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 details 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 wishs to remain anonymous (but who I trust) the worker felt that the information should be made more widely available.

There is no specific profile for the people who most likely to be at risk, the age range is late 20s to mid 50s. The majority (if not all) of those infected have been injectors. There has been one report of smoking from one of the victims, however he was also in receipt of a methadone script and may have minimised his injecting for fear of loosing his script, he had a recent history of injecting and was associating with known injectors, unfortunately no post-mortem was carried out (workers refused to, thinking they were at risk of infection) so there has been no way to confirm whether he was actually injecting.

So far the risk from smoking heroin is only theoretical, none of the confirmed cases or those who have died had anthrax via lungs or through inhalation, the anthrax was all through abscesses. There is an increased risk, in theory, if when smoking heroin you start inhaling as it's candying as you run the risk of inhaling powder rather than smoke. If inhaled the disease progression is very quick and almost always fatal. But this has not been the pattern.

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;

• Injecting under skin
• Injecting into muscle
• Missing a vein or experiencing leakage is a risk factor in many of the confirmed cases
• Excessive use of citric causes extra tissue and vein damage, increasing likelihood of infection
• Injecting contaminated heroin into a vein increases the risk of systemic infection

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.

For more details on the anthrax outbreaks in Scotland you can visit Health Protection Scotland (HPS), for details for the rest of the UK you can visit the Health Protection Agency (HPA).