Wound Botulism Associated With Black Tar Heroin Among Injecting Drug Users

CONTEXT.— Wound botulism (WB) is a potentially lethal, descending, flaccid, paralysis that results when spores of Clostridium botulinum germinate in a wound and elaborate neurotoxin. Since 1988, California has experienced a dramatic increase in WB associated with injecting "black tar" hero...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 1998-03, Vol.279 (11), p.859-863
Main Authors: Passaro, Douglas J, Werner, S. Benson, McGee, Jim, Mac Kenzie, William R, Vugia, Duc J
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Botulism
Botulism - epidemiology
Botulism - etiology
California - epidemiology
Case-Control Studies
Drug addictions
Female
Health risk assessment
Heroin
Humans
Injuries
Likelihood Functions
Male
Medical sciences
Middle Aged
Multivariate Analysis
Regression Analysis
Risk Factors
Statistics, Nonparametric
Studies
Substance Abuse, Intravenous - complications
Toxicology
Wound Infection - epidemiology
Wound Infection - etiology
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Summary:CONTEXT.— Wound botulism (WB) is a potentially lethal, descending, flaccid, paralysis that results when spores of Clostridium botulinum germinate in a wound and elaborate neurotoxin. Since 1988, California has experienced a dramatic increase in WB associated with injecting "black tar" heroin (BTH), a dark, tarry form of the drug. OBJECTIVE.— To identify risk factors for WB among injecting drug users (IDUs). DESIGN.— Case-control study based on data from in-person and telephone interviews. PARTICIPANTS.— Case patients (n=26) were IDUs who developed WB from January 1994 through February 1996. Controls (n=110) were IDUs newly enrolled in methadone detoxification programs in 4 counties. MAIN OUTCOME MEASURES.— Factors associated with the development of WB. RESULTS.— Among the 26 patients, the median age was 41.5 years, 15 (58%) were women, 14 (54%) were non-Hispanic white, 11 (42%) were Hispanic, and none were positive for the human immunodeficiency virus. Nearly all participants (96% of patients and 97% of controls) injected BTH, and the mean cumulative dose of BTH used per month was similar for patients and controls (27 g and 31 g, respectively; P=.6). Patients were more likely than controls to inject drugs subcutaneously or intramuscularly (92% vs 44%, P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.279.11.859