In January, President Barack Obama declared a state of emergency in Flint, Michigan over the city’s water supply, which had been contaminated with lead after the water source was switched from Lake Huron to the Flint River. Residents have developed a slew of health problems like hair loss and stomach pain. Children face long-term neurological risks.
Since drinking the water causes such significant health problems, we wondered: Is the crisis affecting drug-users who have injected the lead-poisoned water directly into their veins?
Local treatment providers and harm reduction advocates in Flint, Michigan were as perplexed as they were interested by our question. The consensus was, this can’t be good—and there may be some specific negative consequences.
But it’s not necessarily what you might think: Lead experts say that the quantity of water injected by a drug-user would be so much lower than the amount absorbed by drinking—despite its going directly into the bloodstream—that shooting lead-contaminated water wouldn’t lead to similarly dangerous lead levels in adults.
“If one were to inject, say, 5 mL at 5ccs of lead contaminated water, the lead would be fully absorbed–it’s going directly into the vascular system,” toxicologist Dr. William Sawyer tells The Influence. Even with full absorption, the amount of lead in the bloodstream does not compare to the amounts typically consumed by other means like drinking. “If one were to drink a liter of contaminated water, that would be roughly 200 times more lead. The only difference is when you drink water with lead, not all of it is absorbed. Some of it passes through the gastrointestinal tract.”
“The injectable amount is really very, very small compared to what is being consumed through drinking water or tea or coffee or baby formula. It’s not a significant dose,” Dr. Sawyer says.
Still, Dr. Sawyer notes there are other dangers to injecting with Flint’s lead-contaminated water: “The big problem is that the intravenous injection should be of the correct pH and it should be of the correct ionic strength that is the right amount of sodium and potassium.”
“In other words, think of a fish that lives in salt water, and now you’re gonna throw that fish into Lake Michigan,” he says. “We are made of salt water. You just can’t put tap water into a person.” He suggests using a saline solution instead, to prevent damage to the veins.
Holly Bradford, coordinator at San Francisco’s Drug Users Union, says her group offers saline in addition to water ampules as part of safer-injection kits for drug-users.
“Sterile water from an unopened ampule is the safest source, followed by boiled water,” says Matt Curtis, policy director of VOCAL-NY, which runs a syringe exchange program. “In most places in the US, tap water is probably not going to result in infections or other harms, but it depends on the source.” Curtis notes that saline is better on the veins, but rougher for fully dissolving drugs into the solution.
“There is a hierarchy of risk, and tap water at least in many cases is not at the top of the list of bad possibilities. In this case we’re talking about a city with a single syringe exchange program with limited hours,” Curtis continues. “Flint and Michigan state officials should be making sure that people who inject drugs have an opportunity to protect themselves, which means supporting better access to safe injection supplies and education on the risks of using contaminated water.”
Curtis worries that regular injection may still cause build-up of lead in the bones, where it’s stored over time. “Poisoning symptoms may not be initially severe and may mimic symptoms caused by some drugs (e.g. constipation) or mental illness (memory loss, depression) and thus be misdiagnosed or just assumed to be the result of regular drug use,” Curtis says. Another toxicologist shared Curtis’s concern, although with caution.
“If you’re injecting a spoonful or a couple spoonfuls of water, you’re not getting as much water as you would in a glass of water, but as a drug user you might be doing it often, so even though the individual dose is small, cumulatively over an extended period of time, you might get a fairly large dose because lead increasing in the blood is eventually stored in bone,” says Dr. Harry Milman, consulting toxicologist and president of ToxNetwork.
Wellness AIDS Services, a non-profit in Flint, Michigan provides community resources including a weekly syringe exchange. Open once a week for three hours, it’s the only syringe exchange in Flint.
Their kits include six packs of water, which Director of Programs Teresa Springer worries is insufficient. Their group is conducting surveys with clients to determine access not only to water for injection, but for drinking. Springer expresses concern that police presence at some water distribution points may deter drug-users, and that some clients have continued cooking with the water and drinking from a filter and experienced head and stomach aches.
Following our inquiry, Wellness AIDS Services surveyed eight participants at their most recent syringe exchange session. Only one person had been injecting with tap water, and has since stopped.