Dear Louise Kelly
I am writing to express my concern about your press release of the 29th January regarding the further confirmed Anthrax death from December.
Firstly in para 3 you refer to the person who died as follows:
"This user died on December 12th and was therefore exposed to heroin in the early stages of this outbreak, however evidence suggests that contaminated heroin may still be in circulation, and drug users all across Scotland must remain vigilant."
To refer to a human being who has died purely by the label "This user" is offensive. This was a person, someone's son, someone's daughter. You use the term patient in the paragraph above. That is preferable. But simply refering to the individual as a man or as a woman or a person is preferable to what is a stigmatising and unpleasant label. It is also, obviously, counterproductive in terms of achieving public health goals to use language like this. One of the key findings of the Fatal Incident Enquiry into the Death of Andrea McQuillter in 2000 (and by extension into the other 43 deaths due to bacterial infection in people who inject heroin in 2000) was that it was challenging to attract people who inject drugs into health services, but that actually this was critical in terms of improving care and response. To utilise language like this - particularly in a press release which will no doubt be picked up pretty much verbatim by many media outlets - is irresponsible as it may serve to reinforce the stigma attached yo having problems with drugs and discourage people from accessing help.
Secondly in the press release you say that:
"It must therefore be assumed that all heroin in Scotland carries the risk of anthrax contamination and users are advised to cease taking heroin by any route if at all possible. While we appreciate that this may be extremely difficult advice for users to follow, it remains the only public health protection advice possible based on current evidence. Users are encouraged to find out more about support services in their area by calling Know the Score on 0800 587 5879 or visiting www.scottishdrugservices.com."
This is inconsistent with other messages which have been released and also inaccurate. The best public health advice is that people using heroin should cease to use an make every attempt to access services and substitute medication as soon as possible. This was the advice given in the letter from the Chief Medical Officer on 22nd January which also carried advice for local areas that they should look at contingency arrangements to ensure waiting times for substitute medication are minimised during this crisis.
I refer you to the findings of the Greater Glasgow Health Board Outbreak Management Team report from 2001 which recommended that there be greater co-ordination and consistency of messages in any outbreaks of this kind.
I would probably make sense for you to develop an approach to communications in this matter which reinforced the key harm reduction messages consistently rather than simply repeating that people should not use heroin.
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