Seven people in San Diego have died in the last two months from a flesh-eating bacteria associated with black-tar heroin use, prompting public health officials to warn the medical community to be on the lookout for additional cases.
The San Diego County Health and Human Services Agency reported Wednesday that the seven people died from myonecrosis, a severe infection that destroys muscle tissue. The dead ranged in age from 19 to 57; five were male.
They were among nine people admitted between Oct. 2 and Nov. 24 to county hospitals with the condition after injecting black-tar heroin, a dark, sticky drug that often contains impurities resulting from crude processing methods.
Two remain hospitalized. One is expected to survive; the other is “quite ill,” said Dr. Eric McDonald, medical director for the epidemiology program at the county health agency.
Dr. McDonald said the outbreak of myonecrosis was the most serious the county has seen in 10 years, although there have been similar outbreaks in California in the late 1990s and early 2000s.
“You just have to recognize it really early and have early surgery, and give antibiotics really quickly, and hope that not enough toxin has been produced to cause death,” Dr. McDonald said in an interview.
The source of the heroin is unknown and an investigation is continuing, the county said. Most black-tar heroin is produced in Mexico and sold in the United States west of the Mississippi River, according to the National Institute on Drug Abuse.
Dr. Wilma Wooten, a county public health official, said people who use black-tar heroin are not only at higher risk of dying from an overdose, but also more prone to developing myonecrosis and wound botulism, a rare but serious illness that attacks the body’s nerves.
The county asked the medical community to be on alert for additional cases of both conditions.
Symptoms of myonecrosis include severe pain and swelling around a wound or injection site; pale skin that quickly turns gray, dark red, purple or black; blisters with a foul-smelling discharge; air under the skin; and fever.
Signs of wound botulism include drooping eyelids, blurred vision, slurred speech, trouble swallowing and difficulty breathing. The condition can cause paralysis that begins at the face and head and travels down the body.
The county warned that “cooking” black-tar heroin does not kill the bacteria that causes wound botulism.
In October, the county confirmed its first case of wound botulism from black-tar heroin use this year. Seven cases were reported last year and three in 2017.
Across Southern California, 13 probable and confirmed wound botulism cases, mostly among black-tar heroin users, have been reported since Sept. 1, the county said.
Dr. Paul Little, medical director at the Laguna Treatment Hospital, an addiction treatment center in Aliso Viejo, Calif., said he hoped the seven deaths would prompt black-tar heroin users to seek treatment.
“If you ever see a wound like this, it’s pretty devastating,” he said. “It’s just another situation where it shows the dangerous epidemic of the opioids we’re facing now.”
