A Case of Acute Pericarditis Following Intravenous Injection of Crushed Morphine Tablets

Anderson, Ryan J.; Corbett, Bryan; Ly, Binh T.

doi:10.1080/02791072.2016.1242028

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…I would be doing say definitely more tablets than eight grams of paracetamol, which is toxic. 3 Other participants commented that cravings for opioids sometimes outweighed their concern of paracetamol overdose when they considered how effective CWE was in terms of removing the paracetamol. Underpinning such experiences, some participants cautioned that white powder and other residue that was left in the extracted solutions compromised the purity of the codeine extract.…”

Section: Harm Reduction (Ccm and Heroin)mentioning

confidence: 99%

“…Medicine tampering involves a range of procedures to manipulate different types of psychoactive medicines in order to enhance their psychoactive effects [1,2]. Reports of harm following intravenous injection of crushed oxycodone and morphine tablets highlight the risk of pulmonary granulomatosis from deposition of talc and other fillers used in the manufacturing of medicines [3,4]. Smoking of fentanyl patches (either whole patches or smaller pieces) have been reported amongst people seeking addiction treatment, setting new demands for services to negotiate severe withdrawal symptoms amongst their clients [5].…”

Section: Introductionmentioning

confidence: 99%

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Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

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Background Tampering of psychoactive medicines presents challenges to regulation and public health. However, little is currently known about what influences the decisions to treat codeine-containing medicines (CCM) with cold water extraction (CWE) from the perspective of individuals employing these techniques. The article identifies factors influencing utilisation of CWE to separate codeine from compounded analgesics, such as paracetamol and ibuprofen, found in CCM. Methods Purposive sampling of 27 participants residing in England who took part in a qualitative interview. Of these, 14 individuals (11 males and 3 females) reported tampering of psychoactive medicines, and the relevant transcripts were included in the analyses for the study. Participants were recruited from one addiction treatment service and from an online survey. The mean age of the participants was 31.5 years (range = 18–42 years). Qualitative data analysis followed the processes of iterative categorization (IC). The codes ‘harm reduction’, ‘information sources’ and ‘changes on the drug markets’ were grouped and summarised. The coding of the data was done in a Microsoft® Word document. Results Two groups of participants were identified in the data analysis: (i) individuals who used CCM (n = 5), and (ii) individuals who used CCM and heroin (n = 9). Participants in both groups used CWE due to concerns of paracetamol overdose from the use of excessive dosages of CCM. For both of them, information obtained from the internet encouraged the use of CWE. Participants using CCM described how the many steps involved in conducting CWE, including sourcing codeine boxes from pharmacies (over the counter), presented a barrier against using CWE. Participants using CCM and heroin explained how reduced availability in the local heroin supply influenced utilisation of CWE techniques to maintain their use of opioids and avoid withdrawal. Withdrawal symptoms and cravings outweighed the concerns about the quality of the extracted codeine mixtures in this participant group, especially the ability of CWE to remove paracetamol and tablet fillers. Conclusions Utilisation of CWE of codeine was influenced by several factors including drug market supply, the availability of detailed information on the internet about CWE and restrictions on codeine sourcing in pharmacies. Risks identified with CWE include consumption of unknown doses of paracetamol if the CWE techniques are not used correctly. Attempts at extracting codeine from CCM should be considered in risk assessments of opioid medicines.

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Section: Harm Reduction (Ccm and Heroin)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

View full text Add to dashboard Cite

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Morphine misuse

2016

Reactions Weekly

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Talc-induced pericardial granulomatosis after recurrent pleurodesis: a rare cause of incessant pericarditis—case report

Coca-Perez,

Rivero-Jimenez,

Lopez-Menendez

et al. 2024

European Heart Journal - Case Reports

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Background Management of relapsing pericarditis in patients who do not respond to medical therapy presents a significant challenge for clinicians. Although pericardiectomy remains a controversial option, it can provide effective relief of symptoms in this group of patients, as we report in this rare case of incessant pericarditis. Case Summary We report the case of a 41-year-old woman with a medical history of two episodes of acute pericarditis, with no symptom-free intervals between them, over a two-year period. These episodes appeared following a third talc pleurodesis that was performed for relapsing catamenial pneumothorax. She became unresponsive to medical treatment with colchicine, indomethacin, anakinra and prednisone, and surgery was finally indicated for symptom relief. An anterior pericardiectomy was performed in which talc-induced pericardial foreign body granulomas where identified in the pericardium and mediastinum samples. Patient recovered painless after six months and no pericardial effusion was shown during the follow-up. Discussion Although talc is a safe sclerosing agent for pleurodesis for the treatment of recurrent spontaneous pneumothorax, extrapleural dissemination to mediastinum and pericardium is plausible, as documented in experimental animal studies. However, to date we could not find any case of talc-induced pericarditis as an extrapulmonary complication of pleurodesis in the medical literature. In this instance, pericardiectomy was a mandatory alternative for symptomatic relief of foreign-body-induced pericarditis and yielded a good clinical outcome.

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A Case of Acute Pericarditis Following Intravenous Injection of Crushed Morphine Tablets

Cited by 3 publications

References 11 publications

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Morphine misuse

Talc-induced pericardial granulomatosis after recurrent pleurodesis: a rare cause of incessant pericarditis—case report

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