Oxycodone
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Obtunded and nonresponsive following intentional drug misuse: case report A 28-year-old man developed obtundation and nonresponsive following misuse of oxycodone for chronic pancreatitis. The patient himself received oral oxycodone by rectal route intentionally which consequently contributed to his death. The man was hospitalised due to failure to thrive and abdominal pain. He was uninsured and unemployed and had been experiencing homelessness for approximately one year. His medical history included alcohol use disorder, intravenous opioid use disorder, hepatitis-C virus, diabetes mellitus type 1, chronic pancreatitis, esophageal varices, mesenteric thrombosis and portal hypertension. He stated snorting of heroin for 3 months prior to the current admission owing to his inability to purchase oxycodone that he had been receiving for chronic pancreatitis for the past 3 years. He was started on oral oxycodone 5–10mg every 4h in on current admission. On admission day 6, he was started on unspecified antibiotics via a peripherally inserted central catheter (PICC) line. On admission days 7–9, he showed mild improvement in physical discomfort. On admission day 10, he was found unresponsive and obtunded. The man was treated with naloxone resulting in immediate restoration of alertness. An empty syringe without needle containing residual white particles was found in his bed linens. It was suspected that he had injected oxycodone surreptitiously into the PICC line. Thereafter, he admitted that he had placed oral oxycodone doses in buccal pouch instead of swallowing and stored in his backpack, which were then crushed, mixed with water and then received rectally as he believed that this was the fastest route for pain relief. He reported the use of 10mg oxycodone. He stated that he was an addict. He given a rationale that he did not want to hinder his discharge. His goals were to be able to drink alcohol and to improve his pain. On admission day 17, he was transferred to the hospice care, antibiotics were discontinued and PICC line was removed. At hospice care, he underwent extensive pain control and was able to drink alcohol. However, he was given opioids via liquid until he could no longer swallow to prevent the likelihood of misuse or diversion. After 12 days in hospice care, he died [immediate cause of death not stated]. It was reported that intentional misuse of oxycodone by patient himself consequently contributed to his death. Fleisch SB, et al. Surreptitious Opioid Misuse in the General Hospital via Rectal Administration: A Case Report. Psychosomatics 61: 405-407, No. 4, Jul-Aug 2020. Available 803498508 from: URL: http://doi.org/10.1016/j.psym.2019.12.001
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Reactions 29 Aug 2020 No. 1819
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