Introduction: Subutex® is a sublingual formulation of buprenorphine that is used to treat opioid dependency. It may be abused parenterally with disastrous consequences. Clinical Presentation: We present 4 cases of parenteral abuse of Subutex® resulting in severe upper limb complications. Treatment: Two vascular complications were treated with combinations of anticoagulants, vasodilators, brachial plexus bock and iloprostol. One severe hand abscess required surgical debridement, and 1 median nerve injury required neurolysis. Outcome: All patients had a poor outcome. Both patients with vascular complications required multiple amputations, the patient with a thenar abscess had severely impaired thumb function, and the patient with median nerve injury has ongoing neuralgic pain, numbness and thenar weakness. Conclusion: The incidence of complications of parenteral abuse of Subutex® is increasing in Singapore. These complications have a poor outcome despite adequate management, and are best prevented by education or legal means.
Subutex® (sublingual buprenorphine hydrochloride) tablets are prescribed by licensed physicians to alleviate symptoms of opiate withdrawal in addicts undergoing a cessation programme. It is increasingly used instead of methadone in cessation programmes, as it is effective, well tolerated and has fewer side effects.1-3 In Singapore, according to Institute of Mental Health figures, over 4000 patients were prescribed buprenorphine in 2004. Although the dispensation and use of Subutex® is theoretically safe, we have recently encountered 4 cases of severe upper limb complications from parenteral abuse, all presenting within the first few months of 2005.
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