Advice on tetanus for people who inject drugs
Updated 23 April 2026
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0.1 What is tetanus?
Tetanus is an infection that can cause severe illness and even death.
Cases of tetanus in people who inject drugs are rare but do happen.
Tetanus is caused by bacteria getting into the body through a wound or through injecting drugs.
It is caught from tetanus bacteria in soil or dirt or in drugs, rather than from other people.
Symptoms usually start about 10 days after infection, but this can range from 4 days and 3 weeks.
Infection may be due to the injecting equipment being contaminated with tetanus from the soil or dirt or from batches of contaminated drugs.
1. Tetanus symptoms
You need to know the symptoms because if you spot tetanus early and get medical help, life-saving treatment can be given.
The first symptoms of tetanus are stiff muscles near the wound (or injection site) followed by stiffening of other muscles and of the jaw until you can’t open your mouth (‘lockjaw’). This can be followed by frequent and painful spasms.
These muscle spasms can affect your breathing and your heart, which can be fatal.
Tetanus has been seen more often among people who injecting drugs in the US. It happens mostly in people who have injected drugs in to the muscle or below the skin (‘skin popping’).
Tetanus cannot be caught by having sex with or living with a person who has the infection.
2. Preventing tetanus
Tetanus can be prevented by vaccination.
Anyone who is not fully protected by the vaccine is at risk of becoming ill.
Injecting drugs may put you at risk of tetanus even if you have had some doses of the vaccine. If you have had the full 5 doses of the vaccine you are unlikely to get tetanus, and if you do get tetanus the illness will be less severe.
3. What to do to reduce your risk of getting this infection
There is no way that you can tell if your drugs are likely to cause this infection.
Because of tetanus, and other infections such as anthrax and botulism, there is no safe way to use drugs like heroin. If possible, you should try to stop taking drugs. Local drug services offer prescribed medications (such as methadone or buprenorphine) and/or other treatment options.
If you are continuing to inject, use as little citric acid as possible to dissolve drugs. A lot of citric acid can damage the muscle or the flesh under the skin, and this damage gives bacteria a better chance to grow.
Check whether you’ve had the 5 recommended doses of tetanus vaccine (3 as part of childhood immunisations, and 2 booster doses later). If you have not had all 5 doses, or are not sure, please discuss with your GP or with a drug service whether you need more doses of tetanus vaccine.
4. Get help from A&E or a GP immediately if you think you might have tetanus
If you get stiff muscles near where you inject, stiffening in the jaw, stomach or back, or problems swallowing or breathing, you should get a doctor (in A&E or a GP) to check it out immediately and tell them that you are worried you may have tetanus.