Global & Disaster Medicine

Black tar heroin, skin popping: Wound botulism

Wound Botulism Outbreak Among Persons Who Use Black Tar Heroin — San Diego County, California, 2017–2018
Corey M. Peak, ScD; Hilary Rosen, MPH; Amanda Kamali, MD; et al.

“…….During September 2017–April 2018, nine cases of wound botulism were reported in San Diego County, California; all patients reported injecting heroin, and seven used black tar heroin, including subcutaneous injection in six patients. Symptoms were first attributed to drug intoxication for four patients; two received the opioid overdose reversal medication naloxone without improvement in symptoms. One patient died.

Figure is a visual abstract that discusses the recent botulism outbreak in San Diego county among black tar heroin users. Symptoms include droopy eyelids, blurred or double vision, slurred speech, and paralysis, difficulty breathing. Early administration of the antitoxin saves lives.

Increasing use of black tar heroin during the opioid crisis might lead to additional cases of wound botulism. Heightened awareness of the disease might improve timely diagnosis and treatment. Prompt diagnosis and administration of botulism antitoxin can be lifesaving….”


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