The ongoing opioid epidemic that has engulfed the country continues to have wound care implications. Health officials are now warning that clinicians be aware of the potential for wound botulism, a rare but potentially fatal illness that is caused by skin popping, a method of injecting in which the user injects a drug under the skin instead of into a vein or a muscle (muscling).
According to recent reports by the Centers for Disease Control and Prevention (CDC) and U.S. News & World Report, the condition has become associated with the use of black tar heroin, a cruder form of the drug that is most dangerous when injected under the skin. The substance has reportedly been found mostly in states west of the Mississippi River and is primarily being sourced from Mexico. According to U.S. News & World Report, more than 40 confirmed and likely cases of wound botulism occurred in California alone last year, with one fatal case occurring in San Diego County. According to the CDC, San Diego County has accounted for nine cases (eight confirmed, one probable) between September 2017 and May 2018, when the county generally sees just one case per year. More than 350 cases were reported to the CDC between 2001 and 2016, with 291 cases reported in California, including 15 in San Diego County. Reported reasons for the increase in cases include bad batches or increased use of black tar heroin, more users injecting the drug through skin popping, more pathogen in the environment, or a combination of such factors, according to the report by U.S. News & World Report.
Wound botulism occurs when the bacterium Clostridium botulinum gets into a wound and makes a toxin that attacks the body’s nerves, which can make breathing difficult and cause muscle weakness or death. It is treatable with antitoxin, but any consequences suffered prior to treatment cannot be undone, according to the CDC. A lengthy hospital stay may also be required. The CDC also warns providers that wound botulism symptoms are similar to those of opioid overdose and can thus be difficult to differentiate. San Diego County officials issued alerts in October 2017 and April 2018 about the rise in cases, and in April, officials said the increase represented “the largest group of wound botulism cases ever reported in San Diego County,” according to the U.S. News & World Report.