Two drug users are seriously ill with the flesh-eating disease necrotising fasciitis, health chiefs have said.
They issued a public health alert as a result of the cases, both from Lanarkshire.
One victim is in hospital in Lanarkshire, another is in hospital in Glasgow.
Eight years ago a similar outbreak claimed the lives of 43 addicts over six months in Scotland, north-west England, the West Midlands and Dublin.
A fatal accident inquiry found 16 addicts from the Glasgow area contracted the clostridium novyi bug from a contaminated batch of heroin which originated in Afghanistan.
Lanarkshire Health Board said investigations into the two current cases were continuing.
He said: "While we are investigating the possible causes of the illness in these patients the clinical picture is similar to that seen in and around Glasgow in 2000.
"At that time there were a number of severe infections among injecting drug users.
"The patients affected may have injected heroin that was contaminated with spores that can cause severe illness.
"We would advise drug users not to inject heroin and warn that muscle-popping, skin-popping, and injecting when a vein has been missed, are particularly dangerous."
Injecting drug users are more vulnerable to the potentially fatal illness, because it commonly enters the body through broken skin.
The Glasgow fatal accident inquiry found the clostridium bug which causes the disease was thought to have found its way into the drug which was being produced in Afghanistan.
RELATED INTERNET LINKS
National Necrotizing Fasciitis Foundation
NHS Lanarkshire
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