There is an ongoing outbreak of anthrax among people who inject drugs in a number of countries in Europe with 13 cases now identified since early June 2012. The latest case in Suffolk brings the total number affected in the UK to seven – five in England (including four fatalities), one in Scotland and one in Wales. The source is presumed to be contaminated heroin.

It is unclear as yet whether these recent cases are linked to the cases in Europe (four in Germany, two in Denmark and one in France) but the HPA is continuing to monitor the situation.

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have concluded that heroin users in Europe are still at risk of exposure to anthrax.

Dr Chris Williams, Consultant in Communicable Disease Control at the HPA (Norfolk, Suffolk and Cambridgeshire) said:

“Anthrax can be cured with antibiotics, if treatment is started early. It is therefore important for medical professionals to be alert to the possibility of anthrax infection in heroin users presenting with signs and symptoms – which include severe soft tissue infections or blood poisoning – to prevent any delays in providing treatment.

“It is possible that further cases may be seen in people who inject heroin. People who use drugs may become infected with anthrax when the heroin they use is contaminated with anthrax spores. This could be a source of infection if injected, smoked or snorted – there is no safe route for consuming heroin or other drugs that may be contaminated with anthrax spores.”

NHS staff were made aware of the possibility of cases of anthrax in people who inject heroin following the first UK case last year and health professionals across the East of England have been reminded of this. Targeted information, including posters and leaflets aimed at heroin users have been sent out by the National Treatment Agency to local drug partnerships for distribution to all organisations in touch with drug users. These include hostels, housing departments, needle exchanges, benefit offices, community pharmacies and social work departments.

Dr Chris Williams continues;

“In light of this recent case in Suffolk, we have advised local agencies to talk to their service users who inject drugs about the risk of anthrax infection.

“People who inject drugs often experience a skin infection but we strongly advise them not to ignore signs such as redness or excessive swelling around injection sites or other symptoms of general illness such a high temperature, chills, severe headaches or breathing difficulties. They should seek medical advice quickly in such circumstances but particularly now as there are concerns that some batches of heroin in circulation may be contaminated with anthrax. Early treatment with antibiotics is essential for a successful recovery.”

More information

At the end of June 2012 in consultation with colleagues across the UK, the HPA produced a one-page reminder for those who commission and provide services to drug users about severe infections among PWID caused by spore-forming bacteria. This has been cascaded to service providers in England by the National Treatment Agency. Severe illnesses in drug users due to  anthrax, botulism & tetanus

More information on the European outbreak is available at the European Centre for Disease Prevention and Control (ECDC)

• Prevalence of drug misuse, including the types of drugs used;

• Trends in drug misuse over recent years;

• Patterns of drug misuse among different groups of the population; and

• Health outcomes related to drug misuse including hospital admissions, drug treatment and numbers of deaths.

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Officials heralded the end of the “Trainspotting” generation as the number of 18 to 24 year-olds seeking treatment for heroin and crack problems has fallen 30 per cent from 12,320 in 2005-06 to 8,603 last year.

But the number in this age group seeking treatment for serious cocaine addiction rose from 1,591 users in 2005 to 2,998 in 2008, reflecting the increasing popularity of the drug in Britain’s pubs, clubs and bars.

Paul Hayes, chief executive of the National Treatment Agency for Substance Misuse (NTA), said that the rise in young people seeking treatment for a dependency on cocaine was significant, as many could be using the drug without feeling like they had a problem. He said: “What seems to be happening is that for people who engage in normal late adolescence, early-20s night-clubbing, pub-going, cocaine use is becoming more normal among that population. It’s become an adjunct to alcohol or cannabis use.

“Most of the increase in powder cocaine use is as part of a lifestyle rather than necessarily the consequences of the problems associated with poverty, crime and social dislocation that often lie behind crack problems.”

Overall, record numbers of adults are being treated for drug addiction, with a total of 207,580 adults undergoing treatment in 2008-09, data from the NTA shows.

“A dramatic generational shift is taking place,” Mr Hayes added. “Young adults with early problem drug use are getting into treatment quicker before their addiction becomes as entrenched as it used to.

“We are optimistic that we may have passed the high water mark in the heroin epidemic that began in the early 80s and the reduction of the number of 18 to 24-year-olds coming forward to treatment is a reflection of a very positive trend.”

While heroin use had been glamorised as “chic” in the 1980s and 1990s, and led to films such as Trainspotting, based on a book by the Scottish author Irvine Welsh, Mr Hayes put the decline in use down to a combination of factors including the availability of treatment and “less ignorance” about the consequence of using drugs.

“Young people are very savvy. They have seen the consequences of using heroin for earlier generations. It’s no longer seen as having any glamour attachment to it at all.”

Heroin and crack, the most addictive Class A drugs, were responsible for 61,636 people seeking treatment last year, but this fell from a peak of 64,288 users in treatment in 2007-08.

But while young people in treatment fell, the proportion of over-35s seeking treatment for the first time for heroin and crack has increased by a fifth from 20,465 in 2005-06 to 24,414 in 2008-09.

There are an estimated 330,000 heroin and crack users in England. The average time for accessing treatment is less than five working days.

Heroin and crack account for 83 per cent of cases in which adults were seeking treatment for the first time in 2008-09, while cocaine accounted for 6 per cent of cases and cannabis also accounted for 6 per cent.

Of the 172,624 adults in treatment for crack and heroin problems, 162,000 (94 per cent) “successfully completed or benefited” from their treatment, the agency said.

Dr Emily Finch, a psychiatrist from the South London and Maudsley NHS Foundation Trust (Slam) with a long history of treating drug users, said: “We are attracting people to treatment earlier. People aren’t using for 10 to 20 years any more, they are using for three to four years.

“It’s good that treatment is attractive and available enough that people do that.

“Reduction in use with young people would indicate to me that we are getting on top of this problem.”

Martin Barnes, chief executive of the charity DrugScope, said that it was encouraging that fewer young people were presenting to services with problems with heroin or crack cocaine.

“However, suggestions that we may have reached the ‘high watermark’ of heroin and crack problems in this country may be premature, not least at a time of recession when a growing number of young people are not in employment or training and overall unemployment is rising.”

The figures come after research published this week suggested that an experimental vaccine to treat cocaine use could help some addicts to halve their dependency on the drug.

Animal and human studies published in the Journal of the American Medical Association found that high levels of anti-cocaine antibodies in the blood can stop addicts experiencing a high. Doctors at Yale University School of Medicine gave the vaccine to 55 cocaine addicts and found that 38 per cent were able to achieve the necessary antibody levels to reduce the drug’s effects, enabling them to wean themselves off it. However, the researchers add that users would require repeated injections to maintain the effects and it may be several years before a viable vaccination is available.

Timesonline.co.uk

After a trial reported success in tackling use of street drugs and crime, Justice Secretary Jack Straw has suggested that prescribing heroin on the NHS may be the only way to deal with some users.

Most people probably think of opium poppies coming from Taliban-controlled fields in Afghanistan or from the Far East’s Golden Triangle, but it is perfectly possible to produce opium in the UK.

Indeed, all of the diamorphine – equivalent to heroin – used in the UK’s addict treatment trial is produced in the country.

Opiates firm Macfarlan Smith, a subsidiary of Johnson Matthey, is the country’s sole diamorphine producer.

It holds contracts with farmers in the south of England – including Hampshire and Wiltshire – to grow crops of poppies, says Ian Godwin, communications director for Johnson Matthey. The firm takes the harvest and processes the poppies into what is called “active pharmaceutical ingredient” (API). This API is then passed on to a UK pharmaceuticals firm to be turned into doses.

The processing of opium poppies is done under government licence in “extremely secure” conditions.

The world’s pharmaceutical firms get their poppies from everywhere from Spain to India, but the biggest producer is Tasmania in Australia. In Tasmania, a thousand farmers grow poppies across about 13,000 acres and it is one of the island’s major exports.

The growing of poppies there can only be done under licence and there are strict controls on access to the field. Possession of opium poppies is a crime.

The heroin prescription trial in the UK, which is being run at the National Addiction Centre, initially used diamorphine imported specially from Switzerland and distinct from the NHS’s own stockpile. It moved to using British diamorphine when that became a cheap enough option. The cost of a year’s diamorphine treatment for an addict is about £15,000, although this includes administering and supervising the injections.

There have been similar trials involving pharmaceutical heroin in the Netherlands, Switzerland, Germany and Canada.

But the UK also has another use for diamorphine. It continues to be used in palliative care, to relieve pain in terminally ill people.

A recent problem with supply led to many doctors using other opioids, says Dr Bill Noble, president of the Association for Palliative Medicine.

“It is virtually the same as using morphine. The only difference is that diamorphine is much more soluble than morphine, which means you can have much lower volume injections.”

It is also used as part of the treatment for some patients with acute heart failure.

Diamorphine does not tend to be used in other countries for palliative purposes simply because it is illegal, says Dr Noble.

BBC News Magazine

Martindale Pharamceuticals was put up for sale by its parent Cardinal Health (CAH.N) in June, according to a transcript of a conference call the company held at the time.

Morgan Stanley (MS.N) is advising Cardinal, a pharmaceutical wholesaler, on the auction of Martindale, which has a price tag of about 150 million pounds, the Financial Times said.

Bidders include CBPE, the former private equity arm of Close Brothers and LDC, the buyout arm of Lloyds Banking Group, the paper said.

Other private equity groups also in the running are Silverfleet, the former buyout arm of Prudential; AAC Capital, the private equity group spun out of ABN Amro last year; and Exponent, set up by four former 3i dealmakers in 2004, it said.

Some potential bidders have shied away due to concerns over the reputational risk of making methadone and worries about the sustainability of its profit margins, the paper said. (Reporting by Megan Davies; Editing by Valerie Lee)

Home Affairs spokesman Chris Huhne said spending tax payers money supplying the deadly class A drug would make the policing the streets easier and help ease  over-crowding in Britain’s prisons.

He admitted that  further trials were needed following a successful pilot study by London’s Maudsley Hospital but added that the scheme was a ‘potentially fruitful way forward’.

Mr Huhne said that the NHS should only supply addicts who had not been able to give up the drug altogether as a last resort.

During a question and answer session at the party’s conference in Bournemouth, Dorset, he told activists: “Clearly we need to try to get addicts off heroin altogether if at all possible but there is an irreducible group that are very resistant to this.”

The Maudsley trial costs the NHS about £15,000 a year for each patient but had achieved dramatic results.

‘The results so far – they are not properly controlled trials, so we need to do more trials and more work on it – they are absolutely dramatic.’

Some three-quarters of the addicts had reduced their use of street heroin and offences had reduced from 1,731 to 547 over a 30-day period – ‘an enormous reduction in crime,’ Mr Huhne said.

Acknowledging it was controversial, he added: ‘I think it goes back to a policy we had many years ago when the number of addicts was much smaller.

‘It has been pioneered in Switzerland … and I would like to see it tested more.

‘Because if we are going to get that sort of dramatic reduction in crime it will make the job of the police enormously easier in concentrating on crimes which really are harming the general public.

‘It will mean that we will be able to get a lot of people out of jail who are repeatedly going back to prison.

‘The harm reduction is something we need to look at very carefully.

‘Let’s get the proper evidence base, expand the pilots, but I think this is a potentially fruitful way forward.’

The comments come less than 24 hours after Justice Secretary Jack Straw said prescribing heroin on the NHS could be the best way to treat the ‘most problematic addicts’.

Writing in his local newspaper, the Blackburn MP said: ‘It may be the best means of reducing the harm they do to themselves, and of stamping out the crime and disorder they inflict.’

Daily Mail.co.uk

The justice secretary’s comments follow trials which showed big reductions in the use of street drugs and crime.

“It may be the best means of reducing the harm they do to themselves, and of stamping out the crime and disorder they inflict,” the Blackburn MP said.

Writing in the Lancashire Telegraph, he says the potential benefits of trying alternative approaches are huge.

‘Imaginative’

Mr Straw says he has been part of the “tough” approach in the past, which has seen a large proportion of offenders jailed after committing crimes to fund their addiction.

But he believes the overriding objective must be to reduce the harm caused by drugs, to users, their families and to the victims of crimes they commit.

“So we need to keep an open mind on alternative approaches, not dismiss them if they don’t fit in with the adjective ‘tough’.

Last week it emerged that a scheme in which heroin was given to addicts in supervised clinics had led to big falls in their use of street drugs, and in crimes committed to pay for them.

More than 100 users took part in the four-year pilot in London, Brighton and Darlington, which was partly funded by the government.

They either injected heroin or received the drug’s substitute, methadone. About three-quarters of those given heroin were said to have “substantially” reduced their use of street drugs.

The National Treatment Agency for Substance Misuse (NTA), which administers drug treatment in England, said the results were “encouraging”.

Mr Straw says the prescription of heroin would only ever be applied to a minority of problematic addicts.

“The prescription of heroin is not a magic bullet. It’s a drastic step,” he added.

BBC News

Last year, there were 29 drug-related deaths in the county, compared to 36 the year before.

This was in line with the picture across England, Wales and Northern Ireland, where there was a 3% fall.

According to Richard Martin, head of drug and alcohol at Derby Community Safety Partnership, the figures were proof that steps being taken to tackle drug death rates were working.

He said: “Treatment is becoming more effective and more accessible, which continues to reduce the dangers that go with illicit drug use.”

For almost three years, the treatment of drug users in Derby has been shared between specially trained GPs and the Bradshaw Clinic, in Charnwood Street, which opened in October 2006.

Together, they aim to keep tight control over the prescription of methadone, which is given to recovering heroin users.

Help for drug-users in the city further increased two years ago when national charity Phoenix Futures, which offers advice and treatment, opened a local branch.

And drug-users have benefited from a change in protocol which means police are no longer automatically sent to the scene when an ambulance is called for an overdose.

Mr Martin said this meant people with the drug-user at the time of the overdose were more likely to call for an ambulance because they no longer feared being arrested.

He said: “We cannot, however, be complacent and are confident that we can reduce even further the number of drug-related deaths in the city.”

Among plans to further reduce deaths are a series of education sessions in the coming months at the Bradshaw Clinic to teach drug-users safe methods of resuscitation.

Derbyshire County Primary Care Trust was asked to comment on measures being taken across the county, outside the city, but a spokeswoman said no-one was available.

However, the county’s drug and alcohol team, which works in partnership with the trust, told the Derby Telegraph in February that drug treatment was improving.

According to the team, the number of people in treatment across the county had risen by a third in the past year.

The latest death-rate figures were revealed in a report by the National Programme on Substance Abuse Deaths.

Professor Hamid Ghodse, one of the authors of the report, said: “Prevention of the loss of life at any age, especially of the young, due to the scourge of substance abuse has to be a top priority for any government.”

The coroner’s office for Derby and South Derbyshire recorded 19 deaths last year, compared to 22 in 2007. And in North Derbyshire, the coroner dealt with 10 deaths, which fell from 14 the year before.

The number of deaths per 100,000 people in the county was 3.9 in the south and 3 in the north.

This was well below the highest death rate per 100,000, 20.7 in Brighton and Hove

(thisisderbyshire.co.uk)

Councils are not doing enough to prepare their communities for the fallout from the recession and face a surge in social problems such as addiction, alcoholism and domestic violence, the leading public sector watchdog warned yesterday.

The Audit Commission said that local authorities in England were now facing the “second wave” of the downturn, as the effects of rising business failures, bankruptcies and unemployment bite.

“Many councils should be doing more to prepare for the expected social, financial and economic development challenges ahead,” it said. “This includes councils that have escaped the worst effects to date, some of which are complacent.”

It coincided with a separate report that found that despite predictions that the recession would lead to an exodus of non-UK nationals, one in 12 employers in the UK plan to recruit migrant workers in the next few months. The study, by the Chartered Institute of Personnel and Development and the consultants KPMG, found that the number of migrant workers rose between the first quarters of 2008 and 2009 while employment of UK nationals fell.

Gerwyn Davies, public policy adviser at the CIPD, said many employers found it hard to fill vacancies with UK workers. “The idea that migrant workers comprise a marginal segment of the UK workforce that is dispensed with when times are tough is clearly wide of the mark. Most are recruited and retained by employers because they provide skills or attitudes to work in short supply amongst the home-grown workforce.”

Official figures due to be published this morning will be closely scrutinised for evidence that the economy is bottoming out. The broad measure of joblessness, which covers those looking for work rather than simply those eligible for state benefits, has been rising at a record rate.

A third report found that low earners are being disproportionately hit by the recession. Amid growing political concern about the alienation of UK-born workers, the Resolution Foundation, a charity, said people with household incomes of between £11,600 and £27,150 were facing severe financial pain, were being overlooked by the government, and missed out on help from employers.

The chief executive of the Resolution Foundation, Sue Regan, said despite signs of economic recovery it was likely that job losses among low earners would continue to rise. “If you look at the sectors where they are most likely to work, they are areas which are likely to [have been] depressed for a long time,” she said.

In its report, Squeezed: The Low Earners Audit, the Resolution Foundation said low earners in work were more vulnerable to the softening labour market “than benefit-dependent households – who are less likely to be reliant on earned income – or higher earner households – who are more likely to have savings and insurance”.

The charity reported a 45% jump in benefit claimants in the distribution, hotels and restaurants sector since April 2008, from 49,000 to 71,000.

The charity estimates that 400,000 low earners were receiving jobseeker’s allowance in April 2008 and at least 180,000 more have joined them since the recession began. “In truth, the figure is likely to be higher because of the higher levels of vulnerability and job insecurity faced by low earners,” it said.

The charity said these workers were likely to have difficulty “bouncing back” from unemployment because “employers don’t tend to invest as much in training them … but the government tends to focus on people with no skills. We would like to see the skills strategy extended specifically to help low earners.”

Guardian .co.uk