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Harm Reduction ⫸CASE STUDIES - It could happen to YOU!⫷

A stainless steel pot doesn't have aluminum. . .

Methadose concentrated oral solution (10mg/ml) is not fit for injection.



The above ingredients are what constitute the red, cherry liquid syrup used at most American MMT clinics. I cringe when thinking about an IV injection of that shit. I've listed in other threads what each of the ingredients in most injected oral concentrates do when IV'd, so I won't do so again here. No, it is not even relatively safe to IV Methadose oral concentrate in small amounts, ever.

This article covors the basics well. Though it is specifically describing the Methadone syrup available in Austrailia, some of the same ingredients apply, as do the warnings.



http://www.saferinjecting.net/injecting-methadone.htm

Actually the concentrated preparation I was thinking of is actually blue and contains different ingredients, but the point is probably moot. i used to rationalize dangerous risk taking behavior a lot a few years ago.
 
I need to give props to this thread, however I think it would be a double edge sword when it comes to drugs like salvia, certain RC's etc. It could however provide a path to psychotherapudic use and further the research these compunds deserve
 
This is going to be one of the best threads on Bluelight if you keep it up man.
 
Fatal intravenous misuse of transdermal fentanyl

Clinical record
A 35-year-old woman with a history of intravenous drug use was brought by ambulance to the emergency department after an intravenous overdose of the contents of a transdermal fentanyl patch.
The ambulance had been called to a private home where there were two people unconscious, a man and a woman. Both appeared to have had acute narcotic overdoses. It was later confirmed that they had shared (and injected intravenously) the contents of a transdermal fentanyl patch (5 mg) found at the scene. Both patients were rapidly assessed by the ambulance officers, and the initial resuscitation concentrated on the male patient, who, at first assessment, appeared to be in a more critical state. He was unrousable and was reported to have Cheyne–Stokes respiration. His blood sugar level was checked (10.5 mmol/L) and he was given 1.2 mg naloxone intravenously. He recovered consciousness within five minutes and subsequently absconded from the scene while the second patient was being treated.
In the interim, the female patient had suffered a cardiorespiratory arrest. Cardiopulmonary resuscitation was commenced, with the assistance of police officers who were also in attendance. According to ambulance records, her initial rhythm was electromechanical dissociation, which subsequently deteriorated into ventricular fibrillation. A direct current countershock (200 J energy) was applied. The patient went into asystole. She was intubated and intermittent positive pressure ventilation with 100% oxygen was started. Naloxone 1.6 mg, adrenalin 10 mg (total dose) and atropine 2 mg were administered intravenously. Subsequently, she developed a narrow complex tachycardia with a rate of 130 beats/minute and had a palpable cardiac output. The total time spent at the scene was 40 minutes, and transport time to hospital took 5 minutes.
On arrival at the emergency department she was unconscious, with a Glasgow Coma Score of 3. Her pupils were dilated and non-reactive to light. She was making occasional attempts at respiration and was ventilated as above with 100% oxygen. Her heart rate was 120 beats/minute in sinus rhythm, systolic blood pressure 55 mmHg and oxygen saturation 97%. One litre of Haemaccel and a noradrenalin infusion were administered, resulting in an initial improvement in systolic blood pressure to 95 mmHg. It was evident that she had vomited at the scene, and clinical signs were consistent with aspiration, which was later confirmed on chest x-ray. Laboratory results for arterial blood, serum and urine are shown in Box 1. She was transferred to the intensive care unit, where she subsequently developed diabetes insipidus, abnormal liver function, disseminated intravascular coagulation and had ongoing haemodynamic instability.
The next day, cerebral computed tomography (CT) scan showed changes in the basal ganglia and mild generalised cerebral swelling consistent with severe hypoxia (Box 2A). A CT scan of her abdomen showed generalised changes in the bowel wall and mesentery consistent with bowel necrosis (Box 2B). Surgical intervention was considered to offer little in view of the severe neurological damage and multiorgan failure. Following extensive discussion with family members, inotropic support was withdrawn and she died soon afterwards.

https://www.mja.com.au/public/issues/177_10_181102/ree10446_fm.pdf
 
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Inhalation Abuse of Fentanyl Patch
Marquadt KA, Tharratt RS, Clinical Toxicology, 1994, Vol. 32, No. 1, Pages 75-78 , DOI 10.3109/15563659409000433

Case Report
A 36-year-old male scraped the contents from a fentanyl patch and placed it in aluminum foil. He heated the foil with a cigarette lighter and used the casing of a pen to inhale the smoke. He was observed by his girlfriend to take one inhalation from the makeshift pipe and then collapse. Upon arrival of the paramedics, he was noted to be unconscious, breathing at 6/m. The heart rate was 120 bpm, and a blood pressure could not be obtained. The victim was ventilated and an oral airway placed. Narcan 2 mg IV push was administered by the paramedic at 10:15 am and the patient slowly awoke. By 10:43 am, in the emergency department, the patient had a respiratory rate of 18/m, blood pressure of 144/89, heart rate of 97 bpm, and was alert and oriented. The patient was discharged from the emergency room at 12:20 with stable vital signs and mental status. Repeat doses of Narcan were not used.
The patient has since expired from a subsequent inhalation session. Autopsy fentanyl levels were as follows: femoral blood 2.66 ng/mL, heart blood 6.05 ng/mL, urine 41 ng/mL, vitreous 3.29 ng/mL, and liver 122 ng/g.
 
The patient has since expired from a subsequent inhalation session. Autopsy fentanyl levels were as follows: femoral blood 2.66 ng/mL, heart blood 6.05 ng/mL, urine 41 ng/mL, vitreous 3.29 ng/mL, and liver 122 ng/g.

You think he'd have learned his lesson from his first OD...
 
Just wanted to add my congrats for this thread. Great idea, awesome way to reduce harm, and outstanding use of heuristics.

Perhaps a sticky at some point under the title "Examples of What Never To Do" or something.
 
Great thread, all of those Subutex abscess's were down right creepy. Those pictures are vividly stuck in my mind now. Creepy. Albeit I'll never inject subutex/suboxone regardless but it makes me very scared of the few times I've injected my Dilaudid tablets because I was hurting so bad & throwing up too much to be able to swallow them due to my illness. I'd rather go pay the ER $1,000 for a Dilaudid & Zofran shot then end up in there getting my arm cut off! I always knew the long term effects of IVing my Dilaudid pills would be really bad so I've only done that like once every 3 months, but I never thought in the short term I'd end up losing my arm. Thanks for the pictures though. I hope those had a lot to do with the ingredients in the subutex preperation.

Im an RN in an emergency room & I've seen A LOT of IV related abscess's in my day but none quite that bad from shooting pills. I've yet to have to see someone get any limbs amputated but I know it happens. 90% of the abscess's I've seen roll through the ER in my area are from the IV use of OxyContin & it generally requires drainage and large doses fo IV antibiotics. Plus you get a nice beautiful mark on your medical record that says "JUNKY"
 
Young people like me think they're invincible. Or I did until I crippled myself from an OD of pod tea. No more sport for me, EVER. My kidneys failed and I almost died. If you're going to do an opiate with a long half life, lie down on bed if you're on your own. That way if you pass out and are unconscious for many hours, the muscles in your legs won't break down and poison your kidneys and disable you for the rest of your life. Basic harm reduction tip.
 
Fatal Intravenous Fentanyl: Abuse Four Cases Involving Extraction of Fentanyl From Transdermal Patches
Amy M. Tharp, MD, Ruth E. Winecker, PhD, and David C. Winston, MD, PhD
(Am J Forensic Med Pathol 2004;25:#2 pp:178-181) DOI: 10.1097/01.paf.0000127398.67081.11

Case 1
A 35-year-old Caucasian man with no known history of drug use was working in his workshop at home one evening. His wife reported that at approximately 12:30 AM, she asked him to come into the house, but that he stated that he would probably continue building porch swings through the night. His father, who stated that he "appeared OK," last saw him alive at 2:30 AM. At approximately 5:00 AM, the decedent’s wife found him lying on the floor of his workshop. Paramedics were unable to resuscitate him. Police investigating the scene found a fentanyl patch, a needle, and syringe in the workshop. External examination of the body revealed no evidence of trauma, except for a 3/4-inch recent contusion with some yellow discoloration at its margins in the left antecubital fossa and a faint petechial-like contusion along a vein on the right forearm. Pulmonary congestion and edema, with a combined lung weight of 920 g, were the only other significant autopsy findings. Toxicological analysis of aortic blood was remarkable for a fentanyl concentration of 5 ug/L, as well as a concentration of 0.8 mg/L of propoxyphene (generally considered to be a nontoxic concentration), and therapeutic concentrations of amitriptyline (0.08 mg/L) and its metabolite nortriptyline (0.33 mg/L). No other organic bases were detected, and testing for norpropoxyphene was not performed. The cause of death was attributed to "fentanyl poisoning," with the manner of death listed as accident.

Case 2
A 38-year-old Caucasian man with a history of drug use was living with his relatives. His family claimed that he had begun a treatment of his drug use in a program that used "morphine patches" for unknown therapeutic purposes. He was last seen alive at 10:00 PM, at which time he complained of nausea. His brother found him dead in bed the following morning at 8:15 AM. Resuscitative efforts were attempted but were unsuccessful. Law officers found a hypodermic needle in the bed beside the body and a ligature on his left hand, with apparent needle marks between the thumb and forefinger. On external examination at the time of autopsy, scars were noted in the right antecubital fossa as well as over each wrist, including a relatively recent puncture site over the dorsum of the left hand, between the thumb and second digit. Internal examination revealed pulmonary congestion and edema, with a combined lung weight of 1500 g, and cardiomegaly (450 g). A focus of granulomatous inflammation was present within the left lung with caseous necrosis, which was found to be due to Coccidioides immitis on silver stains. Focal chronic hepatitis and moderate coronary atherosclerosis were also identified. Toxicologic studies of aortic blood were positive for a 27 ug/L concentration of fentanyl, with no other substances identified. The cause of death was listed as "fentanyl poisoning" with the manner of death as accident.

Case 3
A 42-year-old Caucasian man was found dead in his home, lying prone in the hallway, with his eyeglasses broken and hanging from his face. He had last been known to be alive on the previous day at 10:30 PM, when he had answered a phone call. At the scene, a bottle of diazepam with 11 pills missing from the prescribed number, a methylphenidate tablet, and 2 syringes (1 empty and 1 filled with a clear liquid), as well as an empty box of fentanyl patches were recovered. He had a history of ethanol and multisubstance abuse and was seen in his local emergency room the week prior to his death for treatment of an attempted suicide by Percocet and Restoril overdose, as well as self-inflicted abrasions and lacerations, and ethanol intoxication. Following a work-up, gastric decontamination, and observation, he was sent to a psychiatric hospital for involuntary commitment. It was not determined how he came to be at his home on the day of his death. External examination was unremarkable, with the exception of abundant healed apparently self-inflicted incised wounds on the wrists, abdomen, and forearms. No fentanyl patches were found on the body. Pulmonary congestion and edema, with a combined lung weight of 1920 g, cardiomegaly (450 g), with mild coronary atherosclerosis, and mild hepatic steatosis were found at autopsy. Aortic blood was sent for toxicologic analyses and was positive for 17 ug/L of fentanyl, 0.49 mg/L of paroxetine, low concentrations of cocaine (0.061 mg/L) and its metabolite, benzoylecgonine (0.36 mg/ L), and diazepam (0.15 mg/L). Fentanyl overdose was listed as the cause of death and the manner of death was classified as suicide.

Case 4
A 39-year-old Caucasian man complained of a fever, sore throat, and malaise. He was seen in his local urgent care facility and given hydrocodone cough syrup. Two weeks later, he was found unresponsive in the bathroom of his home by his mother, who admitted removing a needle with attached syringe from his arm. Also found at the scene were 2 empty bottles of hydrocodone, a one-third full bottle of hydrocodone syrup, empty bottles of alprazolam and zolpidem, 2 additional syringes, and 2 empty wrappers from fentanyl patches. He was taken to the local emergency room, where he was pronounced dead. Further investigation revealed a history of drug use, asthma, depression, and psychosis. At the time of autopsy, old needle puncture sites were found within bilateral antecubital fossae, with a relatively recent needle puncture in the left antecubital fossa. Microscopic examination of these sites revealed dermal foreign body giant cells with polarizable material. Internal findings included cardiomegaly (510 g) with left ventricular hypertrophy and hepatosplenomegaly. Numerous foreign body giant cells with polarizable material were present within the lungs, surrounding the pulmonary blood vessels. Toxicologic analysis of femoral blood was positive for 13 ug/L of fentanyl, 0.083 mg/L of hydrocodone, and 0.076 mg/L of oxycodone. Testing of the syringe found at the scene was positive for fentanyl. The cause of death was determined to be fentanyl toxicity, with hydrocodone and oxycodone listed as significant contributing factors. The manner of death was determined to be accident.
 
I hope those had a lot to do with the ingredients in the subutex preperation.
It had mostly to do with the fact that in those pictures, people shot subutex into their arteries, or missed a shot. That can happen with any drug, although pills are more likely to cause bad reactions in these circumstances.

It wasn't because of the specific ingredients in subutex but the actual area of injection for most of those cases.

Plus you get a nice beautiful mark on your medical record that says "JUNKY"

lol
 
Thanks for the support guys/gals. It's something that people can refer to whenever they think "it can't happen to me", because everyone of these people thought the exact same thing. It's hard to ignore the truths in these studies.
I'll make a sticky once I run it by the other mods

CHEMICALSMILE said:
some monkeys are just .... too heavy for some people.

You ain't seen nothing yet :\

Ghosheh, F. R. and S. S. Kathuria (2006). "Intraorbital heroin injection resulting in orbital cellulitis and superior ophthalmic vein thrombosis." Ophthalmic Plastic and Reconstructive Surgery 22(6): 473-475.
A 47-year-old man with decreased vision, ophthalmoplegia, proptosis, and chemosis of his right eye admitted to injecting heroin directly into his orbit. He was placed on intravenous antibiotics for orbital cellulitis, and computed tomography and magnetic resonance imaging were performed. Superior ophthalmic vein thrombosis (SOVT) was noted on magnetic resonance imaging. The patient responded well to intravenous antibiotics, and his symptoms resolved with minimal deficits. Steroids and anticoagulants were not administered. We review the pathogenesis of septic SOVT and briefly discuss the role of anticoagulants and steroids in this setting.
 
I've been too timid to look for intentional abuse of intrathecal injections, have you come across any in the literature?
 
Ha, haven't looked. I'll see if any relate to what goes on here in OD. There's tons of nasty articles, but they don't really apply here, so I tend to think dilute the truth... like how many people would shoot heroin into their eye? I hope no one here :\
I'll check it out though
 
Yeah injecting heroin into your eye is a definite no no if you ask me. Your asking for some kind of crazy damage if you do such a thing. Also I know how easy it would be for some people to shoot into there arteries. But throughout my 4 years in school to get my RN we studied a lot of vein/artery maps & I've personally seen the difference in the blood that comes out bright and froathy when you hit an artery opposed to dark almost black when you hit a vein. I hope people out there educate themselves on what can happen if you don't know the difference and accidently hit an artery! Sure doesn't look like fun to me. I haven't seen any arterial hits come through the ER yet in the years i've been there.
 
In that case, some Femerol and Jugular vein horror stories. That seems to come up every few weeks.
 
Yeah injecting heroin into your eye is a definite no no if you ask me. Your asking for some kind of crazy damage if you do such a thing. Also I know how easy it would be for some people to shoot into there arteries. But throughout my 4 years in school to get my RN we studied a lot of vein/artery maps & I've personally seen the difference in the blood that comes out bright and froathy when you hit an artery opposed to dark almost black when you hit a vein. I hope people out there educate themselves on what can happen if you don't know the difference and accidently hit an artery! Sure doesn't look like fun to me. I haven't seen any arterial hits come through the ER yet in the years i've been there.

Yeh I've seen it as well. And anyone who knows better would know it's arterial blood, but in all the artery shot case stories above ppl didn't know any better. The thing that should separate BL members from junkies is that junkies will shoot into their eye or an artery, whereas (hopefully!) BL members know better. Losing an arm to get high ain't worth it
 
CASE REPORT: Temperate pyomyositis in an injecting drug misuser. A difficult diagnosis in a difficult patient
M Crossley
Emergency Medicine Journal 2003;20:299-300; doi:10.1136/emj.20.3.299

ABSTRACT:: The medical care of injecting drug misusers presents many challenges. Though they can be awkward and unreliable they are at risk of serious medical conditions not often seen in the general population. This case report illustrates some of the difficulties in the diagnosis and treatment of a patient with pyomyositis associated with heroin injection.

CASE STUDY:
A 32 year old man attended the emergency department on the advice of his general practitioner complaining of abdominal pain and vomiting, fresh rectal bleeding, haematuria, and low back pain. He had noticed a swelling on the left side of his lower back, which had become so painful he was barely mobile. He had been injecting heroin for about seven years and had been feeling unwell for two weeks after accidental extravascular injection into his left groin. On closer questioning he admitted to having back pain and requiring elbow crutches to walk for over a year.

On examination he had a temperature of 35.2°C, pulse of 105, respiratory rate of 20, and blood pressure of 100/50. He was dehydrated and looked unwell. He had a fluctuant swelling about 15 cm in diameter on the left side of his lower back, which extended across his sacrum. He was tender over both his greater trochanters. A clinical diagnosis of septicaemia secondary to an abscess was made. As it was not possible to arrange immediate computed tomography the patient was referred to the general surgeons.

The surgical registrar diagnosed septic arthritis involving both hips and sacroiliac joints and advised referral to the orthopaedic surgeons. Orthopaedic opinion was that there was no evidence of septic arthritis in his hips and referred him back to the care of the emergency department. Finally, four hours after arrival, he was admitted to the acute medical ward.

Computed tomography showed a large left sided gluteal abscess (fig 1) communicating through the left sacroiliac joint with the retroperitoneal space (fig 2) and tracking up to the lower pole of the left kidney. Under computed tomographic guidance on day two, two catheters were inserted into the retroperitoneal space and fresh pus drained freely. Blood cultures grew Staphylococcus aureus.

On day 10, repeat computed tomography showed that the abscess, though smaller, contained persistent locules, the left sacroiliac joint remained diastased by pus and there were further locules of pus in the rectospinal musculature. On day 14, he was transferred to the care of the orthopaedic department for open drainage of the abscess and the left sacroiliac joint. He required a further five general anaesthetics for changes of pack and drain removal. On day 64 he was discharged home.

MEDICAL HISTORY
On review of notes it was found that, in the 13 months before this admission, he had attended the emergency department three times and been admitted to hospital twice. He had also been seen in the orthopaedic outpatient department. His initial contact had been an admission, arranged by his general practitioner, when he had a left calf deep venous thrombosis and associated cellulitis. At that time, S aureus was isolated from blood cultures. He was treated with oral flucloxacillin and tinzaparine. He failed to attend for follow up.

Five months later he attended the emergency department with a temperature and low back pain. A diagnosis of psoas abscess was made and he was admitted to the acute medical ward. He absconded from the ward before being seen. The blood cultures that had been taken in the emergency department once again grew S aureus. Attempts made to contact the patient failed as he had lost touch with his family, his phone had been disconnected, and he was no longer registered with a general practitioner. It is interesting to note that the card from this attendance was missing from his emergency department notes, and the blood culture report was filed in the hospital notes only. This information was therefore not available to emergency department staff when he next attended.

Six weeks later he returned to the emergency department complaining of nausea, vomiting, and back pain. He was again admitted under the physicians with a provisional diagnosis of pyelonephritis with muscular back pain. At this stage his haemoglobin was 9.3 g/dl. He subsequently had a normal upper gastrointestinal endoscopy. Once again he developed a deep venous thrombosis. S aureus was again isolated on blood cultures. He was discharged prescribed trimethoprim, flucloxacillin, and warfarin.

After a further six weeks he re-presented to the emergency department with low back pain. His temperature was normal. A diagnosis of muscular pain was once again made. The following week he was seen in the orthopaedic outpatient department, having been referred by his general practitioner for investigation of the persistent low back pain. He was referred for physiotherapy and failed to attend for further follow up.

His next attendance five months later was the episode described initially.

DISCUSSION (ABRIDGED):

Pyomyositis presents in three stages. Initially there is myositis and muscle oedema but no abscess formation. The patient presents with muscle pain and low grade fever. At this stage the condition may be cured by appropriate antibiotic therapy, but it is difficult to diagnose because of non-specific signs and symptoms.5 The most common stage at presentation is stage two, characterised by abscess formation, muscle pain, fever, tenderness, and leucocytosis. This picture is complicated in stage three disease by systemic toxicity. Treatment in the latter stages requires surgical drainage as well as appropriate antibiotics.
 
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