Wound botulism is a rare but serious illness associated with black tar heroin use, especially by subcutaneous injection (skin popping).
(%) of patients Sign/Symptom Subjective muscle weakness 9 (100) Difficulty swallowing 8 (89) Blurred vision 8 (89) Drooping eyelids 7 (78) Slurred speech 7 (78) Difficulty breathing 5 (56) Double vision 5 (56) Descending paralysis 5 (56) Abscess 5 (56) Complication Hospitalization 9 (100) Endotracheal intubation/Mechanical ventilation 6 (67) Death 1 (11) Self-reported illicit drug use Heroin 9 (100) Intravenous injection 9 (100) Black tar heroin 7 (78) Subcutaneous injection (skin popping) 6 (67) TABLE 2.
Tissue trauma, effects of the drug and its fillers, speed ball injection (mixture of heroin and cocaine), booting (drawing back blood before injecting again, usually with unsterile syringes) and skin popping. (21) Skin popping is the most important contributory factor for skin and soft tissue infections and also infections are usually multiloculated and more extensive.
Necrotizing fasciitis is uncommon but potentially life threatening complication particularly seen among IDUs who employ skin popping. This infection usually presents with pain out of proportion of examination & hypothermia or hyperthermia.
Cutaneous necrosis and necrotizing ulcers may develop among IDU users due to several factors like employing skin popping technique, pharmacological effects of the drugs like cocaine which can cause vasoconstriction & thrombosis or due to irritant properties of drug & adulterants, vascular thrombosis & infection.