Loo HW, Yam AKT, Tan TC, Peng YP, Teoh LC. Severe upper limb complications from parenteral abuse of Subutex.
Ann Acad Med Singap 2005;
34:575-8. [PMID:
16284682]
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Abstract
INTRODUCTION
Subutex is a sublingual formulation of buprenorphine that is used to treat opioid dependency. It may be abused parenterally with disastrous consequences.
CLINICAL PRESENTATION
We present 4 cases of parenteral abuse of Subutex resulting in severe upper limb complications.
TREATMENT
Two vascular complications were treated with combinations of anticoagulants, vasodilators, brachial plexus bock and iloprostol. One severe hand abscess required surgical debridement, and 1 median nerve injury required neurolysis.
OUTCOME
All patients had a poor outcome. Both patients with vascular complications required multiple amputations, the patient with a thenar abscess had severely impaired thumb function, and the patient with median nerve injury has ongoing neuralgic pain, numbness and thenar weakness.
CONCLUSION
The incidence of complications of parenteral abuse of Subutex is increasing in Singapore. These complications have a poor outcome despite adequate management, and are best prevented by education or legal means.
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