Orange County, CA health officials are reporting at least three cases of wound botulism during the past month in adults who injected “black tar heroin”. This are the first such cases reported in the county in three years.
All were hospitalized and two required admission to the intensive care unit.
The Orange County Health Care Agency (OCHCA) says most people with injection drug-associated botulism are users of so-called “black tar heroin”, a specific preparation of heroin. Risk is also higher for those who inject the drug directly into tissues, as opposed to veins (skin popping).
California has experienced an epidemic of botulism associated with black tar heroin use in recent years, with more reports of botulism associated with heroin use (50 cases from 2009 to 2012) than any state in the country.
Black tar heroin has been an issue in the US and Europe for years and in addition to California, Washington state has seen outbreaks in recent years.
Mexico is frequently the source of black tar heroin which is a thick gummy substance and because of this it needs to be diluted. Many experts believe the source of the botulism is in the “cutting agent” which is believed to be things like dirt and honey.
Wound botulism is one of five types of botulism (foodborne, infant, Adult intestinal toxemia and iatrogenic botulism are the other four).
Wound botulism occurs when spores of Clostridium botulinum contaminate a wound, germinate and produce botulinum neurotoxin in the body. Most wound botulism cases have been among intravenous drug users.
The OCHCA says the symptoms of botulism include muscle weakness that starts in the head and neck muscles and then moves down the body to involve the arms and then legs; slurred speech; double or blurry vision; and trouble swallowing. In severe illness respiratory muscles are involved and respiratory failure may occur.
Persons with botulism need to be hospitalized for treatment. Severe illness and death can occur in persons whose disease is not recognized early in its course. The only specific treatment for botulism is botulism antitoxin, which should be given as early as possible to ease symptoms.
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