LETHAL INJECTION

For eight Dublin heroin addicts, it was their final injection; the one
that led to a brutal, agonising death. What was in the needle that
poisoned their bodies even more than the drug they craved? Justine
McCarthy examines theories that have implicated too-pure heroin, or
even anthrax one of the most toxic substances known to man.

Last April, a Norwegian doctor sat down at his computer and posted a
medical alert on the internet. Pers Lausund of the Army Medical School
in Oslo chronicled a puzzling case history and flagged it on ProMED,
the internet forum for emerging diseases. He wrote that a heroin
addict had recently died in the Norwegian capital from an unidentified
condition. The man had developed an abscess after injecting into a
muscle, he said. Ten days later, he fell into a coma. Antibiotics had
failed to save him.

Shortly after Pers Lausund posted his alert, the medical staff at
Glasgow's hospitals started noticing more dead addicts than usual.
They all had the same symptoms thirst, nausea, oedema and large, angry
abscesses on the skin. The general symptoms were followed by the rapid
growth of white cells and multiple organ failure. As the deaths
mounted in Glasgow and Aberdeen, the National Institute of Public
Health in Oslo warned that further cases could occur elsewhere.

The comments were carried in a special report of the London magazine
New Scientist, which pointed out in its May 20 edition that many cases
could go undetected. By then, it was already too late for Paddy Kane.
The former fisherman from Dun Laoghaire, Co. Dublin had been admitted
to hospital in Dublin four days earlier and was already dead two days
before the New Scientist warning was published. Most city commuters
had not noticed that the bearded grandfather no longer sat in his
habitual spot on the ground outside the Spar shop in Baggot Street.

A week later, Rosie Lakes was dead too. Rosie would have known Paddy
from dropping by the all-night convenience store in the early hours of
the morning for a coffee break from prostitution. The two Northern men
who ran the brothel where she had worked at the age of 16 had thrown
her out when they discovered the track marks on her arms. By the age
of 18 she was turning over pounds 1,000-a-week on the canal. When
Paddy O'Gorman interviewed her two years ago for his radio programme
she told him her drug habit had started with ecstasy at raves when she
would smoke heroin to come down. She had spent five weeks in detox at
Beaumont Hospital in 1998 but was back on heroin three days after
getting out. Now she too was dead.

Since April, 14 heroin addicts have died in Scotland from the same
unexplained infection. A further eight have died in Dublin and seven
more have survived.

Just last night it emerged that seven people in England and Wales have
also died, each displaying the distinctive post mortem signature of
severe inflamation of the internal organs.

In terms of a heroin-using population totalling an estimated 13,000 in
this country, the statistics seemed to threaten an epidemic. On
average, three heroin users die in Ireland every fortnight either as a
direct or indirect consequence of their habit. It is a grim figure
that stirs little debate or even notice. But when 20 people die in
less than two months and when eight of those deaths remain a mystery,
people start to wonder.

Back in Oslo, Pers Lausund was trying to isolate the cause. He thought
he had solved the mystery when anthrax bacilli showed up in tests of
the Oslo addict's spinal fluid. The result was confirmed by DNA
analysis. In Britain's biological defence laboratory at Porton Down,
where anthrax was first man-made as a potential chemical weapon,
scientists tested blood samples from five of the Scottish victims. Two
tested positive for `protective antigen', the main anthrax toxin. One
survivor in Scotland was said to exhibit the black scab typical of
localised anthrax infection.

Anthrax is a disease of sheep and cattle which is transmissible to
humans. During the Second World War scientists from Porton Down
carried out experiments with it on an island in the Hebrides. So
enduring was its toxicity that the island remains a no-go area to this
day. According to Phil Hanna, an anthrax expert at the University of
Michigan, it is consistent with the injection of heroin into muscle
rather than veins. He explains that infection only spreads when
anthrax spores are consumed by macrophages. These are roving white
blood cells that eat bacteria and they do that much more effectively
in muscle than in blood.

Anthrax is endemic in Pakistan, Afghanistan and Iran, where most of
Europe's heroin originates. The New Scientist has speculated that pure
heroin may have been cut there with material from infected animals
``which means this could have been happening for years. But who
bothers to autopsy dead addicts? Every few months there is a surge in
deaths which is blamed on overdosing with unusually pure heroin, and
no one looks further.''

By this week, however, Irish officials were starting to dismiss the
anthrax theory in favour of the possibility that the heroin involved
had simply been too pure, or not pure enough. The fact is that nobody
will know for sure until American experts have conducted a series of
tests.

In the meantime, one of the side-effects of so many unexplained deaths
is that society is forced to reconsider the whole issue of heroin use.
At a time when most of the country is basking in unprecedented
prosperity, its grip on some sections of the community is as tight as
ever.

While State and regional services have improved in recent years, many
community workers claim that heroin is too often seen as the cause
rather than the symptom of a wider problem.

``Deaths aren't new to me,'' says Labour Party Cllr Eric Byrne in
Crumlin. ``We've been living with it since the '80s. What is shocking
now are the numbers because of this but they'll still go on dying and
jumping off balconies and hanging themselves and over-dosing because
the broader mass of society has not come to terms with it.''

Even as the funerals took place in the past fortnight, a garda
investigation team has been trying to find the source of the
infection. In the main supply bases of Thomas Street, Meath Street,
Ballymun and Crumlin, the dealer of this deadly batch is generally
named as a man in his mid-20s from Crumlin. He was born to an epic
family legacy of crime and is described as ruthless. One local worker
remembers him evicting a family from their home before shouting
instructions to a gang as they drove a stolen car at speed into the
front of the empty house.

The depressing pattern has been well established, however, that
whenever one dealer is picked up by the police there are at least
another two waiting to take his place. A fix may only cost a tenner
but the market is as lucrative, if not more so, than any chased by
conventional corporate ventures. The viciousness of the drugs world
has been plumbing new depths these past couple of years. In that time,
two young men were shot dead and their bodies dumped in the canal; a
young prostitute was strangled to death over a paltry drug debt; three
young Irish men were barbarically murdered in Holland. Now this
outbreak of strange deaths.

Even though there are more than 400 heroin users waiting to join the
treatment programmes already helping 4,400 others (there are 44 drug
treatment centres in Dublin), the authorities have greatly improved
the service in recent years. Yet heroin is as great a scourge as ever,
to society and to the people it seduces.

``If you go back 10 years you'd have 100 to 150 people who have died
tragically from drugs in the Rialto/Dolphins Bar/Crumlin area,'' says
Tony MacCarthaigh, team leader of the Rialto Community Drugs Team.
``We've had this persistently now for a long time. There have been
whole families ravaged by it. In some families a couple of people have
died, or more. Talk about the Hidden Ireland. This is the Hidden Dublin.''