San Diego, California - Three cases of wound botulism in men who injected black tar heroin have been reported in San Diego County within the past month, the San Diego County Health and Human Services Agency announced.

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.”

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.

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.

The CDC injection practices are:

  • Use only new sterile needles and works each time you inject.
  • Never share needles or equipment used to prepare heroin for injection.
  • Clean used needles with bleach only when you can’t get new ones.
  • If you inject drugs to get high, use sterile water to fix drugs.
  • Clean your skin with a new alcohol swab before you inject.
  • If you inject around other people, be careful not to get someone else’s blood on your hands or your needle or equipment.
  • Dispose of needles safely after one use.

The CDC says it is unclear how black tar heroin gets contaminated with the germ that causes botulism. See CDC information on wound botulism.

People experiencing drug addiction or another substance use disorder can get help by calling the County’s Access and Crisis Line at (888) 724-7240.