SHAPING THE DRUG MESSAGE SO PEOPLE WILL LISTEN TO IT

Drugs are bad. Drugs are illegal. Drugs kill.

It is a message drilled home by public health officials. But when
there is a concern that something might be amiss with the illegal
drugs that flood the streets, that message needs to be tweaked in a
way that adds nuance to the usually stark warning. After at least six
people in a small area of Manhattan died, apparently of drug
overdoses, in five days, police and health officials struggled
yesterday to find that balance.

"Drugs, adulterated or not, can kill you," said Dr. Thomas R.
Frieden, the city's health commissioner. But he also had to
communicate to a population already at risk because of drugs, one
probably aware and unconcerned about the usual drug dangers, that
there might be something particularly deadly on the streets.

"It's a very tough balance," said one health official, who insisted
on anonymity so as not to interfere with city officials' public
statements. "How do you tell people the stuff they are using is extra
bad without communicating the idea that it is generally O.K.?"

In the case of the recent deaths in Lower Manhattan, it is even more
complicated because so much remains unknown. The toxicology reports
on what exactly might have been in the drugs are not complete. While
heroin is suspected to be involved in all six deaths, it is still
unclear whether the victims used it separately or mixed heroin with cocaine.

Syringes were found at some of the scenes, according to the police,
but it is unclear whether all victims injected themselves or took the
drugs in some other manner. The investigation also has not linked the
victims together, aside from two young women who were friends, and it
has not found if the drugs were obtained from a central source.

Still, despite all the questions, the deaths set off an alarm for
epidemiologists because of two crucial criteria: commonalities in
place and time.

Officials felt that was enough to issue a stern public warning.

There are about 700 fatal overdoses from illegal opiates in the city
each year, but health and police officials agreed that six people
dying over such a short time and in such a small area was unusual.
City health officials were working late last night to map where and
when all the overdoses over the past year took place.

"We don't know how interesting this is going to get," said another
health official, who also asked for anonymity to avoid prejudicing
the investigation. "It could just be a blip."

Over the years, there have been many scares about contaminated or
especially potent drugs on city streets.

In February, a warning was issued to doctors that the city's
Department of Health and Mental Hygiene had found evidence of
contaminated heroin that had made at least six people dangerously
ill, though no one was believed to have died.

One of the deadliest drug scares in New York occurred in 1994 when a
blend of heroin, named China Cat by dealers, caused 13 deaths in five
days. In that case, the drug killed efficiently because it was purer
and more potent than the heroin usually sold on the street.

Illegal drugs like heroin are altered for several reasons, according
to city health officials. In the past, many deadly blends of heroin
were the result of a drug shortage, which led dealers to bolster
their supply by stealing pharmaceutical opiates that tend to be purer
and stronger.

"They would take a dose that was 10, 50, 100 times more potent then
their usual dose and they would die," said another health official
who works in the city's drug prevention program. That was the case
with the China Cat blend.

More commonly, dealers seek to stretch their supply by adding
substances, like quinine, that they believe have no side effects, but
can sometimes prove dangerous.

Other times, there are the rare cases in which dealers are looking to
kill a user, usually as part of a territorial dispute between rival
dealers. Officials said they have no idea if any of these reasons are
behind the current string of deaths.

And while the focus has been on heroin, it is also possible that the
victims unsuspectingly bought cocaine laced with heroin, which would
mean that the number of people who could be at risk is much larger
since cocaine users outnumber heroin users in the city.