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Injecting - buprenorphine injection dangers

Discussion in 'Buprenorphine' started by frankblank, Jun 25, 2010.

  1. frankblank

    frankblank Newbie

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    I found a couple of PDF's about complications. they are attached

    'Severe Upper Limb Complications from Parenteral Abuse of Subutex'
    shows several gangrenous limbs that had to be amputated

    'Infective Endocarditis Secondary to Intraveinous Subutex Abuse'
    details 12 cases. mortality rate was 42 percent

    Here is another article:

    Complications arising from intravenous buprenorphine abuse
    Sir,

    Following its introduction in the 1980s, buprenorphine (Subutex, Schering Plough) abuse has been reported worldwide.1,2 Within a year of its introduction to treat opioid dependence in Singapore in 2002, buprenorphine became the second top-selling new pharmaceutical product in 2003, and the fourth best-selling product in 2005.3 This rise in popularity was in turn accompanied by an increase in the number of reported cases of abuse.4,5 To better understand the burden of disease and spectrum of complications of buprenorphine abuse, we reviewed the medical records of hospitalized intravenous buprenorphine abusers at the National University Hospital, Singapore, from 2002 to 2005.

    Using the keywords ‘buprenorphine’ and ‘subutex’, we searched the electronic database of our hospital to identify patients who had developed complications arising from active intravenous buprenorphine abuse. We reviewed the medical records of these patients to assess their complications and course of hospitalization, and to identify predictors of their clinical outcomes. We studied 51 patients (39 males, 12 females), mean ± SD age 35.14 ± 7.88 years. Infective complications such as cellulitis (39.2%), endocarditis (19.6%), and myositis/pyomyositis (11.8%), and non-infective complications such as withdrawal symptoms (13.7%), seizures (9.8%) and limb ischaemia (9.8%), were reported. Three patients (5.9%) required ventilatory support, and five (9.8%) were readmitted for further complications, but none died. Using multivariate analysis, we identified the presence of complications such as infective endocarditis, venous thrombosis and respiratory failure to significantly predict prolonged hospital stay amongst these patients (Table 1).


    View this table:
    [in this window]
    [in a new window]

    Table 1 Demographic information, clinical characteristics and hospital outcomes of 51 patients hospitalized for complications arising from intravenous buprenorphine misuse


    We believe that only a multi-pronged approach can deliver the benefits of buprenorphine treatment seen in clinical trials and address the worldwide problem of opioid addiction. Potentially useful measures include observation and close monitoring of buprenorphine administration amongst opioid-dependent patients, stringent control of buprenorphine prescription by trained physicians, newer combination agents to suppress buprenorphine abuse (e.g. buprenorphine/naloxone), adequate education for health-care workers and patients on the appropriate use of buprenorphine, and adequate law enforcement.

    R.C.S. Seet, V.M.S. Oh and E.C.H. Lim

    Department of Medicine
    National University Hospital
    Singapore


    References

    1. O’Connor JJ, Moloney E, Travers R, Campbell A. (1988) Buprenorphine abuse among opiate addicts. Br J Addict 83 1085–7.[CrossRef][Web of Science][Medline]

    2. Strang J. (1985) Abuse of buprenorphine. Lancet 2 725.[Web of Science][Medline]

    3. Southeast Asia Review 2005. IMS Asia
    4. Seet RC, Rathakrishnan R, Chan BP, Lim EC. (2005) Diffuse cystic leucoencephalopathy after buprenorphine injection. J Neurol Neurosurg Psychiatry 76 890–1.[Free Full Text]

    5. Seet Research Chemical and Lim EC. (2006) Intravenous use of buprenorphine tablets associated with rhabdomyolysis and compressive sciatic neuropathy. Ann Emerg Med 47 396–7.[CrossRef][Web of Science][Medline]
     

    Attached Files:

  2. kailey_elise

    kailey_elise Gold Member

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    Very helpful, thank you! But these should be uploaded to the File Archive. :) It's the "Documents" tab at the top right of the page.

    Articles can also be posted there, I believe, and/or in Drug News, somewhere.

    Good find!

    ~Kailey
     
  3. frankblank

    frankblank Newbie

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    Thanks I posted them there. I can't find how to remove them from this post though.

    I know the medical complications were more from unsanitary technique than the effects of subutex, but it was a real eye-opener to me. Swim needs to be more careful.