Wound Botulism (Clostridium botulinum)

Wound borne botulism is the most rare form of botulism in US.  It accounts for about 3% of total botulism cases per year.  It occurs when wounds contact soil or dirt containing botulism spores.  After this, the effects of the toxin are basically the same as the food-borne botulism in which the toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The paralysis usually starts at the eyes, moves to the face, then to the throat, the chest, and finally to the extremities, sometimes winding up in death.  It can be prevented by keeping wounds clean from sources of contamination.

    However, recently the cases of wound botulism have been on the rise due to the surge in numbers of Western US drug users, which can be attributed to the enormous success of the Mexican drug cartels in introducing “black tar heroin.”

What is Heroin?

The source of opium is the opium poppy from the plant Papaver somniferum.  The earliest historic records exist in ancient Sumeria (circa 4000 BC).  Fossil remains of poppy seed cake and poppy pods have been found in the Swiss lake dwellings of the Neolithic Age, showing that opium was known to European civilizations at least 4000 years ago.  Opium reached China in 7th century via the Silk Route.

In 1803, the German pharmacist F. W. Serturner isolated the principal alkaloid in opium, morphium.  The invention of the syringe and the discovery of other alkaloids of opium soon followed: codeine in 1832 and papaverine in 1848. By the 1850s, the medicinal use of pure alkaloids, rather than crude opium preparations, was common in Europe.  Moreover, this morphine was extensively used during the American Civil War, creating an army of drug addicts.  In 1898, there were an estimated 250,000 morphine addicts in the US, most of them veterans.

In this same year, as head of Bayer's pharmacological laboratory, Heinrich Dreser launched heroin (diacetylmorphine), which was converted from morphine, as a common cough medicine, and was met by worldwide success.  Heroin is 150-200% more effective than morphine depending on the method of intake into the body.

Today, the major legal opium production areas in the world today are in government-regulated opium farms in India, Turkey, and Tasmania (Australia). The major illegal growing areas are in Southwest Asia (Afghanistan, Pakistan, and Iran) and in the highlands of Mainland Southeast Asia (Burma, Laos, Vietnam, and Thailand) —popularly known as the “Golden Triangle.”  Some of these industries were propped up by the CIA during the Cold War to combat threats of Communism.  Opium poppy is also grown in Colombia, Mexico, and North Korea, and Lebanon.  
How Heroin Works
Heroin acts as a transport chemical, delivering more morphine to the brain because it crosses the blood-brain barrier more quickly than morphine. Once in the brain, it is morphine that heroin breaks down into that gets the user high.
So if heroin breaks down into morphine before crossing the blood-brain barrier, it is much less efficient: about 1/3 as efficient. With a half-life of two minutes, most of the heroin ingested orally breaks down into morphine. More or less the same thing happens when inhaling. Inhalation is a very efficient means of ingesting drugs--there is very little drug loss. But it is slow and as a result, most of the heroin inhaled is converted to morphine before it reaches the blood-brain barrier.
Heroin is most effective when administered in a way that delivers it to the blood stream quickly: intravenous injection, subcutaneous injection, and smoking.
Black Tar Heroin, A Way to “Cheap High”

    In the early 1970s, almost all heroin bound for US came from the Golden Triangle, through Marseilles, France, creating a virtual monopoly.  The police were able to be victorious over this French Connection, however, and today, three major distributors are available for the American market: France, Mexico, and Colombia.  

Heroin users now have a choice and the heroin distributors are acting more like legal businesses. For example, the heroin coming out of Mexico was relatively poor in the late 1980s and early 1990s; it had purity levels in the 20% to 30% range. At the same time, Colombian heroin was coming into America with purity levels averaging above 60%. The Mexicans were losing market share and so they started to increase their purity levels. Today, Mexican heroin has an average purity level above 40%.

In addition to increased purity levels, the heroin being sold throughout the world has come down in price. From 1984 to 1994, the price of a gram of heroin was cut in half (in real dollars).   Part of the reason for this reduction in price was the introduction of black tar heroin.

Black tar heroin is produced only in Mexico. Black tar heroin may be sticky like roofing tar or hard like coal, and its color may vary from dark brown to black. The color and consistency of black tar heroin result from the crude processing methods used to illicitly manufacture heroin in Mexico. Black tar heroin is often sold on the street in its tar-like state at purity ranging from 20 to 80 percent. Commonly, black tar heroin is sold in small foil or cellophane packets or in small toy balloons.

Black tar heroin is most frequently dissolved, diluted, and injected. Black tar heroin addicts place a small amount of black tar heroin in a spoon. The spoon they use is bent so that it sits level without spilling when placed on a table. Then they add a small amount of water, which is then heated over a flame. Once the black tar heroin has melted it is drawn up into a syringe and injected.

Southern California, primarily Los Angeles, is a major transportation and distribution hub for Mexican black tar heroin and brown powdered heroin destined for drug markets in California and throughout the United States. Nearly all of the heroin produced in Mexico is destined for U.S. distribution, and Mexico-based heroin continues to dominate the market in the western half of the United States.
Why Does BTH = Wound Botulism?

    Black tar heroin is crudely processed and is highly likely to contain strains of Clostridium botulinum or spores.  “Skin popping,” injecting drug under skin and “mainlining,” injecting drug directly into the vein are most efficient ways for taking in heroin into the body, which increase chance of introducing Clostridium botulinum into the body.  Moreover, some dealers cut BTH with material contaminated with dirt.

    In California, where wound botulism is most predominant, the government is trying to combat illegal drug usage.  As a part of their efforts, state and local governments have passed regulations that control syringes.  This forces drug users to reuse and even share syringes with others, increasing the chance of botulism epidemic.

    Botulism spores are resistant to heat, boiling, and desiccation.  Cleaning the skin and cleaning syringes have no effect on toxin-producing spores.  The only way to prevent BTH-related wound botulism is not doing BTH or avoiding injection methods.