The Daily Mail's embarrassingly bad drug reporting

The Daily Mail is certainly no stranger to atrociously uninformed and alarmist drug reporting, but this story from about two years ago about a "schoolboy" in England who died after snorting heroin which he thought was cocaine takes the cake. It's too ridiculous for a summary to do it justice, so I'm going to go through it line-by-line.

Francis Clapham, 16, bought the drug for £1 from a teenager in a park, an inquest heard.

Really? £1? Because that sounds like an incredibly tiny amount of heroin – so tiny that I question if anyone would really go to the trouble to make such a transaction. Your average bag of UK heroin costs £11.13 and contains 200 mg of powder that is, being generous, 50% pure, yielding 100 mg of pure heroin. Divide this by 11.13 and you get a little less than 9 mg of pure dope, which is about equivalent to two Percocets or Vicodins here in the States. Definitely not enough to kill anyone who weighs more than 10 pounds. And all these calculations are generous – how much you get for your money is a hugely dependent on how experienced you are, and people buying £1 bags of drugs of uncertain provenance generally get the dregs, if anything at all (I'd suspect that precisely of 100.00% of all "£1 bags of dope" are entirely baking soda. At most, this kid was getting the equivalent of a little less than one weak pain pill.

But after sniffing the heroin with a friend he collapsed and was taken to hospital where he was put on a life-support machine.

The drug caused organ failure resulting in brain damage through oxygen starvation and he died two months later.

Huh? Overdose deaths happen very rapidly – I've never heard of pure heroin killing someone over the span of two months – and fatalies from overdoses are very low if an ambulance is called and naloxone is used, which appears to have been the case.

The inquest heard that Francis, who did not have a history of drug taking or dealing, was drinking vodka with a friend in a park in Nelson, Lancashire, when he decided to buy the drug.

Ah ha, so the truth comes out! He wasn't only doing [incredibly tiny amounts of heroin] – he was drinking too. Mixing alcohol and heroin (or any painkillers or anti-anxiety medications) is incredibly dangerous – the total risk is greater than the sum of the individual risks – and there is established medical literature that questions the use of the term "heroin overdose" to describe what are really caused in equal parts by heroin and other CNS depressants like benzos and alcohol.

And about that lack of "history of drug taking or dealing" – says who? His friends, who are scared that they're gonna get in trouble? And I dunno how it goes in the UK, but in the US, it's almost unheard of for someone to buy cocaine before they tried marijuana, and given the popularity of ecstasy in the UK, I'm guessing coke generally comes after E, as well. And, as I'll later explain, he was clearly very drunk when this incident occurred, and those 16-year-olds who drink heavily have a tendency to do other drugs as well. So I sort of doubt that he had no history of using illegal drugs (leaving aside the fact that alcohol is definitely a drug, and I'll bet this wasn't the first time he drank).

Pathologist Dr Naomi Carter told the inquest the schoolboy contracted MRSA in hospital and had a reaction to antibiotics but would not have recovered from the brain damage he had already suffered.

Uh, okay, so he actually died of a superbug brought on my endemic overuse of antibiotics.

Not only that, but brain damage? Assuming they're implying that the brain damage "already suffered" was a result of the heroin overdose (and if that's not the case, then he manifestly did not die because of heroin), when the hell in the history of heroin use has anyone ever suffered permanent brain damage from an overdose? A search of Google Scholar reveals some cases of long-term heroin users developing brain damage, but a) it's not at all clear why, or if it even has anything to do with the heroin, and b) this 16-year-old kid, so inexperienced that he bought £1 worth of drugs that weren't even what he thought they were, seems unlikely to have been doing heroin for long.

"I only saw him taking a line of it but he might have had some more in his pocket. We had an argument about the drugs and he stormed out."

"I handed the rest of the package to the paramedics." [...]

Mr Morris added: "The drug was bought for £1 to £2 in the park."

So I guess what the title meant when it said "£1 bag of heroin" was maybe £2 worth of heroin, but really nobody knows. Well, the autopsy could tell us, but either none was done, or the Daily Mail reporter was just too lazy to look for it, or (more likely) too ignorant to even know to look for it, and what to look for. And how do they know that £2 was the maximum amount? Because the dealer, who has an obvious incentive to downplay the amount of heroin he sold the kid, told them so? (Later in the article it mentions that the dealer admitted to what he did and, given that he's a 16-year-old, was not sentenced to any "detention.")

Recording a verdict of accidental death, East Lancashire coroner Richard Taylor said: "It was clearly an accident that he took a substance which he had no idea would end in his death."

"It was entirely down to the heroin he died."

Wow, what an ignorant thing to say. First of all, it was already established that he had been drinking vodka, so to say that it was "entirely down to the heroin" is absurd and shows a total lack of knowledge of the established scientific literature. (Not to mention that 16-year-olds drinking hard liquor in a park is definitely illegal in Britain, and yet the story didn't seem too concerned about this illegal activity (but one that's societally acceptable) which contributed to his death. Secondly, should the antibiotic-resistant infection that he acquired in the hospital that ultimately killed him really get none of the blame?

For my money, I'd say that there are a few possibilities for what actually happened (given, of course, that the proximate cause of death was MSRA – or drug-induced brain damage, if you wanna be generous – not overdose):

1. He actually took a lot more heroin than claimed, and died from complications of the interaction between heroin and alcohol (and possibly benzodiazepines, which aren't mentioned). However, I have never heard of patients getting brain damage from overdoses – even alcohol-enhanced ones. Lethal overdoses are common, but given that he survived the immediate aftermath of the overdose, even the polydrug use theory seems suspect.
2. He drank a lot more than implied, and he was pretty close to death from alcohol poisoning anyway. From what I understand, brain damage is a much more likely symptom of alcohol poisoning than a non-lethal heroin overdose.
3. What everyone thought was heroin was actually something else entirely – perhaps something highly toxic. This seems unlikely, though, given that no dealer would have an incentive to use something lethal as an adulterant as opposed to something simple and safe like baking soda or a crushed aspirin.
4. Some incredibly rare reaction to one of the many substances he may have taken that day.

My money's on hypothesis 2 – alcohol poisoning – but still, the story doesn't make much sense, and the only thing we can say for certain is that the Daily Mail is publishing alarmist misinformation that will ultimately obscure the true risks of drug use and drug prohibition.