SAN DIEGO–Three more cases of wound botulism in people who injected black tar heroin have been reported in San Diego county, bringing the total to six in the past month, the San Diego County Health and Human Services Agency reports. Five of the cases are men and have been confirmed with botulism by the California Department of Public Health. The latest case is a 25-year-old woman who is being tested for confirmation. Although all were hospitalized and treated with anti-toxin obtained from CDPH, one of the previously reported cases, a 67-year-old man, has died. Two of the six cases are connected, but the others appear to be unrelated and the sources of the black tar heroin are unknown. Investigation is continuing and additional cases may occur. “This is the largest group of wound botulism cases ever reported in San Diego County,” said Wilma Wooten, M.D., M.P.H., County public health officer. “Black tar heroin users can suffer from overdose, skin infections, endocarditis, botulism, and other serious illnesses that can be life-threatening. We urge anyone who uses this substance to seek treament.” Symptoms of wound botulism occur within days or weeks of injecting contaminated drug and may be mistaken for drug overdose. Symptoms can include weak or drooping eyelids, blurred or double vision, dry mouth, sore throat, slurred speech, trouble swallowing, difficulty breathing, and a progressive symmetric paralysis that begins at the face and head and travels down the body. If left untreated, symptoms may lead to paralysis of the respiratory muscles, arms, legs and trunk, and can cause death. Prompt diagnosis and treatment are critical to decreasing the severity and duration of illness. Any injection drug users with symptoms of wound botulism should seek medical attention immediately at the nearest emergency department. In addition, those who use black tar heroin should stop and seek treatment for opioid addiction. “Cooking” black tar heroin and using injection practices recommended by the Centers for Disease Control and Prevention may stop some blood borne infections, but will not prevent wound botulism. The CDC says it is unclear how black tar heroin gets contaminated with the germ that causes botulism. People experiencing drug addiction or another substance use disorder can get help by calling the County’s Access and Crisis Line at (888) 724-7240.