'BLACK TAR' HEROIN ADDICTS PRONE TO BOTULISM

Worst risk from injecting directly under the skin

Botulism, the deadly disease widely feared as an agent in biological
warfare, is striking drug addicts who inject a crude drug known on the
street as ``black tar'' heroin.

The drug has become widely used throughout the West Coast in recent years,
and California health specialists have found that addicts who inject the
black, resinous form of heroin beneath their skin or into their muscles run
a major risk of contracting severe cases of wound botulism.

Of 35 addicts studied by doctors with the California Department of Health
Services, all but two required long hospital stays before recovering and
all but five had to be placed on respirators when paralysis of their lungs
threatened to halt their breathing.

The study of the problem is being reported today in the Journal of the
American Medical Association by a team that included Dr. Douglas Passaro,
now an infectious disease specialist at the Stanford University Medical
Center and Dr. Duc Vugia of the state health department in Berkeley.

The doctors followed 26 of the botulism patients and compared them with a
control group of 110 addicts who were recently enrolled in methadone
clinics in four California counties but did not develop the disease.

According to Vugia, the most serious danger of contracting the paralyzing
disease comes from a practice known as ``skin popping,'' where instead of
injecting a drug into a vein an addict thrusts it directly beneath the skin
or into a muscle.

In their study, the physicians found that nearly all the addicts who
developed wound botulism had been ``skin popping'' the drug, while only 44
percent of the men and women in the control group used the crude heroin
that way.

The botulism germ, called Clostridium botulinum, is closely related to the
bacterium known as Clostridium tetani, which causes tetanus, a disease also
known to be common among users of black tar heroin -- especially those who
``skin pop'' the drug.

Both the bacteria are earth-dwelling microbes that thrive best without
oxygen, and because blood is rich in oxygen, wound botulism rarely strikes
addicts who inject the drug into their veins, Vugia said. All the addicts
in the study were careful to use clean syringes in order to prevent AIDS,
he said, so the most likely source of the dangerous bacteria must be the
crude black tar heroin, which is sold cheaply and is often contaminated
with plant material and dirt.

According to Greg Hayner, the pharmacist at the Haight Ashbury Free Clinic
in San Francisco, the use of black tar heroin is increasing sharply as its
price drops. A quantity that used to sell for $100 now goes on the street
for $20, Hayner said, and addicts who ``run out of veins to shoot'' are
turning more and more to the dangerous types of injections.

)1998 San Francisco Chronicle Page A2