Abuse of parenteral opioid (pentazocine) amongst plastic surgery patients in a tertiary health institution in south-south Nigeria − a case series

Abstract

Introduction: Parenteral opioid abuse is not uncommon amongst patients presenting for plastic surgery care, especially health workers. Pain is the commonest reason for initiating and sustaining the injections. Complications such as lymphedema, cellulitis, ulcers etc. are common sequelae of this psychosocial disorder. Aim: This is to review the pattern of pentazocine abuse; with the objectives of: reviewing the demographics, site, and complications of pentazocine abuse amongst patients presenting to the plastic surgery unit. Materials and Methods: Self-administered questionnaires were used to obtain information by direct interview of the patients. Pentazocine injections were specifically looked at while excluding oral opioids such as tramadol tablets. Results: Most patients (60%) are of SS genotype with pain from vaso-occlusive crisis as the inciting factor. Male: female ratio is 1:4. Forty percent (4 of 10 patients) are health professionals. Lymphedema was a complication in 50% (5 of 10 patients), ulcers in 90% (9 of 10 patients); ten percent (1 of 10) had a pre-existing ulcer before the injection following a road traffic accident (RTA). Upper limbs are affected in 60% and lower limbs in 70 % (one patient had traumatic ulcers on both legs). They all expressed desire to stop when pain ceases but still inject themselves occasionally. Conclusion: Pentazocine abuse is common amongst health professionals and SS genotype patients and can be complicated by lymphedema and associated ulcers when injected into soft tissue. There is a need to periodically evaluate health workers with regards to parenteral opioid abuse in order to ensure safety of patients left under their care.