Catastrophic Electrical Injuries Tied to Copper Theft in the Homeless: Clinical and Policy Considerations

Abstract Introduction High-voltage electrical injuries (≥1000 V) cause devastating outcomes, including rhabdomyolysis, amputations, and death. In Colombia, copper’s high market value (~278 M exports in 2023; 7. 50–8. 00/kg locally) has fueled systematic cable theft. This not only disrupts essential services and creates multimillion-dollar losses but also inflicts catastrophic trauma—most often on homeless individuals with substance use disorders. Similar patterns are seen globally in impoverished settings. We propose a syndemic framework, where poverty, homelessness, SUD, and electrical trauma converge to amplify harm. Addressing this crisis requires integrated action across health, social policy, infrastructure, and legal regulation. Methods Retrospective series (January 2024–June 2025) of 15 homeless individuals with electrical burns treated at a referral burn center in Bogotá. Demographic, clinical, and outcome variables were collected and analyzed using descriptive statistics with Wilson 95% confidence intervals. Results Males accounted for 93. 3% (14/15; 95%CI 70. 2–98. 8), with a mean age of 33. 1 ± 8. 4 years. High-voltage injuries represented 86. 7% (13/15; 62. 1–96. 3). The median %TBSA was 11% (IQR 4. 5–16). Rhabdomyolysis occurred in 40. 0% (6/15; 19. 8–64. 3), with peak CPK values reaching 50 330 U/L. Acute kidney injury (AKI) was observed in 6. 7% (1/15; 1. 2–28. 3). Amputation was required in 13. 3% (2/15; 3. 7–37. 9). In-hospital mortality was 20. 0% (3/15; 7. 0–45. 2). Notably, 100% of the patients had a documented substance use disorder (SUD). Conclusions We identified a vulnerable cohort of homeless men with substance use disorders (SUD) who sustained predominantly high-voltage (HV) electrical burns. The convergence of HV trauma, social vulnerability, and SUD explains the severe outcomes observed. Mortality reached 20%—well above reported ranges of 2–12%—while amputations (13. 3%) reflected extensive HV tissue and vascular damage. Rhabdomyolysis occurred in 40% of cases, and all patients had SUD. Copper theft has been consistently linked to fatal electrocutions in Colombia and other low- and middle-income countries, paralleling South Africa’s Izinyoka phenomenon. Framing this as a syndemic highlights the need for integrated responses across public health and legal systems. Applicability of Research to Practice This study identifies a syndemic of homelessness, substance use disorder (SUD), and economic precarity fueling catastrophic electrical injuries linked to copper theft. Outcomes are dire—rhabdomyolysis 40%, amputations 13. 3%, mortality 20%—with immense social costs. Action Priorities. Public Health: Outreach programs offering SUD treatment, mental health care, and standardized protocols for high-voltage injuries. Scrap Market Control: Enforce seller registration, traceability, and cash restrictions. Infrastructure: Replace copper wiring with alternatives like fiber optic, proven effective in Bogotá. Funding for the study N/A.