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).
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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.
Department of Medicine
National University Hospital
Singapore
email: raymond_seet{at}nus.edu.sg
References
1. O’Connor JJ, Moloney E, Travers R, Campbell A. (1988) Buprenorphine abuse among opiate addicts. Br J Addict 83 1085–7.[CrossRef][ISI][Medline]
2. Strang J. (1985) Abuse of buprenorphine. Lancet 2 725.[ISI][Medline]
3. Southeast Asia Review 2005. IMS Asia [http://www.imshealthasia.com/147.html].
4. Seet RC, Rathakrishnan R, Chan BP, Lim EC. (2005) Diffuse cystic leucoencephalopathy after buprenorphine injection. J Neurol Neurosurg Psychiatry 76 890–1.
5. Seet RC and Lim EC. (2006) Intravenous use of buprenorphine tablets associated with rhabdomyolysis and compressive sciatic neuropathy. Ann Emerg Med 47 396–7.[CrossRef][ISI][Medline]
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