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November 4, 1998

Wound Botulism Associated With Black Tar Heroin—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(17):1479-1480. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-17-jbk1104

In Reply.—We used several lines of reasoning to conclude that contamination by C botulinumspores occurs when heroin is "cut" during distribution within California. First, proper skin cleansing should reduce the number of C botulinumspores on the skin, and our finding that skin cleansing did not prevent WB is evidence that skin is not the source of spores. Dr Bamberger and Mr Terplan imply that the primary reason skin cleansing is performed before drugs are injected is to inactivate microorganisms. However, unless prolonged skin preparation is undertaken, the primary aim of skin cleansing is to mechanically remove bacteria. Brief contact with soap or alcohol is helpful because it promotes solubilization of skin oils and the removal of contaminants.1

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