Tissue necrosis: A burden of pentazocine abuse in South East Nigeria

Abstract

Background: Tissue necrosis from pentazocine abuse is becoming a burden in our environment. Pentazocine is an opioid of the benzomorphan class. It is commonly used for post-traumatic and postoperative pain and vaso-occlusive pain of sickle cell disease (SCD). Its prolonged use can lead to addiction and may result in severe injection site necrosis, often worsened by infection due to a lack of aseptic principles during administration. Although pentazocine is a controlled drug in our environment, it is readily available. Objectives: To review patients with tissue necrosis from pentazocine injection, share the challenges in their management, and proffer solutions. Materials and Methods: Clinical summaries of patients with tissue necrosis and ulcers due to pentazocine addiction were reviewed. Results: Twenty-five patients, comprising nine females and 16 males aged 22–61 years, were recorded. Twenty had SCD, while five had other underlying conditions. The duration of abuse was 1–16 years, while the average maximum daily dose was 348.75 ± 346.04 mg. Most patients used multiple sites for injection. Lesions included abscesses, tissue necrosis with ulcers, lymphoedema, exposed necrotic bones, and osteomyelitis. Most had multidisciplinary care. The outcome of wound care was good in two. Three had major limb amputations, four died, three signed against medical advice, six were still receiving care while seven were lost to follow-up. None was completely weaned from the drug at the time of this report. Conclusion: Rising cases of tissue necrosis from pentazocine abuse are disturbing. Treatment is frustrating. Concerted efforts at prevention should be made to stem the tide.