Botulism infection among drug-users on the rise

In the last week there have been reports of a case of botulism in a heroin user from north-west London. The patient involved in this case had injected heroin through skin-popping and was consequently admitted to hospital with a severe infection. The heroin was bought in Watford and Harrow, two separate areas of north London and raises the likelihood that there is a significant batch of contaminated heroin circulating these and surrounding areas.

This latest case highlights the increase in the number of infections of Botulism through contaminated heroin, with 22 confirmed cases in 2009, up from only 4 in 2008 and 3 in 2007. This increase in the number of cases reflects the levels seen in 2006 and 2005 where 22 and 28 cases were reported. These infection cases have steadily increased since the 1990’s among intravenous drug users and those injecting into the skin rather than the veins.

These recent cases follow other reports of contaminated heroin in the past few months, particularly batches of heroin contaminated with anthrax in the last few months reported in both London and Scotland. The nature of the relative secrecy among heroin users means tracking and following these batches of contaminated heroin is particularly difficult and thus ensuring there is current and updated information available to users is absolutely vital in order to limit the number of cases of this deadly infection. Most fatal cases occurring from botulism infections are largely due to failures in recognizing the severity of the disease and estimates put the fatality rate of those who contract the disease at 5%-10%.

There are a number of key symptoms associated with botulism infections and they begin with blurred vision and problems swallowing and speaking followed by further respiratory difficulties and paralysis. Certain measures can be taken to remove the dangers of infection. Smoking rather than injecting should be a main priority however, if users are injecting, rather than aiming for skin or muscle, users should inject directly into the vein as the blood is far more effective at killing bacteria than skin or the muscle. Sharing of needles and syringes should be strongly resisted and levels of citric acid would be kept to a minimum as this can damage the ability of the skin and muscle to fight the bacteria which causes the infection. The injection of different drugs should also be done at different locations on the body as certain drugs like cocaine can further the spread of bacteria.



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