The Risks of Black Tar Heroin

The sticky black heroin that is widely seen west of the Mississippi is associated with a variety of unique health risks. Most of the unique risks of black tar heroin are related to the way the adulterants in the drug clog veins and make long-term intravenous heroin use difficult – which leads to subcutaneous injections, and a wide range of other health risks.

Subcutaneous drug use is associated with a greatly increased risk of soft tissue infection. Some of these infections can be fatal.

Venous Sclerosis

The high quantities of impurities in Mexican black tar heroin can cause vein hardening and narrowing.

Wound Botulism

Botulism is a very rare and very dangerous paralytic toxin disease caused by the ingestion of the clostridium botulinum bacterium. With wound botulism, the toxic bacteria infect an open wound. Black tar heroin is sometimes contaminated with these bacteria, and injection drug use can lead to wound botulism. Any form of botulism is a very serious and often fatal disorder that requires immediate medical intervention.

Seventy-five percent of all cases of wound botulism in the United States occur in California, a statistic that experts attribute to the prevalence of black tar heroin use within that state. Overall cases of botulism in the U.S. are increasing, due to what the U.S. Centers for Disease Control and Prevention (CDC) calls "an epidemic of Mexican black tar heroin abuse in California."

Necrotizing Fasciitis (Flesh-Eating Disease)

A very dangerous deep tissue infection that can lead to limb amputations and even death, necrotizing fasciitis is seen far more commonly among black tar heroin users than in the general population. The most frequent cause of the disease by black tar heroin users is the bacterium Clostridium Sordellii.

Untreated necrotizing fasciitis is fatal in almost 75 percent of cases.


Because black tar heroin users have difficulty injecting the drug into their veins, many inject subcutaneously into the skin or muscle. The anaerobic environment of a subcutaneous injection wound presents the perfect environment for the growth of Clostridium infections, such as tetanus.

Tissue Necrosis (Tissue Death)

Injecting subcutaneously (skin popping) can result in localized tissue death.

Lower risks of HIV

Injection drug users of black tar heroin are at lower risk for HIV transmission than are other IV drug users -- and IV drug users in cities with high rates of black tar heroin use show lower overall HIV infection rates than do IV drug users in cities where powdered heroin use predominates.

The high heat that is needed to ready the drug for injection reduces the risks of sharing drug paraphernalia, and since the drug blocks up syringes, these syringes, if shared, tend to be better cleaned first, which reducing the risks that are associated with needle sharing.

Additionally, the impurities in black tar heroin often lead to venous sclerosis (hardening of veins), which IV drug users to switch to subcutaneous, rather than IV drug use. Subcutaneous drug use poses less risk for HIV transmission than IV use does.

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