Rising instances of death caused by the deadliest toxin known to this planet have caused concern among heroin users and law enforcement officers who must seize the drug. Last year 21 cases of wound botulism in heroin users were confirmed. At least 15 occurred since August. While it appears that the cases were limited to California in 1995, 2 cases pending confirmation have been reported in Arizona this year.

Botulism toxin is produced from Clostridium botulism, closely related to the tetanus bacterium that is also found in soil throughout the country. The toxin is so deadly that less than an ounce slipped into the a cities water supply (Los Angeles water supply for example) could "knock off everybody," according to Dr. S. Benson Werner, state medical epidemiologist and chief of the disease investigation section of the California Department of Health Services.

Once the toxin enters the blood stream, paralysis begins. Normal symptoms are noticed as drooping eyelids, blurred or double vision, and a dry sore throat. Death occurs when the paralysis attacks the muscles used for breathing. Doctors treat the symptoms with a combination of antitoxin and antibiotics. There is no known cure.

"We're not seeing wound botulism anywheren the country with injecting drug users ...  else iIt's quite a phenomenon in the State of California," said Fred Angulo, a medical epidemiologist with the National Center for Infections Disease at the Federal Center for Disease Control and Prevention in Atlanta. However, the recent reporting of two possible cases in Arizona may change that outlook.

Wound Botulism occurs when spores get into an injection site, germinate and release deadly botulinal toxin. Drug users think that heating the heroin will sterilize it, but heat only kills the toxin. The spores survive, then germinate and produce more toxin, usually after being injected by the user. "The spore can persist in boiling temperatures for at least five hours," Werner cautioned. Anyone including law enforcement personnel accidentally injected or stuck by a heroin users needle could be exposed.

Experts suspect the spores may be getting contaminated in the poppy fields or later when the heroin is cut with sugars and starches. One pound of pure heroin is often cut to about 64 pounds of usable narcotic prior to sale on the street.

Wound botulism connected to injectable drugs first was reported in New York City in 1982. In 1988 California started confirming cases. According the Journal of the American Medical Association 1 case was reported in California in 1990; 2 cases in 1991, 3 cases in 1992, 4 in 1993, 11 in 1994 and 21 cases in 1995. In 1994 the United States only recorded 53 confirmed adult cases were reported of which California claimed 11.

Treatment can be costly. The patient receives a vial of antitoxin from horse serum (approx. cost $700). The COC pays for the antitoxin. The antitoxin neutralizes any toxin circulating in the body, but cannot reverse nerve damage caused by the illness. According to Werner, "Some people can be on a respirator three or four months and be in a hospital for five months." While recovery can sometimes be nearly complete, nerve damage often times limits a patients activities for the rest of their lifetime.

Extreme care and caution should be used when seizing and storing any needles related to heroin use. If any type of nick or puncture occur (even if the needle is old or no bodily fluids have been exchanged) immediately report the injury and have the agencies medical facility check for the possibility of wound botulism. Reporting injuries immediately is good procedure for all law enforcements personnel.

Wound botulism simply gives one more crucial reason to be certain every agency regulations and property manual requires all injuries to be reported immediately and followed up with appropriate medical treatment. 

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