Persons who inject drugs should be aware that, although safe injection practices can reduce the risk for some blood-borne infections (e.g., human immunodeficiency virus and hepatitis), wound botulism remains a risk when injecting or skin popping black tar heroin. ([section]) Clinicians caring for persons who inject drugs or persons who fail to respond to naloxone need to perform thorough searches for wounds, be alert for wound botulism, and inform patients of this potentially lethal consequence of injection drug use.
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.
Increasing use of black tar heroin during the opioid crisis might lead to additional cases of wound botulism.
Wound botulism associated with black tar heroin. San Diego, CA: County of San Diego Health and Human Services Agency, Epidemiology and Immunization Services Branch; 2017.
Update: wound botulism cases associated with black tar heroin. San Diego, CA: County of San Diego Health and Human Services Agency, Epidemiology and Immunization Services Branch; 2018.
Wound botulism associated with black tar heroin among injecting drug users.
When federal investigators broke up a sophisticated Mexican drug ring in Lane County in 2007, the familiar black tar heroin sold on the streets dried up.
Black tar heroin is still around, "but it's considered garbage," he said.
During the search, a cache containing 25 kilograms of black tar heroin
, more than 100 bags containing remnants of black tar heroin
,approximately 10 pounds of ammonium nitrate liquid,50 gallons of homemade explosive material,four jugs prepared for use as improvised explosive devices and seven mortar rounds were seized and destroyed,it claimed.