CATES: Counterfeit Botox

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

My mom was a prepper, long before it became a thing. She grew up very poor, and there were many days where the only thing that kept her family from starving was the vegetable garden in the back yard. At harvest time, they canned everything possible, to save for winter or the possibility of a future bad harvest. My mom carried that attitude of always making sure there was food available until the day she died. She made me and my brothers learn everything from how to butcher a chicken to how to can fruits, vegetables, and even meat. She would say, “When you are an adult, you may never have to do this, but none of us can tell the future. I would rather you know how to do this and never need it than need it and not know how.” The lessons in canning always included canning safety, particularly in how to avoid botulism.

Botulism is usually caused by someone ingesting food contaminated by botulinum toxin. Botulinum toxin is produced by the bacteria Clostridium botulinum. Botulinum toxin is one of the strongest toxins in existence. It is a neurotoxin, which means it paralyzes nerves. When it invades nerves responsible for things like breathing, that is when botulinum toxin is really bad and becomes known as botulism. Botulism can easily become fatal.

Botox contains botulinum toxin in extremely tiny quantities. Those quantities are small enough that the nerve paralysis can be kept isolated to one small segment of a nerve. When the botulism toxin is administered in Botox by a trained professional, it can do amazing things. There are the cosmetic applications which smooth wrinkles, which is what most people think of when they hear Botox, but Botox can treat so much more than wrinkles. It can be used to treat neck spasms, overactive sweat glands, overactive bladder, and lazy eye.

One of the best uses of Botox is as a treatment for migraine. An old friend used to have the most debilitating migraines. They would come several times a month, and would make her so ill, she could barely function. They interfered with every part of her life. She tried Botox almost as a desperation move, and it worked! As long as she gets her injections every 6 weeks, the migraines are gone. It’s been miraculous for her and for so many other people in the way it has changed her life.

The bad thing about Botox is both the drug itself and the licenses and training to use it properly can be expensive. This has led to two distinct problems as people try to find cheaper ways to get the benefits of Botox. The first is counterfeit drugs and the second is untrained and/or unlicensed people administering those drugs. So far 19 people have reported harmful reactions across nine states because of untrained/unlicensed people administering Botox and/or because of the administration of counterfeit Botox. All of the individuals who were affected except one received the injection for wrinkle reduction. Of those 19 people, nine required hospitalization, and four needed botulism antitoxin treatment because the injections became life threatening. Texas is not among the nine states where these cases have occurred, but with something as potentially fatal as botulinum toxin, everyone who receives this medication needs to be aware of the potential problems and know what to ask of the person administering in order to be safe.

The Centers for Disease Control and Prevention (CDC) recommends that you ask the person giving Botox if they are licensed and trained to give Botox injections. In addition, ask if the drug they are giving is approved by the Food and Drug Administration (FDA) and if it came from a reliable source (a known pharmaceutical manufacturer). If the person administering cannot answer those questions, the CDC recommends you seek an alternative provider.

If you do get a Botox injection and have blurry or double vision, droopy eyelids, difficulty breathing fatigue, slurred speech, or a hoarse voice, seek medical care immediately. The muscle paralysis that could be causing those symptoms could progress over hours to days and could be fatal. Unfortunately, those things can happen even with the right drug administered by a highly trained and licensed person. Even though Botox can be a miracle, it is still a very strong toxin. Because of that, it’s always best to be safe and seek care if you have received a Botox injection and have unexpected symptoms. Botulism is not something anyone should ever have to experience.