ecstasy in powdered form.

According to the 2013 National Household Survey on Drug Use and Health, some 17 million Americans have taken Ecstasy at least once, more than a half million reported taking it within the past month, and about three-quarters of a million reported taking it for the first time that year. Those monthly-use and first-use figures have been roughly stable for the past few years.

Some of those fun-seekers are going to take too much. And some of them are going to end up ingesting something they thought was Ecstasy, but wasn't. And one or two or three of them might die. Despite breathless media reports, people dying from Ecstasy or from what they thought was Ecstasy or what they thought was a drug like Ecstasy, is not that big a problem, especially compared with the 16,000 or so people who died last year from opiate overdoses. The number of Ecstasy-related deaths each year ranges from the single digits to the low dozens.

Still it is a problem. Any avoidable death is a problem, and those deaths are largely avoidable. They occur because of varying combinations of ignorance, greed and bad public policy. Some people are working to prevent those deaths, and the work extends from the club or rave or festival door to the halls of power in Washington.

The harm reduction group Dance Safe is among those doing that work. The small non-profit offers educational services, encourages people to submit their pills for testing ("drug checking"), and has informational booths at venues that will let them.

Where 20 years ago, the Ecstasy and party drug scene was largely limited to word-of-mouth raves, things have changed, said Dance Safe executive director Missi Wooldridge.

"We've seen a real explosion in the scene that has been transformed from an underground rave culture to a real mainstream electronic dance music culture," she said. "People are likely to experiment with drugs at raves and dances, as well as with friends at parties or night clubs."

They are also likely to be ingesting either adulterated Ecstasy or other new synthetic drugs misleadingly marketed as Ecstasy. That is reflected in reports on drug checking websites such as Pill Reports and Ecstasy Data, as well as drug discussion forums like Bluelight.

Pill Reports warns that Yellow Pacman tablets found earlier this month in Kansas and Texas contain not MDMA but the synthetic methylone, a methcathinone stimulant that is a chemical analog to MDMA, but is not MDMA. And at least two different pills currently being peddled in Canada as Ecstasy are actually methamphetamine.

"A lot of what we're seeing is the new psychoactive substances infiltrating the market and the scene," said Wooldridge. "People can purchase these substances online. I see a lot of positive results for methcathinone, MDPV, methylone, and the like. Similarly, people think they're taking LSD, but it's actual N-Bomb, or maybe ketamine. People operate under misconceptions about what they're taking, and that can be serious because there are lots of differences in things like onset, duration and potency."

Educated, sophisticated drug consumers may take advantage of drug checking services, as well as have advanced understandings of drug potency, duration and the like, but they are a minority. Most people just want to party, and they want to do it with Ecstasy.

"In contrast with some places in Europe, the market for people seeking out new synthetics is very small in the US," said Stefanie Jones, nightlife community engagement manager at the Drug Policy Alliance "But that doesn't mean they're not here. Many of the people buying them are after MDMA, but here in the US, the market is young people, and many are not that well-informed or familiar with notions like drug checking to see what's in that powder. It's largely an uninformed market, so there's a lot of adulteration."

Dance Safe's Wooldridge concurred.

Web sites like Pillreports.com will tell you whether your pills are bunk. Don't eat the Yellow Pacman! It's methylone.
"People are taking these substances unknowingly for the most part, rather than checking them out," the Denver-based activist said. "There is a relatively small segment that is into the experimentation and the understanding, but most users are not that sophisticated and are taking these drugs without really knowing what they are."

When people die, as two people did at New York's massive Electric Zoo festival last year, the pressure is on promoters and club owners to crack down on drugs, to increase security, even to decrease or do away with harm reduction measures out of fear of appearing to encourage drug use. In large part, that's because of the RAVE Act, a 2003 law sponsored by then Sen. Joe Biden (D-DE) that threatens owners and promoters with possible criminal sanctions for encouraging drug use.

"The RAVE Act is the elephant in the room," said Wooldridge. "Its intent wasn't to harm or prosecute legitimate event producers, but to expand the crack house laws and go after people solely having events for drug use or sales. But there has been an unintended consequence. People in the industry fear that if they attempt to address drug use they'll be help legally liable for overdoses or other emergencies. Their legal teams and insurance companies say to stay clear, turn a blind eye, but that increases the risks. We need to educate the lawyers and insurers on this. Show me a case where an event producer has been prosecuted for doing harm reduction."

"If the law is making owners scared, we should change the law so they are explicitly protected," said Jones. "Put the focus on the health and safety of the patrons. Including harm reduction shouldn't be seen as encouraging drug activity, but as prioritizing health and safety. Changing the law at the federal level would send a message to the industry that harm reduction is valuable and you won't get in trouble, and that could change the landscape of festivals."

One woman is working to do just that. Dede Goldsmith didn't mean to become a reformer, but when her daughter, Shelley, a University of Virginia student, died after taking Ecstasy at Washington, DC electronic music show the same weekend at the Electonic Zoo last year, that's what happened.

She told Vox in an October interview that when one of Shelley's friends told her Shelley had taken Molly, her first response was, "Who is Molly?" In her search for answers, she came to the realization that Molly didn't kill her daughter; federal drug prohibition and policies that discourage education about safe drug use did.

On the anniversary of her daughter's death in August, Goldsmith launched the Amend the RAVE Act campaign. Its goal, Goldsmith says, is "to make EDM festivals and concerts safer for our young people. Specifically, I am asking for language to be added to the law to make it clear that event organizers and venue owners can implement safety measures to reduce the risk of medical emergencies, including those associated with drug use, without fear of prosecution by federal authorities. As the law currently stands, many owners believe that they will be accused of 'maintaining a drug involved premises' under the act if they institute such measures, opening themselves to criminal or civil prosecution."

Irony alert: Shelley Goldsmith meets RAVE Act author Joe Biden a year before she died on Ecstasy. (amendtheraveact.org)
"It's not that producers don't care, it’s that they're terrified," said Wooldridge. "Amending the RAVE Act can be a way to organize the community so people don't fear law enforcement if they're addressing drug use. What's more detrimental—a fatal overdose or having harm reduction teams and medical teams on site?"

"The campaign is just getting underway," said Jones. "They're collecting signatures, and Dede is just having first meetings with legislators to try to get them on board, to try to get some bipartisan support."

In the meantime, other steps can be taken.  

"One of the biggest things we can do is to educate with a true public health approach," Wooldridge said. "We need to have honest conversations and we need to implement drug testing; we have to have that opportunity to create an early warning system when these substances begin to appear."

"Education is really, really critical," said Jones. "We need to be able to get real drug education out to young people and meet them where they are. We need to be explicit about what the drugs are, what they look like, what the common dose it. Integrating harm reduction practices into the culture is also really important, and Dance Safe is great at that."

An effective means of tracking new and available drugs, such as a publicly funded, more comprehensive version of the drug checking websites would also be useful. But that requires someone willing to spend the money.

"We don't really have a surveillance system set up to track these new psychoactive substances," Wooldridge complained. "We don't have the public health monitoring. As a non-profit, we do some of that on a small scale, but we don't have the capacity or the resources to really do the job. What are the priorities and where is the funding to collect the data?"

"Changing policy to allow for drug checking is also an important avenue to pursue," said Jones. "If we're going to be in a world where drugs remain illegal, we will continue to have problems with imitations and new synthetics, with people not knowing what they're getting. That would be the least we can do."

There is one other obvious response.

"It's unrealistic to think we can keep drugs out of clubs and bars and festivals. Trying to do that causes more harm than good," Wooldridge said. "We need to be realistic and recognize drug use first and foremost as a health concern, not a criminal justice issue. These drugs are often being sold as something they're not, and that's because of prohibition and the black market," said Wooldridge. "One obvious option is legalization and regulation. Then you'd have quality control and you wouldn't need all this drug-checking."

But we're not there yet. Until we are, people are going to have to watch out for themselves and for each other. Check those drugs, kids!

Police Refuse to Release Description of Toxic Ecstasy Pills, Increasing the Danger of More Deaths

A string of recent overdose deaths in British Columbia has a lot of people deeply concerned. But this reaction by law enforcement is certain to make the problem worse.

VANCOUVER — Police in B.C. are reluctant to tell the public what unique markings are on ecstasy pills suspected to contain a lethal additive linked to five deaths in the province.

That's because they don't want users thinking they're sanctioning the rest of the pills. [CTV]

That is some sick logic right there. Listen, if you don't want people to think you're sanctioning the other pills, then say something like, "we're not sanctioning the other pills." What's so hard about that? But for the sake of saving human lives, at least tell people what the poison pills look like. 

Drug users are people, you know. They don't want to kill their friends. If everyone knows what the poisoned pills look like, they can help get them off the street. Everyone in the ecstasy scene will be on the lookout for the toxic doses and the people supplying that garbage will be strongly incentivized to toss it, or face serious consequences within their own social circle. This will work like 900% better than just telling everyone to stop taking ecstasy altogether.

We'll save for another day the conversation about why poisoned ecstasy exists in the first place (hint: the manufacturing process is dangerously unregulated).  

Tainted Ecstasy Linked to Western Canada Deaths

A cluster of recent fatalities among ecstasy (MDMA) users in western Canada has been linked to tainted drugs. At least five people in Alberta and three in British Columbia have died in the past few weeks. In six of those cases so far, paramethoxymethamphetamine (PMMA) has been found in toxicology reports.

Ecstasy -- or is it? (wikimedia.org)
The outbreak of deaths began last month in Calgary, and by December 29, Alberta Health Services sent out an alert warning that "Ecstasy or a combination of toxic substances sold on the street as Ecstasy is the likely cause of three recent Calgary-area deaths."

Then, in a new joint warning on January 11, the city of Calgary and Alberta Health Services announced that the province's chief medical examiner had confirmed that "paramethoxymethamphetamine (PMMA) and methamphetamine -- not previously associated with street drugs sold in Calgary as 'ecstasy' -- was present in toxicology results for each of five recent Calgary-area street-drug deaths."

On Thursday, British Columbia Provincial Health Officer Dr. Perry Kendall confirmed that PMMA had shown up in one of the BC deaths, while toxicology reports were still outstanding in the two other cases.

PMMA is thought to be a less expensive compound to produce than ecstasy, similar in appearance, and produces similar, though stronger, psychoactive and physical effects. Its use as an adulterant has been linked to earlier clusters of deaths in Norway and the Netherlands.

"There are some important differences in the toxicity of PMMA compared to MDMA" said Dr. Mark Yarema, Medical Director of the Poison and Drug Information Service (PADIS). "Although all have toxic effects, PMMA is considered more toxic than MDMA, with a higher incidence of seizures and elevated body temperature. Also, the onset of action of PMMA is delayed and its initial effect may be milder. This is dangerous as it may result in users ingesting several tablets to achieve a desired effect, with potentially fatal consequences."

If Canada is going to continue to subject recreational drug users to the Russian roulette of buying drugs without quality controls or ingredients labeling in the black market, it behooves drug users to do what they can to protect themselves. They could start by checking in with organizations such as DanceSafe or checking into ecstasy testing kits.

Canada

Chronicle Film Review: Prohibition

Prohibition: A Film by Ken Burns and Lynn Novick (2011, Florentine Films/WETA, 3 discs, 5 ½ hrs., $41.99)

One of America's leading documentarians has done it again. Ken Burns, producer of the widely watched and hailed documentaries, Baseball and The Civil War, has now teamed up with Lynn Novick to examine the rise, fall, and repeal of the 18th Amendment banning alcohol sales and production. It is a worthy effort, and well-executed.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/
The multi-hour must-see premiered over three nights this week on PBS, pulling in nearly four million viewers on its opening night -- very big numbers for public TV. It's also available online at the PBS Ken Burns Prohibition web site.

For most us of Prohibition is ancient history, skimmed over bloodlessly in dusty tomes in high school and undergraduate history courses. My 83-year-old mother, for instance, was still a toddler when revelers across the land tippled with delirious joy to mark repeal. For anyone younger than her -- and that's most of us -- Prohibition is no more than a school lesson, not a thing of living memory, except, perhaps, for an old story or two told by grandpa or grandma.

One of the successes of Prohibition is the way it brings that dry history to life. Through the skillful use of contemporary film, photographic stills, oral history, written remembrances narrated by actors, and a lively narration by Peter Coyote, Burns and Novick are able to recreate the living, breathing reality of second half 19th and early 20th Century America. Staring face to face at the glowering glare of a doughty battle-axe like Carrie Nation or the lizard-lidded, full-lipped gaze of Chicago gangster Al Capone, listening to Al Smith rail against the dries or Mabel Willibrand rally preachers against repeal, helps us put a human face on the  passions and frailties behind the march of the social revolution that was Prohibition and the mass rejection of it that was repeal.

Similarly, vivid scenes of saloon debauchery, with passed out drunks and giddy tipplers, of speakeasies filled with good-time guys and giddy flappers, of mass marches for and against, of political conventions and campaigns in which Prohibition was a burning issue of the day, help put living flesh on the dry bones of history.

The early 20th Century experiment in social control and legislating morality contains many lessons for contemporary activists seeking to undo the damage done by drug prohibition. Burns and Novick deserve our thanks for teasing out the varied strands that turned the 19th Century's temperance movement among mostly rural, Protestant, church-going women into a political powerhouse capable of blunting the power of big booze, shuttering the breweries and distilleries, and eliminating the saloons men saw as their last refuge from the demands of wife and children.

For me, the most important achievement of Prohibition is the way in situates the temperance movement within the broader social and political context of a tension-filled, rapidly evolving America. As Burns and Novick make abundantly clear, Prohibition did not happen in a vacuum. Among the forces propelling it were many of the same forces active today propelling reactionary social movements: racism (directed against newly arrived Irish, German, and Jewish immigrants), nativism (ditto), religious bigotry (aimed at those Catholic immigrants), nationalism (against mainly German-American beer brewers, especially during World War I), and rural vs. urban tensions.

But while it may be easy to ridicule the reactionaries of the last century, the roots of Prohibition also come uncomfortably close for present-day progressives. The temperance movement -- in all its intemperance -- was closely tied to "what about the children!" sentiment and women's suffrage, a cry for healthy living,  as well as the sort of "do-gooderism" conducted by "busybodies" that still informs much of the discourse when it comes to drug policy reform today.

As Prohibition shows most excellently, the politics of morality and social control are deep and twisted, and unraveling them reveals some unflattering facets of progressivism, as well as the more easily derided absolutists of what could fairly be called the Christian Right.

Where Prohibition is perhaps most useful to modern day drug reformers is in its depiction of the social ills it generated. Much as the Drug Policy Alliance likes to say "drug abuse is bad, drug prohibition is worse," viewers of Prohibition could fairly draw the conclusion that "mass drunkenness is bad, mass drunkenness under Prohibition is worse." Burns and Novick sketch the rapid expansion of organized crime under Prohibition, the gang wars of Chicago and New York, the corruption of cops and public officials -- all the side-effects of prohibition so familiar to present day reformers.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/
But they also look at its public health consequences, which -- like current drug prohibition -- were also in many ways disastrous. There were mass deaths from bad bathtub gin, deaths from drinking wood alcohol, outbreaks of "Jake Leg," a neurological disorder caused by contaminated whiskey that crippled hundreds, if not thousands, and while alcohol consumption initially declined, that decline was soon reversed, and with even more unhealthy drinking patterns.

In the end, Prohibition died of neglect, ridicule, and changing social attitudes, forged at least in part by the experience of Prohibition itself. And at the end, it revealed itself to be hollow, crumpling with amazing rapidity after the Great Depression hit and the big city, immigrant-friendly Democrats under FDR took power. Before the end of FDR's first year in office, Prohibition was history.

There are many lessons and parallels for contemporary drug reformers in Prohibition, but they are not exact and may not apply across the board. Alcohol prohibition lasted barely a decade, but drug prohibition is now in its second century. Why one was a flash in the pan and the other remains a painful, enduring legacy are questions that need to be answered if we are ever to leave drug prohibition in the dustbin of history along with Prohibition. Prohibition can help us start to ask the questions that will give us the right answers.

Disappointingly, Ken Burns doesn't appear interested in pursuing the parallels, nor even the dissimilarities, between Prohibition then and prohibition now. He does not reference the prohibition of other drugs in Prohibition (although heroin and cocaine were already criminalized federally and marijuana was being banned in a number of states), nor, as he has made clear in interviews, does he see a useful comparison between the two.

But that disagreement or lack of boldness notwithstanding, Prohibition is still a great viewing experience that brings alive a critical episode in US social and political history, an episode who reverberations still linger and whose contours are still echoed in drug prohibition. This is your history, America -- watch, enjoy, learn, and ponder.

Michigan Medical Marijuana Protest Draws 1,000+

photo courtesy Bruce Reith, South West Michigan Compassion Club
Medical marijuana supporters angered by resistance from elected officials and a state appeals court decision effectively shuttering dispensaries statewide rallied in large numbers at the state capitol in Lansing September 7. The Detroit News estimated the crowd size at about 1,500 people.

Touting signs reading "Patients are not Criminals" and "Weed Deserve Better," as well as signs directing their anger toward Attorney General Bill Schuette, who praised the appeals court decision, protesters poured onto the capitol lawn by the busload. Young and old, on foot and in wheelchairs, the crowd listened and cheered as speakers denounced the decision and praised marijuana for improving their health.

photo courtesy Bruce Reith, South West Michigan Compassion Club
Schuette, a Republican, has argued that medical marijuana use is only justified in limited circumstances and that any sales are illegal. The appeals court ruling was "a huge victory for public safety and Michigan communities struggling with an an invasion of pot shots near their schools, homes, and churches," he said.

One of the biggest cheers of the day came when a plane carrying a sign reading "Schuette: Keep the Patients Off the Streets" flew over the capitol.

"This has never been about cannabis," said Robert Redden, 61, a medical marijuana cardholder whose Oakland County home was raided in 2009. "This is about our rights."

Under last month's court ruling, most of the estimated 400 to 500 dispensaries in the state have shut down or are in the process of doing so. That leaves the nearly 100,000 card-carrying medical marijuana patients in the state with limited options for obtaining their medicine.

Under the state law approved by voters in 2008, patients can possess up to 2.5 ounces of usable marijuana and can grow up to 12 plants or have a designated caregiver grow it for them. But many seriously ill people are too sick to grow their own, and if they don't happen to know someone who can grow for them, now their only option is the black market.

photo courtesy Bruce Reith, South West Michigan Compassion Club
But buying medical marijuana on the black market has its risks. Not only do patients have to get involved in street-corner illegal drug sales, they also face the risk of contaminants in the street weed they purchase. The owner of a lab in Gaylord that tests medical marijuana subjected some samples of street weed to analysis and found mold and high levels of pesticide contamination.

"I want our medicine to be legal," said Stephanie Whisman, whose Bay City dispensary was raided. "I'm tired of them shutting down dispensaries. I've been raided twice. I've never been charged with anything. But they've taken everything I've owned."

Whisman said she didn't want to have to buy pot on the street. "I have my card. I went through my doctor. I did everything legal on my part. Why can't I go to a safe place to get my medicine?"

Lansing, MI
United States

Scottish Liberal Democrats Back Prescription Heroin

Scottish Liberal Democrats at their party conference in Perth voted Saturday to make campaigning for heroin maintenance treatment part of their party platform. Heroin users should not be fined or imprisoned, but should be given the drug through the National Health Service, party members agreed.

Tavish Scott's Lib Dems want "heroin on the NHS." (Image via Wikimedia)
The Liberal Democrats are an opposition party in Scotland, holding 16 of 129 Scottish Parliament seats, 11 of 59 Scottish seats in the British Parliament, and one of six Scottish seats in the European Parliament. They are fourth of five major political parties, behind the National Party, Labor, and the Conservatives, but ahead of the Scottish Greens. They are led by Tavish Scott.

The Lib Dems argued that both society and heroin users would benefit from prescribing the drug. Overdose and tainted drug deaths would decline, and addicts would not have to turn to crime or prostitution to feed their habits, they said.

"For drug offenders, fines and jail time simply don't work. In fact a fine will make it much more likely for a drug user to turn to a life of crime to fuel their habit," said Callum Leslie, a candidate for Mid Fife and Glenrothes. "Instead, the Liberal Democrats want to see a much greater use of Drug Treatment and Testing Orders (DTTOs) and Community Service Orders (CSOs). The evidence shows that these methods work. Offenders are forced to pay back the community they harmed and have a chance to get drug free for good. Controlled diamorphine [heroin] treatment is a method that works where other methods have failed. It stops offenders getting street heroin, which can be fatal and turns offenders to further crime to fund their habit."

"There is a great cost to society, and the public purse, if offenders are just abandoned to a cycle of crime and prison," said Alex Cole-Hamilton, Liberal Democrat candidate for Edinburgh Central. "DTTOs and CSOs are measures that would save public money by keeping drug abusers out of jail. Drug offenders should not be treated the same as murderers. We should work to treat the problem of drug abuse, not lock addicts away and condemn them to a life of crime."

United Kingdom

Heroin Drought Causing Problems in England

A scarcity of heroin in England is leading to a growing number of drug overdoses and poisonings as users ingest dope cut with other substances by dealers trying to stretch supplies, The Guardian reported this week. Scene watchers there are calling it the worst drought in years.

Are you sure that's heroin? Be careful out there, especially in England
The drought is being blamed not on seizures by law enforcement agencies, but on a fungus that has blighted the Afghan opium poppy crop, reducing the size of this year's poppy crop by half. Afghanistan accounts for more than 90% of the world's opium production and likely 100% of the British heroin supply.

"There is a very significant heroin shortage across the UK at the moment," said Gary Cross, head of drug policy for the non-profit group Release.  "It has been going on for some time now, but the last two months have seen stockpiles exhausted."

"I've never known anything like it in 30 years," wrote one long-time heroin user on an on-line forum discussing the shortage.

As dealers and users scramble to grapple with the shortage, users are turning up at hospitals after ingesting adulterated heroin or, in some cases, fake heroin consisting of a powerful sedative, caffeine, and paracetamol, a bulking agent. Some have passed out after smoking or ingesting, while others have reported vomiting, amnesia, and flu-like symptoms.

"This 'heroin drought' appears to be serious and geographically widespread," said Neil Hunt, director of research at KCA, a nationwide community drug treatment service. "Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardize information about what's out there.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky," said Dr. John Ramsey, who runs a drug database at St. George's Medical School in London. "We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

Harm reduction drug agencies are aware of the problem and working to address it. Several of them held an urgent meeting last week to discuss setting up an online warning system to give users notice about contaminated or adulterated drugs.

London
United Kingdom

Former Spanish Drug Czar Says Legalize Drugs

Madrid
Spain

Government-Sponsored Murder in the Name of Prohibition

This fascinating piece in Slate recalls the government's seldom-discussed effort to enforce alcohol prohibition by poisoning people:

Frustrated that people continued to consume so much alcohol even after it was banned, federal officials had decided to try a different kind of enforcement. They ordered the poisoning of industrial alcohols manufactured in the United States, products regularly stolen by bootleggers and resold as drinkable spirits. The idea was to scare people into giving up illicit drinking. Instead, by the time Prohibition ended in 1933, the federal poisoning program, by some estimates, had killed at least 10,000 people.

It's a nightmarish tale of prohibitionist lunacy that's worth reading in its entirety. Government officials were viciously calculating in their actions and callously blamed naïve drinkers for the consequences.

Today, prohibition kills people in different, yet equally abhorrent and unnecessary ways. Its advocates continue to deny responsibility for the predictable and inevitable consequences of the policies they defend and the death toll has grown to incalculable proportions, spanning the globe. The drug war leaves sickness and murder in its wake at every turn, yet many among us remain blind to the lessons learned nearly a century ago.

Prohibition: Contaminated Drug Supply Threatening Cocaine Users in North America, Heroin Users in Europe

Problems with contaminated drug supplies reemerged on two fronts this week, with health authorities in Scotland announcing another case of anthrax among heroin users and health authorities in Quebec warning that cocaine continues to be contaminated with levamisole, a veterinary de-worming agent.

http://www.stopthedrugwar.org/files/anthraxspores.jpg
anthrax spores
In a press release issued last Friday, Health Protection Scotland announced the first anthrax case among heroin users in the Edinburgh area had been confirmed. That brings to 33 the number of confirmed cases among heroin users, all but two of them in Scotland. One was reported in Germany and one in London. Eleven people have died of anthrax from tainted heroin, 10 of them in Scotland.

"There is no way to tell if your heroin is contaminated and there is no way to take heroin which we can advise is safer or less likely to result in illness or death if it has anthrax contamination," warned Dr. Colin Ramsey, consultant epidemiologist for Health Protection Scotland. "Drug users are advised that the only way to avoid the risk of anthrax in this outbreak is not to take heroin. While we appreciate that this may be extremely difficult advice to follow, it remains the only public health protection advice possible due to the nature of anthrax infection."

Such advice dismays harm reductionists, who have called for more informational campaigns and the prescribing of pharmaceutical heroin to addicts.

Users should seek urgent medical attention in the event of symptoms such as redness or swelling at or near an injection site, or other symptoms of general illness such a fever, chills or a severe headache, as early antibiotic treatment can be lifesaving, Health Protection Scotland said. Marked swelling of a limb which has been used as an injection site is a particularly important sign of possible anthrax infection.

Meanwhile, in Montreal, the National Public Health Institute of Quebec has issued a report on levamisole contamination in cocaine (sorry, French only) in the province. According to that report, eight out of 10 blood samples taken from known cocaine users in Quebec contained the cutting agent.

When ingested by humans, levamisole can cause nausea, dizziness, and diarrhea. Chronic use can lead to neutropenia, a potentially lethal blood disorder, or a related condition, agranulocytosis.

The US DEA first reported the presence of levamisole in cocaine in 2002 and its use is on the rise. In November 2009, Center for Substance Abuse and Mental Health Services published a survey indicating that 70% of cocaine seized in the US contained levamisole.

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