Promethazine use among chronic pain patients

Abstract

Background Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the “high” from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. Methods Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. Results The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. Conclusions The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.

Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence

“…While there have been reports of nonmedical use of promethazine in combination with opioids from the US [23, 24], India [44], Vietnam [45], and Nepal [46], this, as well as nonmedical use of other prescription antihistamines (hydroxyzine and alimemazine), was uncommon in the present study, in combination with opioids or by itself. However, lifetime medical use of prescription antihistamines was high, reflecting that these drugs are commonly prescribed in Swedish medical care.…”

“…Recent US studies have indicated that the prescription drug promethazine—an antihistamine which is often used to treat anxiety and sleep disorders (Sandoz Inc., 2006)—might also have a misuse potential among persons with opioid dependence [23], as well as among chronic pain patients [24] and in the general population [25]. The study by Shapiro et al [23] investigated couse of promethazine and opioids and showed that 26% of patients in MMT had tested positive for promethazine, while only 15% of these had a valid prescription.…”

Nonmedical prescription pain reliever and alcohol consumption among cannabis users

“…In contrast to substitution, use may also occur in a complementary fashion, such as using a second drug as a way to augment the effects of a primary drug. For example, a case study of pain clinic patients reported that promethazine can augment the feelings of euphoria among those using prescription pain reliever products (Lynch et al, 2015). Substances that are ingested by the same person can have markedly different effects depending upon their pharmacokinetics, absorption and distribution throughout the body (FDA, 2015).…”

An assay of drug‐induced emesis in the squirrel monkey (Saimiri sciureus)

“…In addition, some currently available antiemetics appear to have abuse liability, for example, the antihistamine cyclizine, likely due to its stimulant effects . Moreover, the antihistamine promethazine and NK‐1 receptor antagonist aprepitant have both been reported to potentiate the euphoric effects of opioids, increasing the likelihood of misuse. Therefore, the availability of an experimental subject in which the effects of a candidate antiemetic could be examined concurrently with assessments of cognitive disruption and abuse liability could accelerate the discovery of new pharmacotherapies that are both effective and have a reduced side‐effect profile.…”