Wednesday, June 13, 2018

PRO/EDR> Botulism - USA (05): (NM) wound, injection drug-related

BOTULISM - USA (05): (NEW MEXICO) WOUND, INJECTION DRUG-RELATED
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Date: Mon 11 Jun 2018
Source: Las Cruces (NM) Sun-News [edited]
<https://eu.lcsun-news.com/story/news/local/2018/06/11/officials-investigate-apparent-wound-botulism-case-dona-ana-county/692926002/>


The New Mexico Department of Health is investigating a case of
apparent wound botulism in a 21-year-old woman from Dona Ana County,
the department announced on Mon 11 Jun 2018.

The suspected source of infection is contaminated black tar heroin,
the department stated in a news release. The woman injected black tar
heroin under the skin, also known as "skin popping." The woman is
currently hospitalized.

This is the 1st case of wound botulism that has been reported to the
department in 2018. There was 1 confirmed case in Dona Ana County in
2017. It is not known whether there are other cases in New Mexico or
neighboring communities of Texas or in the Mexican state of
Chihuahua.

"We are asking healthcare providers to carefully consider wound
botulism in patients who are showing symptoms, especially if they have
a history of injection drug use," Department of Health Cabinet
Secretary Lynn Gallagher said in a statement. "People who inject drugs
should be aware of the signs and symptoms associated with wound
botulism and seek immediate medical attention if they begin to
experience any of those signs or symptoms," Gallagher added.

Botulism is a rare but serious paralytic illness caused by a nerve
toxin produced by the bacterium _Clostridium botulinum_. Wound
botulism is caused by the toxin produced from an infected wound.
Injecting heroin under the skin can cause areas where there is little
or no oxygen available which allows the organism's spores to germinate
and grow and produce a deadly toxin leading to progressive descending
muscle paralysis and death.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The following is a discussion regarding black tar heroin, which,
because of being injected intramuscularly, can subject the injected
drug user to a number of infections, including botulism, tetanus, and
necrotizing fasciitis
<http://www.drugaddictiontreatment.com/types-of-addiction/heroin-types-of-addiction/comparing-heroin-and-black-tar/>:

"Black tar heroin is a type of illegal narcotic derived from morphine.
Commonly called black tar heroin, heroin content is not actually what
distinguishes this particular drug from other kinds of opiates. While
black tar does contain an amount of heroin that can range from 29 to
80 percent, the drug is actually identified by the amount of
comparatively crude derivatives of morphine that result from
incomplete acetylation. Without delving into the chemistry too
exhaustively, black tar is an unrefined product that is made without
the complex equipment and chemicals necessary to produce heroin with a
high level of purity. Black tar is manufactured primarily in Mexico,
and is also commonly referred to as black, brown, manteca, night, or
dark. It is also produced in smaller quantities in other parts of
Latin America.

"Black tar use has spread throughout North America and can also be
found in parts of Europe. Since the drug does not require the advanced
equipment necessary to make pure heroin in white powder form, it is
relatively cheap to manufacture and therefore cheap to purchase. It is
less expensive to buy than white powder heroin, and it is much less
expensive than commonly abused prescription opiates such as Vicodin or
OxyContin.

"Black tar is distinct in appearance from white powder heroin. It
ranges in color from black to light brown, and it is sold either as a
cola-like chunk, a coarse powder, or a sticky substance with the
consistency of melted tar, hence the name. Black tar can be injected
in its tar-like form, snorted in its powder form, or smoked. The
effects of black tar are similar to the effects of other kinds of
opiates, and include feelings of euphoria, relaxation, loss of
anxiety, and anesthesia. Side effects can include nausea, vomiting,
diarrhea, constipation, and dry mouth.

"The most common method of using black tar is injection, and this
method poses risks apart from the dangers of the drug itself. For one,
black tar users frequently suffer from venous sclerosis, a condition
in which the veins shrink and harden. It may become impossible for
users to inject intravenously if they develop venous sclerosis,
forcing them to resort to subcutaneous injection. However, this method
includes its own risks, such as cellulitis and necrotizing fasciitis.
When black tar users inject repeatedly, they put themselves at risk
for contracting wound botulism due to the impurities and adulterants
present in the drug. The sticky consistency of the drug may also put
users at greater risk of HIV if they are washing needles and reusing
them.

"The cheapness of black tar has helped to make it comparatively
popular among young users who are inexperienced with drug use.
Complications from drug use are more common when users are
inexperienced. In addition, the impurities present in black tar, as
well as the inconsistent ratio of heroin present in the drug, make
overdose or death from complications due to the adulterants much more
likely. Like all derivatives of morphine, black tar is extremely
addictive. Dependency can occur after very few uses, and tolerance can
also increase rapidly, causing users to experience irresistible
cravings for increasingly large amounts of the drug." - Mod.LL

HealthMap/ProMED-mail map:
New Mexico, United States: <http://healthmap.org/promed/p/233>]

[See Also:
Botulism - USA (04): (NM) wound, injection drug-related, fatal
http://promedmail.org/post/20180422.5761852
Botulism - USA (03): (CA) wound, injection drug-related
http://promedmail.org/post/20180411.5740879
Botulism - USA (02): (AK) http://promedmail.org/post/20180323.5706323
Botulism - USA: (CA) wound, injection drug-related
http://promedmail.org/post/20180214.5628631
2017
---
Botulism - USA (13): (AK) http://promedmail.org/post/20170930.5349662
Botulism - USA (12): (NY) nitrogen-infused coffee, risk, alert, recall
http://promedmail.org/post/20170920.5329208
Botulism - USA (11): (NM) wound, injection drug related
http://promedmail.org/post/20170719.5189504
Botulism - USA (10): (CA) nacho cheese, type A toxin, unrelated 2nd
death http://promedmail.org/post/20170525.5060186
Botulism - USA (09): (CA) gas station food, nacho cheese conf, fatal
http://promedmail.org/post/20170523.5056161
Botulism - USA (08): (CA) gas station food, nacho cheese
http://promedmail.org/post/20170519.5047996
Botulism - USA (07): (CA) gas station food, nacho cheese
http://promedmail.org/post/20170512.5031065
Botulism - USA (06): (CA) gas station food, RFI
http://promedmail.org/post/20170508.5021002
Botulism - USA (05): deer antler herbal tea, FDA recall
http://promedmail.org/post/20170507.5018201
Botulism - USA (04): (CA) deer antler tea
http://promedmail.org/post/20170429.5003486
Botulism - USA (03): (TX) wound, drug-related, 2005-2015
http://promedmail.org/post/20170427.4999639
Botulism - USA (02): (CA) satay, risk, recall
http://promedmail.org/post/20170420.4982801
Botulism - USA: (CA) wound, non-drug-related
http://promedmail.org/post/20170402.4942916]
.................................................sb/ll/msp/jh
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