Shaikh’s death: how many would 4kg of heroin really kill?
On Christmas Eve this was part of the Chinese statement about the impending execution of Akmal Shaikh:
Akmal Shaikh was convicted and sentenced to death penalty for serious drug trafficking on solid evidence. In fact, 150mg of heroin of high degree of purity would be lethal. The amount of heroin he carried was 4030g, enough to cause 26800 deaths.
Of course, this is misleading claptrap and anyone with a firing neurone will raise an eyebrow at these numbers. It is possible to do a ‘back of an envelope’ calculation of how many deaths 4kg of heroin might cause.
Let’s imagine that the whole 4kg of heroin got through to London. In the UK purity runs at around 40% so by the time the heroin is cut with the usual crap then there might be approximately 10kg to sell. Now, generally heroin is sold in £10 bags and the NTA Treatment Outcome Profile form (used to monitor drug treatment in the UK) regards 0.2g as the equivalent of a street bag. The annual Drugscope survey suggested it is more likely to be about 0.15g but for this simple calculation we’ll stick with 0.2g heroin per bag. So, that gives us 10,000 grams or approximately 50,000 street bags.
I would suggest that a moderate heroin habit might be around 3 bags of heroin daily – that’s pretty middle of the road and possibly on the low side if anything. It would need around 46 users taking 3 bags per day for 365 days to use up the 4kg. Let’s say they eke it out a bit and we will round it up to a nice even 50 users.
The estimated mortality of heroin users is undeniably high. One study in Spain which followed a cohort of heroin users showed an annual mortality of 3.4%. However, a UK cohort study over 22 years in London gave an average annual mortality of 1.84%. For this calculation we’ll go for 2% – I suspect this is probably a bit on the high side; treatments have improved and the first study readily admitted that it had an unusually high mortality.
But we’ll go with it and a mortality of 2% works out at as one death in our notional cohort of 50 users smoking 3 bags daily until the 4kg of heroin is gone.
The statistic presented by the Chinese is clearly misleading. There is a bleak irony in Shaikh’s death by injection and in a stroke the Chinese have doubled the death toll attributable to 4kg of heroin.
Of course, this is all largely a side issue and the arguments around the death penalty seldom dwell on such a trite analysis of the numbers. Perhaps the Chinese (and certainly a large number of Daily Mail readers) may suggest justice is still served if there is a single death that can be blamed on drug smuggling. And I would readily agree that the wider costs of heroin addiction have a much wider impact.
However, we may not agree on how to manage the issue of drugs. If the Chinese are going to bandy around meaningless statistics to justify their tawdry policies then the numbers deserve some scrutiny.
Particularly when they are used to justify a grim act of abject inhumanity.
This is a well observed and important point but you omit to mention that the vast majority of heroin mortality risk is associated with the drugs illegality; unknown strength and purity contributing to overdose risk and infection (note the recent anthrax deaths in the UK), with marginal unhygenic/unsupervised using environments and the high risk behaviours they promote (sharing etc) compounding the problem and maximising risks.
Illustrating the point is the fact that no one has ever died of an overdose in a swiss-style supervised heroin clinic, nor has anyone received anthrax infected heroin or contracted blood bourne diseases through sharing and dirty needles. In such scenarios (supervised use and pharmaceutical supply) heroin related mortality falls to near zero, indeed prescribed heroin users have the same life expectancy as non users.
There is nothing new in drug war propaganda twisting statistics, and whilst the murderous Chinese need it more than most, we play much the same games here. See here: http://transform-drugs.blogspot.com/2007/11/transform-commentry-in-british-medical.html
Yes, absolutely fair point and well made. The mortality risk is almost all attributable to the illegality and the illicit nature of the use. I didn’t go into it as this story is something of a ‘perfect storm’ when it comes to controversial issues – death penalty, drugs trade, mental health issues, China and human rights, and even the Afghan war have been dragged in.
You mention the Swiss heroin clinics – but I am not sure you mean ’shooting galleries’ or the use of IV heroin in a small group of treatment-resistance users. There weren’t any deaths in the recent NAOMI study looking at IV heroin but there were some fairly significant adverse effects including convulsions and OD. While the clinical setting was obviously able to manage them and there were no deaths the use of heroin even in that setting isn’t completely without risk. However, I still agree with your main point.
Shaikh was executed at the Chinese government’s belief that drug smuggling is murder by extension, and so for the protection of Chinese citizens such criminals must be harshly punished. It is impossible to take the Chinese government’s ‘concern’ for the lives of Chinese citizens impacted by drug addiction seriously while the directors of the China National Tobacco Corp are respectable members of society.
China National Tobacco Corp deals tobacco to one-in-three of the world’s cigarette smokers. This corporation services the addictions of 350 million Chinese people with a product which will kill more than 150 million of them. If the Chinese government were true to its word about needing to protect its citizens from drug-related health problems, addiction and death then we would surely see the directors of the national cigarette conglomerate on death row. However, the ‘once-removed murderers’ of the China National Tobacco Corp not only remain unpunished for the undoubted lethal impact of their drugs, but are rewarded as captains of industry.
This double-standard fatally undermines the credibility of both the Chinese and the UK’s drug regimes; both country’s policies are constructed over this central hypocrisy.
Some drug-users with interests in equally-harmful drugs are more equal than others. Users and traders of certain potentially-dangerous drugs face trial and execution, while other users and traders of certain *other* potentially-dangerous drugs enjoy full rights of possession and commerce over *their* dangerous drugs, and even benefit from state-subsidised addiction.
Re. the adverse effects of the way illegal drugs are sold and used, one of our pathology lecturers (a man who is such a natural comic performer that he obviously missed his alternative calling as a stand-up) gives a well-attended medical student lecture each year on Deep Vein Thrombosis. This always includes a little bit where he mentions the different ways in which injecting illicit drugs can cause thrombi of various kinds. One that always elicits gasps of horror from the students is the bit where he invites them to consider a heroin addict shooting up in a cubicle in the pub toilets and asks them:
“So… where do you think the water comes from…? …and what sort of things do you think might be in it?”