Question - The use of black tar heroin poses a heightened risk for wound botulism attributable to its production, preparation and mode of use. How do each of these parameters (production, preparation and mode of use) contribute to the increased risk for the development of wound botulism in users of black tar heroin?
Answer- The cited resource notes “Black tar heroin is a dark, gummy drug primarily produced in Mexico and often contains adulterants to increase bulk or contaminants introduced during illicit transport to the United States, such as inside car tires or other unsanitary locations where the drug might be exposed to soil containing C. botulinum spores. Preparation of black tar heroin for injection through cooking does not destroy C. botulinum spores, which can survive high heat and later germinate to produce BoNT. Skin-popping can create an anaerobic environment of necrotic tissue in which BoNT can be readily formed and released. (Peak CM et al. Wound botulism outbreak among persons who use black tar heroin- San Diego County, California, 2017-2018. MMWR Morb Mortal Wkly Rep 2019; 67: 1415-1418)