As a second drug user dies of anthrax in Blackpool, a former addict explains why warnings about the disease are ignored

When Cath injected herself with heroin, unaware it had been contaminated by anthrax, her wrist immediately began to swell and turn red. The pain was shocking. But she felt only anger and irritation.

"I wanted my usual buzz," she said. "I'd been a heroin addict for 23 years. I knew I'd spiked my vein properly. I couldn't understand why the gear wasn't working."

So she injected herself a second time. This time her entire arm swelled up. The red turned to purple. It spread up towards her elbow and down towards her fingers. The pain intensified but the drug high still didn't come.

It was 2010 and Cath had infected herself with anthrax at the height of the largest single common-source outbreak of human anthrax in Britain in more than 50 years. The deaths spread across Europe: 126 cases were eventually identified, including 119 in the UK. At least 14 people died.

This week health experts said a second drug user had died of anthrax in Blackpool, weeks after the first such death in the town.

During the 2010 outbreak, everyone in Cath's community knew of the risks. Her needle-exchange clinic had posters warning that heroin contaminated with anthrax could kill and listing the symptoms. News of deaths and amputations caused by the disease spread across the drug users' grapevine. But Cath couldn't care less. "My eyes slid over those posters," she says. "I didn't think of my body as something I needed to keep alive – it was a just a piece of skin with veins that I could put drugs into."

That day, as she watched her arm turn from purple to black, she just felt annoyed that her elusive hit hadn't materialised. She injected herself a third time. Finally, the opiate kicked in.

When she woke, hours later, sweat was pouring off her and the pain in her arm was excruciating. "It still didn't occur to me that the heroin had been contaminated," she said. "I just thought it was another abscess."

Cath was so used to abscesses that she barely bothered going to hospital to have them treated, not caring that doctors had considered amputating her infected arms and feet on a number of occasions.

After three days, however, she was unable to stand the pain any longer. Diagnosed with anthrax, she was immediately put on an intravenous, antibiotic drip – the only vein to be found was in her neck. She was told an amputation was the most likely option but that death was a possibility.

"I couldn't compute that I had anthrax," she said. "It was the stuff of terrorism and war to me. But it didn't make me think I should stop taking heroin. All I was worried about was that if they amputated my right arm, I'd have to learn how to inject with my left."

Cath was lucky. The antibiotics killed the infection and on the fourth day, she was given 28 pills to take every day for two weeks and sent home. The first thing she did was to call her dealer.

Last week, for the first time since the 2010 outbreak, the European Centre for Disease Prevention and Control, and the European Monitoring Centre for Drugs and Drug Addiction admitted Europe was again in the grip of an anthrax outbreak, probably linked to contaminated heroin.

There have been 10 cases identified across Europe since early June. The official advice from the Health Protection Agency (HPA) is that more cases are to be expected.

"It's likely that further cases among people who inject heroin will be identified as part of the ongoing outbreak in EU countries," said Dr Fortune Ncube, an expert in blood-borne viruses with the HPA. "The Department of Health has alerted the NHS of the possibility of people who inject drugs presenting to emergency departments and walk-in clinics with symptoms suggestive of anthrax."

How the anthrax found its way into the heroin this time has puzzled police and health experts. In 2010, the contamination in the UK was eventually traced to a single batch infected with anthrax spores from an infected goat or contaminated hide somewhere in transit between Afghanistan or Pakistan and Scotland, probably in Turkey.

There are other causes. Heroin can be naturally contaminated after harvesting from soil where an animal had died from anthrax. It can also can be contaminated if infected bone meal is used during the cutting process.

Whatever the source, experts are highly critical of the advice that has been given to users in the past fortnight.

Often, when there is a health scare among drug users, the advice government hands down through treatment agencies is to use drugs in safer ways. With HIV, for example, users were encouraged to use needle exchanges. This time, however, the advice is simple: stop using heroin and seek help from local treatment centres, which can provide support including substitute medication.

That, according to some experts, is impracticable. They say that in an environment where it can take users six months to get access to heroin substitutes such as methadone or Subutex, asking users to stop using is futile.

The National Treatment Agency for Substance Misuse disputes this timescale. It says the average waiting time to get treatment in England is five days – the lowest it has ever been – and even quicker in an emergency.

"The HPA campaign assumes users know what they're doing," said Mark Styles, a director for the DetoxPlus and Pierpoint addiction treatment centres in St Annes-on-Sea, near Blackpool. "That's one hell of a presumption."

Styles has come across half a dozen cases of anthrax in his 16 years of working with heroin users. "They're not remotely interested in the risk of contracting anthrax," he said. "To tell someone with a drug addiction that they need to stop taking the drug, is like telling me I can't drink water."

Scott March agrees. An addict for 16 years, he eventually detoxed last year. March knows of at least four people who have died from anthrax linked to contaminated heroin. "It was scary to be using drugs, knowing it could have anthrax in, but the urge to use is so powerful, that there's no fear strong enough to stop you," he said. "Even if you knew your needle was full of contaminated heroin, the fear wouldn't be strong enough. You can't see past the denial."

In the unlikely event that users were engaged enough to care about infection, added Styles, they would probably not spot its onset. "The symptoms of anthrax are minor compared to the horrendous physical effects of taking heroin. Users are suffering so much anyway that they're simply not going to notice any difference," he said.

Cath was aware she could infect herself with anthrax a second time after leaving hospital. "The contaminated drugs were still going around," she said. "But my urge to use again was stronger than my will to live."

Nine months after her anthrax infection, however, she decided to detox. "I didn't give up immediately after having anthrax but it did make something click very subtly inside me," she said.

Cath has now been clean for two years, including more than a year of treatment. She has trained as an aromatherapist and masseuse. "If I can give up, then anyone can – with determination and good treatment," she said.

"I had anthrax, been an addict for 23 years and had got to the point where I was effectively not human: I was rotting, I lived like a rabid, stray dog. But now I love life now and my family are proud of me. When she looks at me, my mum doesn't have anguish in her eyes any more."