An important new report by Claire Cole, Lisa Jones, Jim McVeigh, Andrew Kicman, Qutub Syed & Mark A. Bellis was published yesterday by the Center for Public Health at John Moores University. Titled 'A Guide to the Adulterants, Bulking agents and other Contaminants found in illicit drugs' (pdf) the report answers the question 'What else are people eating, snorting and injecting when they take illegal drugs?', and offers a detailed review of the available evidence on drug contaminants, making a series of pragmatic recommendations on how related harms can be minimised.
Whilst demonstrating that most adulterants are benign, it also highlights that others present a range of serious risks, including death. The seriousness of these risks has most recently been demonstrated by the anthrax contaminated heroin issue, and there is a useful section on the frequently ignored issue bacterial contaminants. The summary table of drugs and adulterants is copied below in three parts (click image to see full size).
Transform has covered a number of these issues in the past including the appearance of lead as a bulking agent in cannabis.
If there is one shortcoming in the report is its failure to state that these issues are unambiguously and entirely the fault of prohibition and the illicit production and supply infrastructure it has created. Instances of contaminants in licensed medical drugs (the counterfeit issue mentioned briefly on page 45), or alcohol and tobacco are very rare - and when they do occasionally occur, authorities are able to rapidly respond and immediately remove products from the market, in ways obviously impossible with an unregulated criminal trade. The recommendations in the report - whilst obviously pragmatic and sensible - limit themselves to symptomatic responses within the existing legal and policy framework. They only consider how to reduce the harms created by prohibition rather than exploring the possibilities for legal regulated supply that would eliminate the problems outright.
This shortcoming is particularly notable regarding opiate injecting where advice is limited to making users aware of risks and educating about safe injecting. Given that legal opiate prescription models for injectors already exist, are legal, and are obviously not associated with any of the problems the report describes, its unclear why they do not feature in the recommendations, even as a discussion point.
None the less, the authors should be congratulated on an important (if long overdue) piece of scholarship. It remains for others in the drug field to consider and act on its implications regarding longer term reforms that might deal with the cause of the problem, rather than just the symptoms.