Intra-Arterial Self-Injection of Methadone Tablets Into the Femoral Artery

Acute Hand Ischemia after Intra-arterial Injection of Meprobamate Powder

“…According to the International Narcotics Control Board, abuse of prescription drugs has become more common in recent years and will soon exceed illicit drug use due to easier drug availability (9). This could account for the increase in cases of accidental IA injection of various abused substances being reported (2,5).…”

“…Muscle contractures and functional deficits soon develop, which can then become permanent (1,5). Eventually, there can be necrosis, gangrene, infection, and ultimately amputation (1)(2)(3)(4)(5)10). Thereafter, longterm sequelae, such as chronic pain and complex regional pain syndrome, can also develop (1).…”

“…Experimentally, they have been shown to cause embolization, by traveling to vessels with diameters approximating their own, and occlusion of larger vessels by bead aggregation (16). A review of the literature indicated that similar complications had occurred after accidental IA injection of microcrystalline cellulose-containing drugs, such as methadone, zolpidem, or codeine tablets (2,10,15). In addition, pulmonary embolism due to microcrystalline cellulose has also been reported (17).…”

“…Accidental intra-arterial (IA) drug injection is an infrequent but limb-threatening incident that can lead to devastating consequences, including skin necrosis, abscess formation, rhabdomyolysis, compartment syndrome, limb ischemia, severe gangrene, and even loss of the affected limb (1)(2)(3)(4)(5). In the past, the vast majority of reported morbidities were iatrogenic complications caused by unintentional IA administration of barbiturates or benzodiazepines during sedation or general anesthesia (1)(2)(3).…”

“…In the past, the vast majority of reported morbidities were iatrogenic complications caused by unintentional IA administration of barbiturates or benzodiazepines during sedation or general anesthesia (1)(2)(3). More recently however, given the increasing popularity of attempted intravenous self-injection by illicit drug users, increased incidence of complications secondary to inadvertent IA drug injection is seen more commonly in emergency departments (EDs) worldwide (2,4). We present a case of acute right hand ischemia in a drug abuser after IA injection of a crushed meprobamate tablet dissolved in water.…”