Wilson Matthew W, Bonnecaze Alex K, Dharod Ajay, Miller Peter J
From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
South Med J. 2017 Mar;110(3):217-222. doi: 10.14423/SMJ.0000000000000624.
Prescription drug abuse is a major public health problem in the United States, with the rate of opioid-related deaths nearly quadrupling between 2000 and 2014. Extended-release oral oxymorphone hydrochloride (Opana ER) is a long-acting opioid prescribed for chronic pain; however, it also has the potential to be abused via intravenous injection. This retrospective review sought to analyze specific complications and sequelae requiring intensive care unit resources for patients intravenously abusing extended-release oral oxymorphone.
We retrospectively reviewed the medical records of patients identified for drug abuse between January 2012 and December 2015, identifying patients who intravenously abused extended-release oral oxymorphone. Medical charts were reviewed to identify associated sequelae and patients requiring an intensive care unit level of care.
We identified 53 patients who required treatment in an intensive care unit setting as a consequence of intravenously abusing extended-release oral oxymorphone. Twenty-eight patients (52.8%) required endotracheal intubation with mechanical ventilation for either acute hypoxic respiratory failure or protection of airway. Acute kidney injury developed in 48 patients (90.6%); 28.3% of these patients failed to regain renal function and required renal replacement therapy. Bacteremia was diagnosed in 36 patients (67.9%) and 30 patients (56.6%) were diagnosed as having acute infective bacterial endocarditis.
Our patients demonstrated a great need for critical care resources and severe sequelae related to intravenous drug abuse. Clinicians should be vigilant for the possibility for clinical decompensation when initially evaluating patients reporting intravenous abuse of extended-release oral oxymorphone.
在美国，处方药滥用是一个重大的公共卫生问题，2000年至2014年间，与阿片类药物相关的死亡率几乎增长了两倍。缓释口服盐酸羟吗啡酮（奥施康定缓释片）是一种用于治疗慢性疼痛的长效阿片类药物；然而，它也有可能通过静脉注射被滥用。这项回顾性研究旨在分析静脉滥用缓释口服盐酸羟吗啡酮的患者需要重症监护病房资源的特定并发症和后遗症。
我们回顾性分析了2012年1月至2015年12月期间确诊为药物滥用患者的病历，确定静脉滥用缓释口服盐酸羟吗啡酮的患者。查阅病历以确定相关后遗症以及需要重症监护病房护理水平的患者。
我们确定了53例因静脉滥用缓释口服盐酸羟吗啡酮而需要在重症监护病房接受治疗的患者。28例患者（52.8%）因急性低氧性呼吸衰竭或气道保护需要气管插管并进行机械通气。48例患者（90.6%）发生急性肾损伤；其中28.3%的患者肾功能未能恢复，需要进行肾脏替代治疗。36例患者（67.9%）被诊断为菌血症，30例患者（56.6%）被诊断为急性感染性细菌性心内膜炎。
我们的患者显示出对重症监护资源的巨大需求以及与静脉药物滥用相关的严重后遗症。临床医生在初步评估报告静脉滥用缓释口服盐酸羟吗啡酮的患者时，应警惕临床失代偿的可能性。
