26 November 2013

Head-shops: Regulation or Prohibition

This is our chance to have a radical shift in drugs policy. But we're going to end up with more prohibition...again.

Recent legislative proposals and media coverage have pushed the subject of “head-shops” to the top of the drugs agenda. It has also been a recurring theme for me in recent workshops, hence this article, to explore head-shops more closely, especially in relation to the retail and regulation of Novel Psychoactive Compounds (NPCs).

Though no statutory figures exist, anecdotally there has been a significant increase in the number of head-shops in the UK. The Angelus Foundation[1], says that there are in excess of 250 in the UK, based on on-line research and liaison with trading standards. As they acknowledge, this may not be an accurate figure. Part of the problem in counting head-shops is that (a) there is no clear definition of what would constitute a “head-shop” and (b) there is no licensing or regulatory framework that would enable local authorities to keep track of such shops.

For the purpose of this article, I am going to consider a head-shop to be any retail outlet where a significant proportion of its sales includes NPCs or other psychoactive substances.

Head-shops have proliferated in step with a growing market for NPCs. The growing availability of un-regulated psychoactive compounds has coincided with cheap empty retail units in town-centre locations. There are a number of independent traders, and a smaller number of chains. The ambience, product range and willingness of outlets to ‘self-police’ vary massively.

Workshop observations: The issue of head-shops has cropped up repeatedly during recent workshops. In a number of different areas, participants have noted the sudden and significant impact that the arrival of a new head-shop has had on local drug patterns. This has included changes within night-time economy, impact on door-staff, presentations in custody and A+E, and demands on drug services.

Sadly, much of the reporting is anecdotal. There is no routine recording of NPC usage and its links to Hospital admission, drug service usage, or offending behaviour. As such, reports from agencies of local shifts in use and behaviour are hard to evidence. But the consistency and regularity of these reports in workshops makes them compelling and hard for me to ignore.

Head-shops v. On-line retailing: A key concern is that head-shops, rather than on-line retailers that provide the more ready access point to people under 18s. Most of the websites require some form of credit or debit-card payment and this, combined with the requirement to have things delivered to the home, acts to some extent as a barrier to younger purchasers.
Head-shops on the other hand are much more accessible and accept cash payments. They also remove any lingering misgivings about home deliveries or using cards online.

Head-shops also allow for more impulsive, less considered use. The process of ordering online, the selection process and the delayed delivery mitigate against impulsive use (to an extent.) Whilst a punter may purchase impulsively, they may be more considered than when buying in a shop. So the presence of a town-centre head-shop may provide a readily accessible point for the impulsive purchase of NPCs by younger people.

Conversely, a counter argument can be made FOR head-shops. Their products may be risky, but the same can be said for wholly unregulated street drugs. Does the presence of a head-shop undermine street drug markets, providing a less risky alternative? This argument has certainly been made by colleagues noting that in areas with easy access to unregulated NPCs they have seen less injection of mephedrone. But conversely some areas with easy access to legal white powder stimulants from head-shops have seen injecting of these compounds in place of street drugs.

At the very least some head-shops will at least try to ensure that they don’t sell to under-18s, through measures like checking ID. This at least provides a modicum of control which doesn’t exist in street settings.

The pressure for change: At present the media are building up a fine head of steam in relation to head-shops and politicians are not far behind. The odds are the present situation will not be allowed to continue. There are two courses of potential action – to regulate the industry or to clamp down on it.

The Angelus Foundation is pushing for such an approach, supporting an amendment to the Antisocial Behaviour, Crime and Policing Bill, [i] which says:

It is an offence for a person to supply, or offer to supply, a psychoactive substance, including but not restricted to-
(a) a powder;
(b) a pill;
(c) a liquid; or
(d) a herbal substance with the appearance of cannabis,

which  he knows, or has reasonable cause to believe, to be so acting, that the substance is likely to be consumed by a person for the purpose of causing intoxication.

This clause would require significant revision in order to be viable. At present it would probably make it illegal to sell tea and coffee, and the simple measure of dying a product like “Exodus Damnation” pink would get round the strictures of clause (d) in the proposal. As it stands it wouldn’t criminalise end users and doesn’t result in the closure of shops.

The response in Ireland has been subtly different and creates a system of Closure Notices and Closure Orders for head-shops selling intoxicated substances.[2] This piece of legislation importantly includes a “reverse burden of proof,” requiring retailers to prove to the court that a product was NOT sold for human consumption, irrespective of any wording on packaging.
Further, importantly, the legislation doesn’t criminalise end-users but does provide scope to close down retailers. The Mirror[3] claims that this legislation reduced the number of head-shops from “
from 100 to six in three months.”

In lieu of regulatory or prohibitive legislation, a variety of piece-meal responses have emerged. The use of the Intoxicating Substances (Supply) Act 1985 was successfully used in Leeds.[4] Attempts to use Trading Standards legislation failed in Chester due to a botched case.[5]
Police enforcement action against head-shops in Wales used more conventional approaches, including charges for drugs offences related to cannabis and charges for money-laundering.[6]

Elsewhere Police and Trading Standards have been more and more inventive, exploring other branches of legislation relating to cosmetics, chemical storage and fire safety to apply pressure to head-shops. There are many such avenues that could be explored. For example, synthetic cannabinoids, sold as “herbal incense” would need to be safe to use as instructed – when placed on a incense burner. As they would release toxic, intoxicating fumes if heated they would be an easy target for Trading Standards in their current form – they are not safe or fit for purpose as “incense” or “pot-pourri.” But this is a temporary measure – it would be easy to relabel the product to side-step this issue.
Another potential issue is the insurance of head-shops. It will be interesting to see how many shops are covered for building insurance if they cover significant amounts of chemicals on site, and if they have valid employer’s liability insurance given the chemicals on site.

All the interventions so far have been prohibitory and restrictive rather than regulatory. However, they haven’t resolved the issue of NPCs and prohibitive responses may have their own unintended consequences.

Sale of NPCs is not restricted just to head-shops. There is a thriving market in less typical retail outlets ranging from newsagents through to fast-food shops. This is an issue that has recently been highlighted by Max Daly in Drugscope.[7]  So restriction or banning of head-shops runs the risk of driving the products in to a range of other outlets which could be still harder to regulate.
We have already seen that as an existing product is prohibited they are firstly discounted massively on websites and post-prohibition sold via other outlets including car-boot sales, pubs and under the counter in head-shops. With no mechanism for regulating shops or reimbursing retailers post-prohibition, it is inevitable that prohibition will see residual products dumped on to the market.

Clamping down on head-shops does nothing to address on-line side of distribution which would persist even if head-shops were closed down. It’s worth noting that the primary distribution channel for mephedrone prior to it becoming a controlled drug were on-line suppliers, rather than head-shops.
And it’s also worth stressing that it easier to hold a shop-based retailer to account than a virtual one.

Regulation would require a significant step change in terms of drug strategy. It must be said that some of the current head-shops see themselves as having some moral and social values and endeavour not to supply to younger people. But the lack of a regulatory framework and the moral ‘flexibility’ of some outlets means that head-shops are certainly not “off-limits” to younger purchasers. One participant on training recently described how her existing older clients were up in arms about the behaviour of the local head-shop, as they saw children in school uniform queuing for NPCs.

The current legislative and regulatory framework is confusing and widely misunderstood. And in truth the current options for agreeing a regulatory framework are distinctly limited.

A key option would be to require “head-shops” to be licensed by a Local Authority. This could open up a range of control options including:

  • Vetting and training of staff
  •  Requirements to check ID in relation to age
  • Control over where shops can open and when they can trade
  • Capacity to remove licences in response to emergent problems.

Regulation requires licensed substances: At present there are some limited legal barriers to the sale of products that are NOT controlled drugs or medicines.
Whilst many of the NPCs currently sold carry “adults only” or “not for under 18s” badges there is limited legal basis for this. The rationale for such voluntary age-restriction is more politic than legal. By attempting to legal sales to “informed adults” retailers are slightly better protected from litigation. It may also have been intended to reduce political and media ire but is clearly becoming less effective in this regard. 
It is also intended to protect retailers from falling foul of the Intoxicating Substances Supply Act (1985) which makes it an offence to supply an inhalable product to a person under 18 where it is known that it will be used for intoxication. Originally intended to deter the sale of solvents, it has also been applied to the sale of some NPCs.

The key obstacle to regulation is the legislation relating to the sale of medicines. At present products are sold “not for human consumption,” and variously sold as “research chemicals” or other flags of convenience, so that they do not fall foul of the Medicines Act.

The greater the extent to which retailers acknowledge that their products are sold for the purpose of intoxication, the more the products are likely to fall within the scope of the Medicines Act. In itself, this doesn’t happen just because a retailer gives a customer advice about a substance.  So when for example the Daily Mirror says “Legal highs: Store worker flouts drug laws to dish out drug advice to customers[8]” this isn’t strictly accurate. The provision of advice on its own doesn’t put the retailer on the wrong side of legislation. But it DOES make it easier for the Borderline Products Team at the MHRA to conclude that the product in question is being sold for the purpose of ingestion and as such should be considered a medicine. However, to reach this stage, the MHRA would have to consider and reach such a decision and, until such a decision was reached, the substance in question would still not be subject to the strictures of the Medicines Act.

So whilst the provision of verbal advice about doses and choice of compound nudges retailers closer to restriction under the Medicines Act, it’s a long way from having a product or family of products labelled “medicines” by the MHRA.

Where the provision of advice about choices or usage does leave retailers more exposed is in the event of someone suing for damages – citing breach of Duty of Care.

At present retailers shelter behind the “Not for Human Consumption” claim which is often backed up by assertions that the product should not be ingested and medical help sought if taken. This wording is in part a defence against products being brought under the Medicines Act. But it is just as important as a defence against civil litigation.

If a product were sold as a “legal high,” and the user were harmed as a result of taking it, it should be possible to sue the supplier, or possibly the manufacturer. The retailer would have to demonstrate that they had taken “reasonable care” to avoid “actions or omissions” that they could “reasonably foresee” could cause harm to (for example) a purchaser.

In most legitimate retail settings, this “reasonable care” would involve ensuring that the products were as safe as possible, fit for purpose and packaged appropriately with information on how to use the product safely.

At present, with NPCs retailers attempt to side-step the risk of being sued by the wording on packaging. It may well be that anyone attempting to sue a retailer for harm arising from use would fail, because the retailer could reasonably argue that the products were not intended for consumption and were clearly labelled as such.

This defence could however be undermined if the retailer also gave advice about consumption. It would then be easier to demonstrate that the retailer was aware of the use to which the product was probably going to be put, irrespective of the wording on the package.

Ultimately such a decision would need to be made by a court. But herein lies our stumbling block.

If head-shops were somehow licensed or brought within the ‘harm-reduction’ fold, then they would no longer be able to shelter behind the “not for human consumption” dodge. The very act of describing how to use specific products more safely would hole the defence against negligent claims below the waterline.

So while on the one hand it may be desirable to encourage NPC retailers to work collaboratively with drug services to develop safer retail models, they would in turn need to ensure that their products were safe to consume – probably an insurmountable barrier for most retailers. It would also mean that the substances would likely fall under the purview of the Medicines Act.

In order to achieve licensed, regulated head-shops, we would also need products which could be licensed and regulated too, requiring changes to the Medicines Act, Misuse of Drugs Act, and a slew of other pieces of legislation. We would probably need to adopt an approach more like New Zealand, which allows for the sale of products whose safety has been adequately demonstrated.

Over the next few months, it seems more likely that the indirect methods of policing head-shops mentioned earlier will be replaced by prohibitive legislation. It would be really desirable if instead we could have a sensible discussion. Are we safer with regulated head-shops which can be licensed and vetted? Possibly. Can we achieve this unless we also licence some of the products that they sell? Probably not. And is the Government going to explore this as an option as part of their exploration of responses to NPCs? Well, never say never but there will be few people more astounded than me if they do.

[1] http://www.prnewswire.co.uk/news-releases/over-250-headshops-in-uk-are-selling-legal-highs-says-angelus-foundation-232476221.html
[2] http://www.attorneygeneral.ie/eAct/2010/a2210.pdf
[3] http://www.mirror.co.uk/news/uk-news/legal-highs-labour-looking-clamp-2715685
[4] http://www.westyorkshire.police.uk/news/men-charged-landmark-legal-highs-case
[5] http://www.chesterfirst.co.uk/news/122737/case-against-chester-legal-high-shop-owner-dismissed.aspx
[6] http://www.southwalesargus.co.uk/news/10765334.Five_released_on_bail_following_raids_in_Newport_and_Cwmbran/
[7] https://pressfolios-production.s3.amazonaws.com/uploads/story/story_pdf/50357/503571385371333l7hrMWTLRGE8jGSPOYMw.pdf
[8] http://www.mirror.co.uk/news/uk-news/legal-highs-uk-skunkworks-worker-2644152

[i] http://www.publications.parliament.uk/pa/cm201314/cmpublic/antisocialbehaviour/memo/asb52.htm

28 October 2013

Krokodil Feeding Frenzy

Bad journalism and dodgy bulletins increase confusion and fear over desomorphine

 About twenty years ago, the Observer ran an article entitled "Ice Storm Cometh," detailing the experience of Crystal Meth in Hawaii, with police chiefs warning how it would devastate here next. Cue numerous senior Police Officers undertaking 'fact-finding missions' overseas, and American DEA bods coming here and briefing on the peril.

Since then it's been fairly quiet on the meth front; use has crept up slowly and is becoming a more significant issue in London in some parts of the club scene. But like the crack epidemic of which we were also warned, we've been spared the worst excesses so far.

But the media do love a good drug scare story. And the new villain in town is desomorphine. Except that's not very exciting so the Russian slang term Krokodil gets used instead.

Despite the fact that there's not been a single, toxicology-confirmed case of desomorphine use in the UK, it hasn't stopped the media running hyperbolic stories, shot through with factual errors and topped off with salacious graphic images of infected wounds. The mainstream media have been bad enough but the on-line and 'citizen media' have been just as irresponsible in their reporting.

So what's been said and what do we really know?

About the drug: 

 Desomorphine is the shortened chemical name of the drug dihydrodesoxymorphine. This drug was first synthesised and patented in the 1930s. It was marketed in Europe under the brand name Permonid as a short acting potent opiate analgesic.

As a drug in its own right it shares the same risks as other powerful opiates - risk of dependency, overdose, and risks relating to non-sterile injecting practices. As a drug, correctly synthesised in sterile conditions, it is not going to destroy body tissues or cause infections. So it is utterly erroneous to describe it as the "drug that eats addicts." The drug itself does no such thing. But contaminants in the drug and injecting practice can and will cause infections. The drug is widely referred to by its slang name Krokodil. The exact reason for this are unclear. Numerous articles claim it's because the necrotised, wounded skin of injectors looks reptilian. Others argue that during the conversion process an intermediate product called Clorocodide is produced, and Krokodil is a play on this term.

Desomorphine is synthesised from codeine ( 3-methylmorphine). There are a number of ways this can be done. One uses some of the same processes involved in the conversion of pseudoephedrine to methamphetamine, chemicals including phosphorous and iodine.

Often the chemicals involved in a synthesis will sound far more dangerous than they really are, especialy in the hands of a journalist. So for example ammonia may be involved in a synth or an extraction. it was widely used to make freebase cocaine in the sixties and seventies. So when reports say "ingredients include household cleaners" it is probably a reference to ammonia. Likewise, solvents are often required. So the presence of solvents like petroleum or kerosene are not going to be uncommon. Hydrochloric acid is routinely used to acidify base drugs, including pharmaceutical compounds. It just sounds much more spectacular in the media.

A key source of codeine will be pain-killer tablets. Tablets also contain lots of other material besides the active drug: fillers and binders, coating, flavourings and so on. A commonly available source of codeine, co-codamol tablets will contain a low dose of codeine alongside a high dose of paracetamol. If the paracetamol isn't successfully removed, it will end up causing significant liver damage with repeat use.

It is possible, with time and effort, to remove all these adulterants, and using a clean synthesis process end up with desomorphine.

In practice the end product will invariably be highly impure, and will include tablet residue, leftovers of the chemicals used in the synth, and other additives which may or may not intensify the hit - antihistamines, anti-nausea tablets, caffeine, benzos etc.

Desomorphine, if of high quality, would (according to wikipedia) be 8 - 10 times the strength of morphine (or effectively 3 times the strength of heroin/diamorphine) but with a shorter period of effect 1-3 hours.

Problems related to desomorphine use:

As a strong, short acting opiate, desomorphine use is likely to cause significant problems, especially when injected. The short duration of effect means that dependent users will need to use more frequently - starting to enter withdrawal after three or four hours will get in the way of sleep or other activities.
The short duration of effect also means more injections and this inevitably speeds up vein damage and wounding.

All these problems are going to be worsened by poorly-made street 'krokodil,' the slang name for the home-made desomorphine used in Russia and the Ukraine. The various chemicals used may be toxic, especially in high doses, and the presence of other contaminants increases the risk of infection. 

These problems are made much worse in Russia by the limited availability of treatment services for drug injectors. There is a desperate shortage of effective needle exchange, woundcare and opiate substitution therapy. This means that injectors will routinely reuse equipment, that wounds will go untreated until they are life-threatening, and alternatives such as methadone hard to come by.

So the pictures of "krokodil" with the clains that the drug is "eating victims" should be properly captioned stressing that a combination of poor chemistry, lack of sterile injecting equipment and poor treatment interventions caused these problems.

Desomorphine in the UK? 

So far there have been no confirmed cases of desomorphine use in the UK. However that hasn't stopped various commentators and the media talking up the drug. And if there's one way to increase interest in a substance amongs potential users, it's to write incessantly about how strong and dangerous it is. 

Concern about desomorphine in the UK have been fuelled by some ill-advised bulletins, some commentary from medical sources and some abysmal journalism. 

In July 2013 a warning started to circulate in Gwent, Wales,saying "
"there is in circulation mephedrone (MCAT)cut with petrol.  This is being both sniffed and injected.  It does smell of petrol.  Injecting is resulting in burns / serious wounds / necrosis around injecting sites.  It is reported to be being cut in Wales, following attempts to replicate what is being sold in and around Bristol.  It is being called various things including Fert and Crocodile."

This warning and follow up discussions were highly confusing. They were largely based on second-hand reports from users and there was no analysis (as far as I know) of this "mephedrone cut with petrol." What the bulletin and the subsequent media coverage did was create the idea that a product being called "Crocodile" was being sold, that it involved petrol in the mix, and that it was causing serious injecting complications.

So for example Wales Online cited Controlled Drugs liaison officer Roger Booth, saying  "there is a circulation of mephedrone cut with petrol.This is being sniffed and injected.Injecting results in burns and wounds leading to necrosis, it’s called crocodile – not to be confused with Krokodil.

Interviewed in the same article  Booth goes on to say "The only reason I can think they are using petrol [to cut with mephedrone] is because it allows them to take it in another way as it’s normally in powder form.”

This all sounds very serious but makes very little sense. Mephedrone is a water soluble drug which means it needs no further chemical treatment to make it injectable. The idea that adding petrol would be added either as a 'cut' or to 'take it another way'  is nonsense of the first order. 

Further, petrol is highly volatile (vaporises easily at room temperature) and so even if mephedrone were contaminated with a solvent like petrol, it would rapidly vaporise from the powder if left open at room temperature. 

Possible explanations include that someone was trying to remove another contaminant from mephedrone using a hydrocarbon as a solvent or it was another drug imported dissolved in a solvent. Possibly some mephedrone being sold was cut with something insoluble in water and users were using a solvent like petrol to make it injectable. But importantly this whole story so far lacks any of the drug being analysed.

One would hope the local drugs agency would help stop the myths spreading but instead Kaleidescope seemed to have added even more speculation, with Martin Blakeborough quoted in the same article saying: "It’s a very nasty concoction. It reacts to your skin , creating abscesses and it effectively burns your skin. It’s a very nasty drug because in many ways petrol is worse than mephedrone.Normally when people snort glue or petrol they do so because it acts as a hallucinogenic but in this instance I’m not totally sure what they get from it, perhaps it gives them a bit more of a rush.”

A couple of months later the issue of desomorphine was given a major lift in the media thanks to an article in the Gloucester Citizen in which local Doctor, Allan Harris rattles through a list of drugs that he's heard a bit about and makes some loosely factual statement about each. On Krokodil he says "Another drug coming into fashion is Krokodil. It is caused nasty necrosis, or cell death. It has come from Russia and is very unpleasant. There are plenty of warning signs that it could be in Gloucester. It is cheap and nasty and causes damage to the point where you can see someone’s bones through their skin."

This article didn't elaborate on these "plenty of warnings," but the Independent picked up on the Story giving Doctor Harris a whole article to expand on this. And the evidence in the Independent? . in an article shot through with errors Harris says "To date I have only seen one patient where I suspected he’d used Krokodil." The reason for this suspicion? Client saying they'd used this substance? Toxicology? No. "He had been a long-term heroin user, but suddenly lost a great deal of muscle tissue from gangrene at the site of an injection."

Dr Harris didn't get to expand on the evidence for this being Krokodil in this article. But Vice picked up on the Independent story and piled error on top of error with the willing help of Dr Harris, who had by this time clearly developed a taste for media attention.. So in an article entitled Has Krokodil, the Flesh-Eating Street Drug, Made Its Way to the UK?a 'journalist' conducts an interview with Dr Harris. 

Near the start there's an interesting point - where the writer says "We tried to negotiate whether to call the drug “krokodil” (from the Russian) or to Anglicise it now that it had made its way over from the mainland and start referring to it as “crocodile”. (I've used the former here, but Dr Harris was pretty adamant about using the latter.)" Two important points here, both underlined:

  • the article now asssumes it is "over here" and
  • the term Krokodil and term Crocodile are being mixed up, when Crocodile was already causing confusion as as term in Wales for some mephedrone that may have a petrol smell.
So the interviewer asks about the case mentioned in the Independent which Dr Harris thinks may have been Krokodil. He says:

"It’s a bit retrospective really because it was a few years ago now. At the time, I just thought it was the citric acid burns of a heroin user, but looking back the tissue destruction was far, far in excess [of what you'd expect from that]. When you get citric acid issues you usually get second-degree burns, but this actually took out a huge crater of all the forearm muscle. When you took out the dead tissue you could actually see the tendons moving at the base of this crater and the bones as well – so pretty much like these horrific pictures you see on the warning leaflets for krokodil... Looking back, it didn’t fit at all with citric acid because that’s an irritant but no worse, really, than a slight infection. This was actually very, very disproportionate."

The person in question had subsequently died, and the interviewer asks if it has been confirmed that Krokodil was involved. Dr Harris says "Investigations are ongoing. I couldn’t say for sure, I’m afraid. We’re still waiting on the toxicology results from the coroner."

Based on this Dr Harris appears to have had a client who had a very severe bacterial infection following injection. Many bacterial infections can cause the severe tissue damage and necrosis described by Dr Harris. In point of fact many of the injuries attributed to desomorphine and it's "flesh eating" properties are the result of bacterial infection through contaminants in the mix or non-sterile injecting practice. 

By the sounds of it no tissue samples were taken, and no identification of the pathogen causing the wound or the drug injected is now possible. but based on it looking like pictures of krokodil wounds, Dr Harris has been willing to be quuoted repeatedly saying he thinks it may have been Krokodil.

Astonishingly, before the end of the article, it does get worse, and goes in a loop back to the Welsh Mephedrone/Petrol/Crocodile story when Dr Harris abandons chemistry and grammar in one fell swoop saying "They’re krokodilising Mkat – you know, “meow meow” – to make it injectable and more potent so we’ve seen more intravenous mephedrone use recently to compensate for the reduction in heroin."

So the claim being made now is that the rationale for adding petrol to mephedrone was to make it more potent and injectable.Mephedrone should be water soluble without addition of any other chemicals, provided it hasn't been adulterated with an insoluble cut. And petrol only features in the production of desomorphine as a solvent. 

So thanks to a confusing, unsubstantiated briefing from Wales and a Doctor in Gloucester who has piled further unwarranted assertions on top of each other, and some journalists unable to fact check and take unconfirmed single-sources we end up in a position where the following has become "fact"
  • krokodil is in the UK
  • MCAT is being treated with petrol as a way of "krokodilising it.
Not wanting to miss out on the Krokodil feeding frenzy, the Huffington Post arrives late at the table  with an attention-grabbing headline: 'Krokodil' Trend Of Flesh-Rotting Drugs Hits UK.

Having little new to add the article is salaciously padded with pictures of injecting wounds. The article starts with the claim "Branded "cannibal heroin" for literally rotting users from the inside out, it costs £5 a hit on the street and contains a toxic mix of codeine, gasoline, paint thinner, industrial cleaning oil, and alcohol."

There's not a single source mentioned for this availability or price point. And it hadn't been branded "Cannibal heroin" until the Huff needed a snappy name for it. Once again Dr Harris appears for a quote, saying ""I've already treated one case and I'm sure that in the coming years I will see more." Other drugs workers who tried to balance the piece, stressing that there was no confirmed evidence that Krokodil was on sale in the UK were selectively quoted and their caveats disregarded.

The article also builds on the mephedrone/petrol idea saying Mephedrone "after a spate of alleged deaths...disappeared into obscurity. Now, it has been reincarnated as an injected drug to rival crack and heroin, with experts warning its use is parallel to the deadly krokodil...Police have warned mephedrone is being mixed with petrol and the toxic combination, unsurprisingly, reacts to skin, creating abscesses as it effectively burns flesh. Dr Harris, along with police officials, have branded the trend "krodilising" for having the same fixing process and level of addictiveness."

Despite the unwarranted reporting in the Huff article, it was recirculated by agencies including, unbelievably, Drugscope, who should have been writing corrective pieces not redistributing the offending article.

In Conclusion

 The use of Krokodil in Russia is clearly a significant health issue The loss of life and wounds are horrific but importantly are not caused by the drug desomorphine per se. The risks stemming from a poorly-made short acting drug are worsened by poor access to needle exchange, healthcare and treatment.

There may be desomorphine being prepared and used in the UK. It's certainly possible. But there's no evidence of it at this time.  Relatively low access to OTC Codeine should reduce the risk of it becoming a mass-market drug as is claimed in Russia.
There are certainly people injecting mephedrone and, since prohibition the quality of mephedrone has become more variable. Irrespective of the addition of petrol or not, there is plenty of evidence that mephedrone injecting can cause serious soft tissue infections. 

And we have plenty of things to be aware and concerned about - some potentially stronger-than-average heroin in Wales and Milton Keynes; deaths related to PMA in pills sold as Ecstasy.

What we desperately don't need is wildly inaccurate articles which start off as supposition and hearsay, and over a couple of months morph into fact thanks to poor journalism and professionals who should really be more careful with what they say. There is clearly a public health lesson here. But it's not about desomorpine. It's the reporting of desomorphine.