What is already known about this topic?
Wound botulism is a rare but serious illness associated with black tar heroin use, especially by subcutaneous injection (skin popping).
What is added by this report?
During September 2017–April 2018, nine cases of wound botulism were reported in San Diego County, California; all patients reported injecting heroin, and seven used black tar heroin, including subcutaneous injection in six patients. Symptoms were first attributed to drug intoxication for four patients; two received the opioid overdose reversal medication naloxone without improvement in symptoms. One patient died.
What are the implications for public health practice?
Increasing use of black tar heroin during the opioid crisis might lead to additional cases of wound botulism. Heightened awareness of the disease might improve timely diagnosis and treatment. Prompt diagnosis and administration of botulism antitoxin can be lifesaving.