CALIFORNIA CLUE TO LETHAL INJECTIONS

Health experts investigating a mystery infection which has killed 11
heroin users in Glasgow believe a spate of similar deaths in
California may offer some important clues, The Observer has learned.

Five addicts in San Francisco died in a three-week period last year
from horrific infections contracted after injecting drugs. As with the
Glasgow cases, the victims developed large abscesses around the
injecting area which spread rapidly as their condition
deteriorated.

On 16 June last year, San Francisco's public health department warned
injecting drug users of a potentially deadly bacteria. The advice,
similar to that issued earlier this month in Glasgow, stated:
'Injection drug users who develop swelling, redness, warmth, pain or
tenderness at or near an injection site should seek medical attention
immediately.'

The deaths were linked to a contaminated batch of black tar heroin, a
crude, sticky, dark-coloured form of the drug produced in Mexico that
is extremely difficult to break down when poorly made. Black tar
heroin use is concentrated almost entirely in the western United
States and is unavailable in this country.

But the San Francisco experience has provided the experts in Glasgow
with evidence that backs up one of their theories: that victims were
taking crudely manufactured heroin which was difficult to dissolve,
forcing them to use excessive levels of citric acid to break it down
for injection.

Doctors believe that when such large amounts of acid are injected
straight into tissue, it causes severe localised damage which creates
the perfect conditions for bacteria to spread rapidly.

All 11 people who died and the 14 other users affected by the outbreak
in Glasgow have injected directly into tissue or accidentally after
missing a vein. All had used citric acid to dissolve the drug.

A pathology report on one of the Glasgow victims is understood to have
found citric acid levels about six times higher than normal.

Laurence Gruer, a consultant in public health, said: 'That is
certainly one of the avenues that we are pursuing. The reports we are
getting from users is that they were having much more difficulty
dissolving the heroin than usual. This means that the drug they were
injecting into themselves was much more acidic than usual and you can
imagine the damage that would cause when injected straight into tissue.'

His colleague, Said Ahmed, added: 'The heroin in the San Francisco
cases was rough stuff and that seems to offer the most plausible
explanation for our problem as well.'

But even if this theory proves to be correct, it only partly explains
the Glasgow outbreak. While it would establish what created the
conditions for the infection to spread so rapidly, it would not reveal
which bacteria caused the deaths. Experts are still focusing on
contamination of a batch of heroin by a single specific strain of
bacteria because all the victims died in the same way.

The bacterium blamed for the San Francisco deaths was Clostridium
perfringens, which caused the horrific flesh-eating infection, necro
tising fasciitis. According to Gruer, small traces of Clostridia were
found in two samples from the Glasgow victims but this is not thought
to be responsible for the deaths.

Health officials have called in experts from the Centre for Disease
Control in Atlanta, the world's leading authority in investigating
unexplained outbreaks of infection.

A twelfth heroin user died in Glasgow on Friday but the authorities
said it was too early to establish whether the death was caused by the
same infection.