Botulism in heroin
The Public Health Laboratory Service of England and Wales has reported three suspected and one confirmed case of wound botulism during 2002 among injecting drug users.
Symptoms begin with blurred vision and difficulty in swallowing and speaking, but sometimes diarrhoea and vomiting can occur. The disease can progress to paralysis and breathing problems. More than 90% of cases are treated successfully but it can prove fatal. The recovery period can be for many months.
The bacterium is anaerobic — it only grows in the absence of oxygen. Wound botulism in injecting drug users tends to occur when the drug user injects into the muscle rather than into veins. If the bacterium gets into the muscle it can grow easily because it is an oxygen-free environment. It is believed that an infected batch of heroin may be the cause of the outbreak. GPs, hospitals and drug services across the UK are being informed of these cases to ensure they are vigilant for symptoms of botulism.
More detailed information can be found on Public Health Laboratory Service website at:
The Public Health Laboratory Service have advised injecting drugs users to be particularly careful. They state:
- There is no way that you can tell if your heroin is likely to cause this infection.
- Smoke heroin instead of injecting.
- If you must inject, do not inject into the muscle or under the skin: make sure you hit the vein – your blood is better at killing the bacteria than your muscle.
- Do not share needles, syringes, cooker/spoons or other ‘works’ with other drug users.
- Use as little citric acid as possible to dissolve the heroin. A lot of citric acid can damage the muscle or the body under the skin, and the damage gives bacteria better chance to grow.
- If you inject more than one type of drug, inject each at a separate place on your body and with clean works for each injection. This is important because certain drugs (e.g. Cocaine) could give bacteria in heroin a better chance to grow.
- If you get swelling, redness or pain where you have injected yourself, or pus collects under the skin, you should get a doctor to check it out immediately, especially if the infection seems different to others you have had in the past.