buprenorphine and Discitis

Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events.. This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008.. The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity.. The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.

Topics: Abscess; Adult; Bacterial Infections; Buprenorphine; Discitis; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Narcotic Antagonists; Retrospective Studies

We report a case of Enterobacter cloacae spondylodiscitis related to risk practices in intravenous drug addicts (IVDA).. The patient, a former heroin addict, was receiving long-term, high-dose buprenorphine maintenance treatment. He had been misusing the treatment, injecting it daily for several months. The clinical course included several uncommon features that are usually found in IVDA patients: subacute infection, apyrexia, and minimal inflammatory syndrome. This infection also led to the discovery of his HIV infection.. Any dorsolumbar pain in IVDA patients, including those receiving regular drug maintenance treatment and especially those with HIV infection, should suggest spondylodiscitis, because of these patients' enhanced sensitivity to infection and the frequent bacteremia caused by persistent or transitory relapse involving injection (exchange of material, reuse of needles, syringes, cotton swabs, and risk of contamination through the hands or saliva).

Topics: Adult; Analgesics, Opioid; Buprenorphine; Discitis; Enterobacter cloacae; Enterobacteriaceae Infections; Heroin Dependence; Humans; Male; Substance Abuse, Intravenous