The truth behind pure heroin and bad heroin media stories

It will come as a surprise to many that in reality 'pure heroin', and changes in purity being the cause of overdose death of drug users in the UK is a media myth.

As a headline, 'pure heroin kills addicts' is powerful and common – but it is a myth with it's origins in well meaning warnings issued on the basis of assumptions rather than evidence. Heroin can become contaminated with dangerous organisms, and the term 'bad heroin' or 'contaminated heroin' has been coined to describe it, however the term bad heroin is greatly over-used in the media, and in relation to overdose they are also perpetuating the myth of dangerous adulterants being added to heroin – which just doesn't happen.

In the article below, Ross Coomber from Plymouth University, and Jon Derricott from Exchange Supplies look at the (lack of) evidence to support these strongly held beliefs about the dangers of heroin, and discuss how concentrating on these myths may detract from the more important messages about what really does cause drug related deaths... The unkindest cut.

You can also hear Ross Coomber presenting on this topic at the National Conference on Injecting Drug use, by clicking here.

The unkindest cut? 'investigative journalism', drugs and research
A lot has been made in the media about the practices of street dealers regarding the cutting of drugs such as heroin, cocaine and ecstasy. Two particular stories are worth referring to for their prominence, but numerous others could be referred to for their more subtle impact.

Each story raises once again the spectre of drug dealers routinely selling street drugs cut with a range of harmful substances including ground glass, sand and brick-dust. The common belief is that this is done as a means to increase profit, but has a cost to the buyer in both financial and health terms. A previous Druglink feature i by one of the authors reviewed how the forensic evidence for such cutting was missing, the numerous reasons as to why dealers wouldn't generally benefit from cutting in this way and how in fact the vast majority of cutting actually takes place prior to importation, not by street dealers. If such practices do take place, the evidence suggests they are not the norm.

How is it then that just about every time a journalist goes out on the street to either purchase street drugs or to interview dealers about what they do to drugs, they turn up 'evidence' suggesting that dangerous adulteration is routine?

This directly contradicts extensive research carried out in numerous countries. In the following stories, we will see that 'investigative journalism' turns up heroin consisting of 'ground glass', brick-dust and sand, in one instance a dealer claims that this is a regular, way of selling drugs. We also find that appearances may be deceptive and that journalists perhaps need to develop a more critical eye.

Head in the sand?
The first story, in what is an otherwise well regarded article in the Guardian, reported that heroin, 'so benign in the hands of doctors, becomes highly dangerous when it is cut by black-market dealers - with paracetamol, drain cleaner, sand, sugar, starch, powdered milk, talcum powder, coffee, brick dust, cement dust, gravy powder, face powder or curry powder'ii.

No corroboration for this statement was provided. Further to this, in a much publicised television documentary for Channel 4 upon which the article was based, the same journalist told us that they: 'filmed a dealer cutting his heroin with glucose (for bulk), ground paracetamol (for the buzz, I think) and sand (for the colour)' (personal communication).

This surprised us for a number of reasons: most evidence suggests that little cutting is actually done by those who sell on `the street' and that when it is; the cutting agent is usually a sugar such as glucose or lactose. It would be highly unusual for an `ordinary' dealer to go to the trouble of adding three different cuts when most dealers don't add anyiii. It would be even more unusual for a dealer at this level to add two cuts of relatively benign and difficult to detect substances such as glucose and paracetamol and to then add sand for colour.

Presumably, to obtain the required colour a significant amount of sand would have to be added. Sand is non-soluble and fairly easy to spot. Simply put, sand would be a foolish cutting agent to add, particularly when relative care had apparently been taken with the other two substances.

Unanswered questions
The impression given by the film is that `this is what dealers do' but the evidence available from more in-depth research in the UK, replicated in the US and Australia suggests that that is not the case. If this is what this dealer does, he would be unusual even amongst those dealers that do cut the drugs they sellvi.

So what is going on here? Enquiries to the journalist as to how the dealer involved was sourced, whether he was paid for his information and whether it was possible that he was simply giving the journalist the information that he appeared to want, were questions that went unanswered.

Could it perhaps also be that a relatively inexperienced or naive dealer might believe that this is the kind of thing he should be doing? (we have all heard the stories) and even though he didn't normally do so, he may not have wanted to be seen on national television to be lacking in street credibility and dealing acumen.

Hidden agendas
It is entirely possible that the real problem here, as is so often the case with certain types of `investigations' into the drugs world that the simplest rule of research hasn't been followed: be critical of your findings and guard against bias (respondents telling you what you want to hear) in your responses.

The broader context within which the story sits is perhaps also important. Both the Guardian piece and the television programme made a case for the provision of clean, pharmaceutical heroin to street users because most of the dangers accruing from heroin addiction are the result of black market involvement.

The point has been made elsewherev that proponents of harm-reduction and prohibition have uncritically assumed the common existence of dangerous adulteration and both use it to buttress their arguments, but provide no substantial evidence for it. It probably is the case that using pharmaceutically pure drugs of consistent strength would be better for users than buying from the black market, but that isn't a case for exaggerating the risks that pertain there.

Fake heroin
In the second `investigation', an Observer journalist was despatched to buy street drugs in three urban centres and one `rural backwater'. Forensic analysis of the drugs obtained, produced the `shocking' headlinevi: `Sweetener, stone and even ground glass were found in the drugs bought around Britain'.

This echoes a discredited 1993 Time Out article claiming that dealers used ground glass as a cutting agent. Looked at closely and with a little further investigation, the Observer story in fact reveals the opposite. Nearly all of the samples bought and tested contained relatively `normal'vii levels of purity and few cutting agents. We subjected each of the samples obtained by The Observer as well as two further street samples obtained by the second author, to more rigorous testing to determine their exact composition and diamorphine content, (see table).

The Cardiff sample that was said to contain the stone and 'ground glass' was clearly a fake sale. Importantly, it does not even vaguely resemble heroin (see picture) - no attempt had been made for it to do so. By and large, dealers have fairly regular clientele, even those on the `front-line', they also want users to return to them if possible. All dealers would like a reputation for dealing good drugs. Admittedly, some may care more than others, but no dealer lasts long by selling poor quality (never mind fake) drugs all the time. Fake drugs are likely to be sold under two primary circumstances: if the dealer is desperate to make a deal and ready to disappear afterwards, or more commonly if they think the individual is in some way not genuine, such as an inexperienced user who makes them suspicious (showing insufficient levels of being `street'), or someone like a journalist?

In this article, the journalist actually spells out how he had to learn to look like a genuine buyer. The fake he bought was his first foray into obtaining drugs. One dealer interviewed recently in Sydney, Australia declared that he did (very rarely) sell fakes but didn't bother to make them look realistic, `what's the point' he declared, `you don't want anyone to hurt themselves'. Most users have regular dealers and as such regular clientele are very unlikely to be sold fake drugs. Whichever way you look at it fake-sales will not be a common experience to the average user if indeed they ever experience it. The experience of an investigative reporter however may well differ.

Quartz not glass
All the other heroin buys tested broadly conformed to what the existing evidence about cutting suggests, although the purity of most of them was at the low end of the average range.

What of the Cardiff fake though? There was a great deal less mileage in that than was reported. The forensic scientist who tested the drugs, Jim Campbell of SureScreen, had actually written `quartz' not glass - the Observer changed the definition to suit their strident headline, perhaps believing that they were simply confirming a 'well known fact'.

Quartz is the commonest mineral on the planet. Pick up a handful of dirt, small stones, dust and the chances are very high that quartz will be found - quartz not ground glass, no sharp edges were evident! This fake is not the result of some psychotic grinding down glass to cut drugs with, it is someone picking up some dirt from the floor and using that as a fake. On detailed analysis, the heroin content of this sample was less than 0.01%!

What we find then, is that these investigations have only served to obfuscate the issues. Academic research is usually subject to peer review where the methods and assumptions of the research are questioned. The well-publicised investigations outlined above, question research without referring to it, appear to break many of the golden rules of research proper and fail to recognise their own shortcomings. Did these journalists merely report what they set out to find? We suspect so.

Analysis of test street heroin purchases
Source %Diamorhine content
Cardiff 0.01 (see note below)
Dorset 37.03
Liverpool 24.8
Edinburgh 24.56 (see note below)
Bristol 21.67 (see note below)

Sample obtained by Observer reporter.
Note 1: the purity levels reported here are substantially different to those reported on the same samples in the Observer. This is because we subjected the samples to much more rigorous testing.
Note 2: 'brown' heroin only contains around 70% diamorphine when 'pure'. 70% purity does not infer 30% cutting agents. Degredation and or other opiate alkaloids may easily account for the rest.
Note 3: these are one-off test purchases and as such, cannot be taken as representative of average purity in the above areas.

Grateful thanks to Jim Campbell of SureScreen Diagnostics Ltd for his invaluable help in testing the heroin samples, and to The Observer newspaper for allowing us to retest their samples.

At the time of writing, Ross Coomber was Principal Lecturer in Sociology at the University of Greenwich.

Jon Derricott from Exchange Supplies is a writer and trainer specialising in safer injecting and harm reduction.

i Coomber, R. (1999) `Cutting the crap: The reality of drug adulteration', Druglink, July/August, Vol 14, Issue 4, pp. 19-21.
ii The Guardian (2001) `Special Report - Drugs in Britain: Make heroin legal', Thursday, June 14.
iii For example see Coomber, R. (1997) `The Adulteration of Drugs: What Dealers Do, What Dealers Think', Addiction Research, Vol 5, No. 4. pp. 297-306
iv See i and iii above as well as Coomber, R. (1997) `Dangerous Drug Adulteration - An International Survey of Drug Dealers Using the Internet and the World Wide Web (WWW)', International Journal of Drug Policy, Vol 8, No. 2, pp. 18-28; and, Coomber, R. (1997) `How Often Does the Adulteration/Dilution of Heroin Actually Occur: An Analysis of 228 `Street' Samples Across the UK (1995-1996) and Discussion of Monitoring Policy', International Journal of Drug Policy, Vol 8, No. 4. pp. 178-186
v Coomber, R. (1997) `Vim in the Veins - Fantasy or Fact: The Adulteration of Illicit Drugs', Addiction Research, Vol 5, No. 3. pp. 195-212
vi The Observer (2002) `Drugstore Britain: How easy is it to 'score' in Britain today?', Sunday April 21.
vii Hansard 21 Apr 1999 : Column: 581.