Clostridium botulinum neurotoxin (BoNT) is the most poisonous substance to humans known today. All forms of BoNT intoxication present the same clinical syndrome of symmetrical and descending flaccid paralysis of motor and autonomic nerves, which can cause respiratory arrest leading to death. The toxin is regarded as a priority agent, a potential agent in biowarfare, and a bioterrorism threat. Research in the last decades has generated an improved understanding of the mode of action of the botulinum neurotoxin. However, despite large research efforts, the development of new means of pharmacological and immunological protection has been slow. Several new diagnostic assays have been presented; however, they are merely useful alternatives for varying scenarios and no ideal assays. Likewise, various antidote concepts have been studied but no new antidote has yet passed the first phase of clinical trials. Consequently, the available treatment is still conventional antibodybased antitoxins that bind toxin molecules in the circulation. Similarly, the development of new vaccine concepts has been slow, and despite various side effects, toxoid-based vaccines are routinely used for immunisation of risk groups. In parallel with the improved understanding of its mode of action, the botulinum neurotoxin is increasingly used as a drug to improve various neuromuscular and secretory conditions. In addition, the cosmetic use of botulinum toxin has also increased rapidly in the last decade and as a result the commercial interest in the toxin has grown immensely. With the growing interest for the toxin, the manufacturing and the global trade of counterfeit botulinum toxin are emerging problems. Biosecurity issues related to the increasing number of producers - including illicit producers - and the access to the potent toxin are of concern. Therefore, actions to prevent illicit production and misuse are important issues for the community.