San Diego County health officials announced today that three wound botulism cases have been reported in the past month. The cases are linked to injecting black tar heroin.

Public domain photo/Psychonaught
Public domain photo/Psychonaught

Two cases have been preliminarily confirmed by the California Department of Public Health and the third case is being tested for confirmation. The men are 28, 42 and 67 years old. All were hospitalized and treated with anti-toxin obtained from CDPH.  All remain under medical care.

The three cases appear to be unrelated and the sources of the black tar heroin are unknown. Investigation is continuing and additional cases may occur.

“Overdose is not the only significant health risk for people who use black tar heroin,” said Wilma Wooten, M.D., M.P.H., County public health officer. “Clusters of botulism cases associated with this drug have occurred in the county in the past, including three last year and five in 2010.”

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.

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.

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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.

Any injection drug users with symptoms of wound botulism should seek medical attention immediately at the nearest emergency department. In addition, those who use black tar heroin should stop and seek treatment for opioid addiction. “Cooking” black tar heroin and using injection practices recommended by the Centers for Disease Control and Prevention stop some blood borne infections, but will not prevent wound botulism.