Limb ischaemia after intra-arterial injection of Temazepam gel: histology of nine cases.

Abstract

Aims-To record the histopathological findings associated with intra-arterial injection of Temazepam gel by nine drug misusers. Methods-Standard histological examination and immunocytochemistry for endothelial markers (factor VIII related antigen, Ulex europaeus lectin) were carried out.

Intra-Arterial Self-Injection of Methadone Tablets Into the Femoral Artery

“…The IA injection of drugs of abuse causes limb ischemia and rhabdomyolysis through a number of mechanisms, including direct cytotoxicity, which is increased with highly lipid-soluble drugs when compared to those that are more water soluble (9,10). Additionally, endothelial inflammation, vasospasm, venous constriction, thrombosis, and crystal formation all have been shown to cause limb ischemia either independently or in combination (5,(11)(12)(13)(14)(15)(16)(17). Methadone tablets contain microcrystalline cellulose, the only component of methadone tablets shown to cause gangrene when separately injected into the femoral arteries of dogs (5).…”

Research design considerations for clinical studies of abuse-deterrent opioid analgesics: IMMPACT recommendations

“…The “abuse-deterrent” formulation of temazepam in the United Kingdom in the 1990s and Australia in the 2000s offers a graphic example of unintended consequences associated with circumventing ADFs that led to greater morbidity among injecting drug users. Although the formulation was intended to reduce injection misuse, it apparently did not do so, but it did appear to be responsible for an increased rate of injection site complications [8,27,29,30,58,59,61]. For formulations intended to deter crushing and injecting, participants recruited from syringe exchange programs and drug treatment programs may offer considerable insight into the perception of new opioid formulations in the addiction community [27].…”

Akute Ischämie nach intraarterieller Drogeninjektion

“…Fatale Verläufe sind nach Injektion von aufgelösten Zolpidem-Tabletten durch die mikrokristalline Zellulose (5) und nach Injektion von Oxymetazolin (Nasenspray) beschrieben worden (16). Eine histologische Untersuchung nach Injektion von Temazepam Gel zeigte Muskelzellnekrosen, interstitielle Ödeme, ausgedehnte arterielle, venöse und kapillä-re Thrombosen und Endothelzellschwellungen (7). (6), intraarterielle Iloprost-Infusionen (11,14,18), intraarterielle Papaverininfusion (3), hyperbare Sauerstofftherapie (1) und Kombinationstherapien (2,5,13).…”