Local complications of pentazocine abuse: Case report and review

Kumar, Subodh; Soren, Subhas; Simlai, Jayati; Kumari, Ranju

doi:10.4103/ipj.ipj_53_17

Cited by 3 publications

(6 citation statements)

References 37 publications

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“…Such repeated and prolonged high doses of the drug result in local tissue changes that range from induration, necrotizing tissue infections, ulceration, and myofibrosis to florid osteomyelitis. [ 1 8 , 16 17 18 ] Almost all these reported local tissue complications were observed in our study. Various mechanisms have been adduced for this phenomenon.…”

Section: Discussionsupporting

confidence: 58%

“…Pentazocine is an acidic drug that is more soluble in an acidic medium and precipitates in a neutral or alkaline medium such as the interstitial fluid. [ 17 19 ] The precipitates induce chronic inflammatory processes that result in vascular thrombosis, necrosis, and fibrosis. This is worsened by contamination by microorganisms, leading to infection as injections are given without knowledge of or recourse to proper technique and asepsis.…”

Section: Discussionmentioning

confidence: 99%

“…With dependence and addiction, victims who obtained the drug based on medical indications resort to self-injection without the knowledge of safety measures required for such procedures. [ 7 8 9 10 ] The results are tissue infection and necrosis. [ 7 8 9 10 ] This is becoming a burden in our environment as reports show that treatment of the addiction is often unrewarding, making tissue infection and necrosis unrelenting and recurrent.…”

Section: Introductionmentioning

confidence: 99%

“…[ 7 8 9 10 ] The results are tissue infection and necrosis. [ 7 8 9 10 ] This is becoming a burden in our environment as reports show that treatment of the addiction is often unrewarding, making tissue infection and necrosis unrelenting and recurrent. [ 7 10 ] This results in significant disability, morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Tissue necrosis: A burden of pentazocine abuse in South East Nigeria

Cosmas Mba,

Onyebueke,

Okwesili

et al. 2024

J West Afr Coll Surg

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Background: Tissue necrosis from pentazocine abuse is becoming a burden in our environment. Pentazocine is an opioid of the benzomorphan class. It is commonly used for post-traumatic and postoperative pain and vaso-occlusive pain of sickle cell disease (SCD). Its prolonged use can lead to addiction and may result in severe injection site necrosis, often worsened by infection due to a lack of aseptic principles during administration. Although pentazocine is a controlled drug in our environment, it is readily available. Objectives: To review patients with tissue necrosis from pentazocine injection, share the challenges in their management, and proffer solutions. Materials and Methods: Clinical summaries of patients with tissue necrosis and ulcers due to pentazocine addiction were reviewed. Results: Twenty-five patients, comprising nine females and 16 males aged 22–61 years, were recorded. Twenty had SCD, while five had other underlying conditions. The duration of abuse was 1–16 years, while the average maximum daily dose was 348.75 ± 346.04 mg. Most patients used multiple sites for injection. Lesions included abscesses, tissue necrosis with ulcers, lymphoedema, exposed necrotic bones, and osteomyelitis. Most had multidisciplinary care. The outcome of wound care was good in two. Three had major limb amputations, four died, three signed against medical advice, six were still receiving care while seven were lost to follow-up. None was completely weaned from the drug at the time of this report. Conclusion: Rising cases of tissue necrosis from pentazocine abuse are disturbing. Treatment is frustrating. Concerted efforts at prevention should be made to stem the tide.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tissue necrosis: A burden of pentazocine abuse in South East Nigeria

Cosmas Mba,

Onyebueke,

Okwesili

et al. 2024

J West Afr Coll Surg

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“…Considering that xylazine is a full κOR agonist, we note two prominent historical and international examples of nonmedical use of the κOR agonist pentazocine: the "Ts and Blues" (pentazocine and tripelennamine) outbreak in the midwestern United States from 1977 to 1981 (75-77), and pentazocine injection in Nigeria (78) and India (79)(80)(81)(82). In both settings, characteristic skin lesions beyond the site of injection, eschar formation, and wound cratering were observed (83)(84)(85)(86), with morphological similarity (61) to reports involving xylazine from Puerto Rico (62), the Philadelphia area (16,(63)(64)(65)(66), and New Haven, Connecticut (67). κOR distribution in human skin has led to its study as a therapeutic target (94)(95)(96), suggesting new directions for research into wound etiology.…”

Section: Discussionmentioning

confidence: 99%

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration

Bedard,

Murray,

Huang

et al. 2023

Preprint

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Xylazine has been found in the unregulated drug supply at increasing rates, usually in combination with fentanyl. It has become critical to understand its basic pharmacology, how it impacts behavior, and how it interacts with fentanyl in rodent models of opioid administration. Despite commentary from scientists, politicians, and public health officials, it is not known if xylazine impacts the efficacy of naloxone, the opioid receptor antagonist used to reverse opioid induced respiratory depression. Furthermore, few studies have examined the effects of xylazine alone, without co-administration of ketamine. Here, we examine the impact of xylazine alone and in combination with fentanyl on several key behaviors in male and female mice. We demonstrate differential locomotor responses by dose and sex to xylazine. Surprisingly, our results further indicate that naloxone precipitates withdrawal from xylazine and a fentanyl/xylazine combination, in both sexes, with enhanced sensitivity in females. Further, we show that xylazine is a full agonist at the kappa opioid receptor, a potential mechanism for its naloxone sensitivity.One-Sentence SummaryWe present surprising new insights into xylazine and fentanyl pharmacology with immediate implications for clinical practice and frontline public health.

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