Injection Drug Use and Wound Botulism

Key points

• You can get wound botulism from injecting illicit drugs.
• If you have symptoms of botulism, immediately see a healthcare provider doctor or go to the emergency room.
• Tell the healthcare provider about any illicit drugs you used in the past two weeks and how you used them.

Injection drug use and wound botulism

Wound botulism can happen when Clostridium botulinum or related bacteria (germs) get into a wound and makes a toxin. This toxin attacks your body's nerves, which can make it hard to breathe and can cause muscle weakness and even death.

People who inject illicit drugs are at risk for getting wound botulism, a serious illness that can be life threatening.

Your risk of getting wound botulism increases if you:

• Inject illicit drugs under your skin ("skin popping")
• Inject illicit drugs into your muscle ("muscle popping" or "muscling")
• Inject black tar heroin

When to seek emergency care‎

If you have signs and symptoms of botulism, immediately see a doctor or go to the emergency room. **Do not wait. **

Symptoms usually do not start right away.

Symptoms of wound botulism usually do not appear immediately. They usually appear within a few days to two weeks.

Symptoms can look like opioid overdose.

Some symptoms of wound botulism can look like symptoms of opioid overdose. Opioids are painkilling drugs, such as oxycodone, oxymorphone, hydrocodone, and hydromorphone, as well as heroin.

These symptoms include slurred speech or inability to talk, weakness, and trouble breathing.

Naloxone (commonly called "Narcan®") can reverse the effects of an opioid overdose if given in time. It will **not **reverse symptoms of botulism. If you or someone you know still has symptoms after Naloxone use, seek medical care immediately.

Be direct and honest with the doctor.

Tell your healthcare providers about any drugs you have used in the past two weeks and how you used them.

Wound botulism can be mistaken for other, more common illnesses. Your doctor needs to know if you use injection drugs, so you can be diagnosed and treated quickly and correctly.

How injecting heroin can give you botulism

Every year in the United States, about 20 people are diagnosed with wound botulism. Most get it from skin popping or muscle popping black tar heroin.

We don’t know how black tar heroin gets contaminated with bacteria that cause botulism. The heroin might get contaminated when produced, transported, cut or mixed, prepared for use, or some other time.

Equipment used to prepare or inject the drug might also spread the bacteria to anyone who uses the equipment.

Key facts:

• Contaminated drugs do not look different from non-contaminated drugs.
• Lab testing is the only way to tell if your drugs are contaminated.
• Heating ("cooking") heroin will not kill the bacteria. It takes special conditions to kill this germ.
• If you share contaminated heroin or "works" with another person, both of you might get botulism.

If you are ready to quit using

You can prevent wound botulism by not injecting illicit drugs. If you are ready to quit using, these resources can help you succeed:

• Call the national help line 24/7 at 1-800-662-HELP (1-800-662-4357).
• Find a treatment center near you.
• Find a doctor experienced in treating drug addiction.The doctor may discuss options to help you quit, including counseling, peer support groups, and medication called buprenorphine.

If you can't or don't want to quit using

If you can't or don't want to stop using right now, don't share needles or "works." Always use safer injection practices. CDC's HIV Risk Reduction Tool provides information on safer injection practices you can do to protect yourself and others.

We don't know if using safer injection practices can prevent botulism. But using safer injection practices can help prevent other infections, including infection with HIV and hepatitis C virus. Reduce your chance of getting a serious illness by using clean needles and equipment and cleaning your skin before you inject.

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