title: Development of a filter to prevent infections with spore-forming bacteria in injecting drug users.
abstract: In heroin injectors, there have been a number of outbreaks caused by spore-forming bacteria, causing serious infections such as anthrax or botulism. These are, most likely, caused by injecting contaminated heroin, and our aim was to develop a filter that efficiently removes these bacteria and is also likely to be acceptable for use by people who inject drugs (i.e. quick, simple and not spoil the hit).
  
  
  
  A prototype filter was designed and different filter membranes were tested to assess the volume of liquid retained, filtration time and efficiency of the filter at removing bacterial spores. Binding of active ingredients of heroin to different types of membrane filters was determined using a highly sensitive analytical chemistry technique.
  
  
  
  Heroin samples that were tested contained up to 580 bacteria per gramme, with the majority being Bacillus spp., which are spore-forming soil bacteria. To remove these bacteria, a prototype filter was designed to fit insulin-type syringes, which are commonly used by people who inject drugs (PWIDs). Efficient filtration of heroin samples was achieved by combining a prefilter to remove particles and a 0.22 μm filter to remove bacterial spores. The most suitable membrane was polyethersulfone (PES). This membrane had the shortest filtration time while efficiently removing bacterial spores. No or negligible amounts of active ingredients in heroin were retained by the PES membrane.
  
  
  
  This study successfully produced a prototype filter designed to filter bacterial spores from heroin samples. Scaled up production could produce an effective harm reduction tool, especially during outbreaks such as occurred in Europe in 2009/10 and 2012.
authors.affiliation: Department of Pharmacy and Pharmacology, Claverton Down, Bath, BA2 7AY, UK.
authors.forename: Nour
authors.initials: N
authors.lastname: Alhusein
authors.affiliation: Department of Pharmacy and Pharmacology, Claverton Down, Bath, BA2 7AY, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Scott
authors.affiliation: Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kasprzyk-Hordern
authors.affiliation: Department of Pharmacy and Pharmacology, Claverton Down, Bath, BA2 7AY, UK. a.bolhuis@bath.ac.uk.
authors.forename: Albert
authors.identifier: 0000-0001-9307-0515
authors.initials: A
authors.lastname: Bolhuis
mesh_terms: D001412:Bacillus subtilis / Q000302:isolation & purification; D001431:Bacteriological Techniques / Q000295:instrumentation*; D004340:Drug Contamination / Q000517:prevention & control*; D004867:Equipment Design; D005374:Filtration / Q000295:instrumentation; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D040261:Harm Reduction; D003932:Heroin; D006556:Heroin Dependence / Q000382:microbiology; D006801:Humans; D011108:Polymers; D013171:Spores, Bacterial / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000382:microbiology; D013450:Sulfones
chemical_list: D011108:Polymers; D013450:Sulfones; C022840:polyether sulfone; D003932:Heroin
keywords: Anthrax; Bacterial spores; Filter; Heroin; PWIDs