SAN DIEGO _ A death and six cases in only one month have San Diego County's public health department sounding an alarm about wound botulism among the region's black tar heroin users.
According to the county Health and Human Services Agency, a 67-year-old man died recently despite being treated with antitoxin after he was hospitalized with botulism symptoms, which can range from double vision and slurred speech to drooping eyelids and difficulty swallowing.
Dr. Sayone Thihalolipavan, the county's deputy public health officer, said it's the largest concentration of wound botulism cases ever recorded in San Diego County and the man's death appears to be the first in the county caused by the disease, spurring heightened vigilance in local emergency rooms, intensive care wards and drug treatment centers.
"It's definitely very concerning because we haven't seen this many cases before, we're not aware of similar cases in surrounding counties, and we've already had one death. That's why we're trying to do everything we can to get the word out," Thihalolipavan said.
He said it's the street drug itself that appears to be the problem. Investigators suspect that there is a supply of black tar heroin in the community that is infected with clostridium botulinum, the bacteria that produces the powerful neurotoxin that causes wound botulism.
It's extra bad news for a drug treatment community already struggling to respond not just to black tar heroin smuggled across the border with Mexico but also with the trend of creating fake heroin by mixing the potent painkiller fentanyl with other ingredients designed to mimic black tar heroin. A bad mixing job makes overdose more likely.
Jeanne McAlister, chief executive of the McAlister Institute, a large drug and alcohol treatment center in San Diego, said that she and her employees have noticed a sustained increase in the availability of black tar heroin on local streets as the price of prescription opioids increases because of a crackdown on overprescribing.
"It's cheaper and more potent at the same time, and it's much more available, absolutely," McAlister said. "I just know that, if I wanted to, I could walk out on the street and in two blocks be able to buy something."
She said the main focus of treatment centers is currently overdose. The idea that the drugs people are taking may be contaminated with deadly bacteria has not yet entered the public consciousness.
"We're going to have to keep an eye out for that for sure," McAlister said.
Left untreated, wound botulism causes progressive paralysis, starting with the face and moving toward the legs. The most severe complications occur when the toxin paralyzes the muscles of the chest, causing respiratory failure.
As to why San Diego is seeing an uptick in wound botulism cases while other Southern California counties aren't, Thihalolipavan said investigators have found no clear answer. They have discovered, however, that those who have been infected have not been part of the same homeless population recently hit by the region's deadly hepatitis A outbreak.
The fact that these infections are occurring among drug users makes diagnosis more difficult. Many of the symptoms of wound botulism are similar to those of heroin overdose, and it may take some time to discover the true cause.
"Even if they're seeking treatment, providers might not be recognizing it for what it is," Thihalolipavan said. "Patients can think they're feeling out of whack due to the drug itself and not realize that the drug is actually contaminated."
