Pulmonary Effects of IV Injection of Crushed Oral Tablets: “Excipient Lung Disease”

Nguyen, Vicky T.; Chan, Edie Y.; Chou, Shinn-Huey S.; Godwin, J. David; Fligner, Corinne L.; Schmidt, Rodney A.; Pipavath, Sudhakar

doi:10.2214/ajr.14.12582

Cited by 42 publications

(62 citation statements)

References 44 publications

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“…[78] Serious cutaneous complications have also been reported in individuals who crush and inject buprenorphine tablets; such complications appear to be at least in part due to the presence of silica in generic formulations. [79,80] Intravenous injection of opioid formulations not intended for parenteral use has also been associated with pulmonary complications [81,82] and endocarditis. [83,84] Costs associated with acute bacterial infections such as endocarditis, cellulitis, osteomyelitis and sepsis in individuals who abuse via injection have been shown to be substantial.…”

Section: Differences In Routes Of Abuse Between Populationsmentioning

confidence: 99%

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Gąsior

Bond

Malamut

2015

Postgraduate Medicine

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Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking and vaping) and injection. However, reported routes of abuse vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations aim to hinder extraction of the active ingredient, prevent administration through alternative routes and/or make abuse of the manipulated product less attractive, less rewarding or even aversive. There are currently five opioid analgesics with a Food and Drug Administration abuse-deterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.

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Section: Differences In Routes Of Abuse Between Populationsmentioning

confidence: 99%

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Gąsior

Bond

Malamut

2015

Postgraduate Medicine

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“…In addition to pigment particles, there are clear bifringent particles in the granuloma (figure 7) that may be talc particles, added to give the paint a matte appearance 12. Talc is well known to cause the formation of foreign body granulomas when inhaled15 16 or injected intravenously,17 and may enhance the inflammatory response in this case. In general, the formation of foreign body granulomas consists of a chronic immune response to foreign particles too large to be phagocytosed.…”

Section: Discussionmentioning

confidence: 94%

Under pressure: progressively enlarging facial mass following high-pressure paint injection injury

2016

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SUMMARYHigh-pressure paint injection injuries are relatively rare industrial accidents and almost exclusively occur on the non-dominant hand. A rarely documented complication of these injuries is the formation of a foreign body granuloma. We report a case of a 33-year-old man presenting with extensive facial scarring and progressive right paranasal swelling 7 years after a high-pressure paint injury. After imaging investigations, an excision of the mass and revision of scarring was performed. Access to the mass was gained indirectly through existing scarring over the nose to ensure an aesthetic result. Histological analysis revealed a florid granulomatous foreign body reaction to retained paint. To the best of our knowledge, this is the first reported case of a facial high-pressure paint injury with consequent formation of a foreign body granuloma. BACKGROUND

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“…This decreases the risk of infectious diseases, poisoning, and severe somatic complications. Medications intended for oral use but crushed and diluted in water and then injected as well as injected illicit drugs, like heroin, cocaine, and methadone, commonly contain microscopic insoluble material, such as talc, cellulose, crospovidone, and starch, which can induce even fatal pulmonary vascular injury . Prevention of such complications by all possible means is crucial.…”

Section: Discussionmentioning

confidence: 99%

Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine

Keltanen

Heikman

Muhonen

et al. 2019

Drug Testing and Analysis

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Laboratory methods for differentiating intravenous substance abuse from medical oral or sublingual use are lacking. The disaccharides lactose and sucrose are common excipients in both medical preparations and illicit drugs. If substances are abused intravenously, the disaccharides are excreted unchanged in urine. This study evaluated whether urine lactose indicates recent intravenous abuse of substances with special reference to buprenorphine (BPN). Samples were attained from 21 patients in assessment for opioid maintenance treatment (OMT) and from 29 patients already enrolled in OMT. Patients were divided in two groups. Group 1 patients reported intravenous abuse of BPN within 48 hours and Group 2 more than 48 hours since the last injection. The urine samples were assayed for lactose using an enzymatic method. To verify intravenous abuse, examination of needle marks and mass spectrometric analysis of abused substances was performed. Urine lactose concentration was significantly higher in Group 1 (86 mg/L) than in Group 2 (24 mg/L). All samples with lactose concentration more than 140 mg/L were given by the Group 1 patients, who all had recent injection marks. A significant inverse correlation was found between the time from last injection and the urine lactose concentration within the 48‐hour post‐injection period. Elevated lactose concentrations in urine could indicate intravenous abuse of substances containing lactose. The co‐occurrence of higher than 140 mg/L of lactose in urine by means of enzymatic assay verified by fresh puncture sites is a potential indicator of recent intravenous abuse of BPN.

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Pulmonary Effects of IV Injection of Crushed Oral Tablets: “Excipient Lung Disease”

Abstract: The radiologist has a critical role in recognizing and reporting excipient lung disease because the referring clinician may be unaware of the patient's i.v. drug abuse.

Cited by 42 publications

References 44 publications

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Under pressure: progressively enlarging facial mass following high-pressure paint injection injury

Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine

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