Monday, April 23, 2018

San Diego: 6 Cases Of Wound Botulism Among Injection Drug Users

Credit CDC


According to the CDC, about 20 people each year (in the U.S.) contract wound botulism, mostly from subcutaneous injection of black tar heroin.

A pretty low number, which makes the following headline from San Diego's Office of Communications all the more remarkable.

Three More Wound Botulism Cases Reported in County

Three more cases of wound botulism in people who injected black tar heroin have been reported in San Diego County, bringing the total to six in the past month, the San Diego County Health and Human Services Agency announced today.

Five of the cases are men and have been confirmed with botulism by the California Department of Public Health. The latest case is a 25-year-old woman who is being tested for confirmation. Although all were hospitalized and treated with anti-toxin obtained from CDPH, one of the previously reported cases, a 67-year-old man, has died.

Two of the six cases are connected, but the others appear to be unrelated and the sources of the black tar heroin are unknown. Investigation is continuing and additional cases may occur.

“This is the largest group of wound botulism cases ever reported in San Diego County,” said Wilma Wooten, M.D., M.P.H., County public health officer. “Black tar heroin users can suffer from overdose, skin infections, endocarditis, botulism, and other serious illnesses that can be life-threatening. We urge anyone who uses this substance to seek treament.”

Symptoms of wound botulism occur within days or weeks of injecting contaminated drug and may be mistaken for drug overdose. Symptoms can include weak or drooping eyelids, blurred or double vision, dry mouth, sore throat, slurred speech, trouble swallowing, difficulty breathing, and a progressive symmetric paralysis that begins at the face and head and travels down the body.

If left untreated, symptoms may lead to paralysis of the respiratory muscles, arms, legs and trunk, and can cause death. Prompt diagnosis and treatment are critical to decreasing the severity and duration of illness.

(Continue . . . .)

Beyond the everyday hazards of overdosing, Hepatitis C, Hepatitis B, HIV, Staphylococcus aureus, and even tetanus, there are exotic risks including wound botulism and wound anthrax (see Eurosurveillance: Anthrax Encounters Of The 4th Kind).
Black tar heroin is cheap, and therefore popular, but it is crudely refined and can be cut (or more properly adulterated) with a variety of substances, including (reportedly) ground up paper, shoe polish, and whatever floor sweepings might be available.  
This creates a thick, sticky substance which is difficult to inject intravenously, making skin popping or muscle popping the preferred route, which can often lead to tissue necrosis and abscesses under the skin. 

According to the CDC's Wound Botulism page:
We don’t know how black tar heroin gets contaminated with the germ that causes botulism. Because the germ lives in soil, it might get into heroin when the drug is produced or transported, when it is cut or mixed with other substances, when it is prepared for use, or through some other way. Drug-use equipment (“works”) used to prepare or inject contaminated drugs might also spread the botulism germs to anyone who uses it.
Key facts:
  • You cannot see the germ that causes botulism. Contaminated drugs do not look different from non-contaminated drugs. Lab testing is the only way to tell if your drugs are contaminated with the germ that causes botulism.
  • Heating (“cooking”) heroin will not kill the botulism germ. It takes special conditions to kill this germ.
  • You cannot get botulism from another person. It is not contagious. But if you share contaminated heroin or equipment (“works”) with another person, both of you might get botulism.
Between the nation's mounting opioid epidemic, the recent outbreak of severe internal bleeding due to rat poison laced Spice/K2, and now this latest cluster of wound botulism in San Diego, the societal and personal costs of drug abuse continue to climb.


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