Injecting subutex.

[Tre001]

My roommate injects subutex and I thought it was part of subutex but I read up on it when he started complaining about numbness and discoloration in his hands and feet. The numbness comes all the time. But his hands just started turning a tint of dark yellow. Im very worried since I started studing this cause what I read is amputation is a likely factor because of this?? If so what step out of how many is he in?

[Beanie81]

Everyone whom shoots up NEEDS TO READ THIS WEBSITE & VIEW THE PICTURES:

http://www.annals.edu.sg/pdf/34VolNo9200510/V34N9p575.pdf#search=%22injecting%20subutex%22

If your roommate is shooting up in a artery vs a vein (some know no difference) he is a potential risk for losing his hand/arm/or even life. Even in his vein can be harmful & yes it can call for amputation, gangreen to grow, staph infection ect.

[Beanie81]

Patient 6 was a 49-year-old man who had been abusing Subutex and Dormicum for two years. He was admitted for sepsis with PUO. Echocardiogram showed large tricuspid valve vegetation (Figs. 5a&c). Blood culture grew Staphylococcus aureus. He continued to have fever and chills. Subsequent blood culture grew Methicillin-resistant Staphalococcus aureus (MRSA). After interrogation, he admitted injecting Subutex in the ward. He developed hospital-acquired MRSA septicaemia. He was treated with four weeks of IV vancomycin and oral rifampicin but without success. He underwent tricuspid valve excision and bioprosthetic valve replacement. He was also a hepatitis C carrier. He continued to abuse Subutex post discharge. Two months later, he was admitted to the orthopaedic unit presenting with severe low back pain. MR imaging of the spine showed discitis. Blood culture grew MRSA colony. Repeat echocardiogram showed very large vegetation on the prosthetic tricuspid valves with significant obstruction. He was given another course of IV vancomycin, gentamycin, clindamycin and oral rifampicin. He failed to respond to the medical therapy and developed heart failure and septic shock. He underwent open heart vegetation excision (Figs. 5d&f), and died two days postoperation.

Patient 7 was a 31-year-old man who had been abusing Subutex and Dormicum for two years. He presented with an altered mental status. He was diagnosed to have septic encephalopathy secondary to multiple brain septic emboli (Fig. 6). His blood culture grew group G Streptococcus viridans. His long line tip culture grew Acinetobacter baumanii. He had positive toxoplasmosis antibodies and positive hepatitis C serology. Echocardiogram showed tricuspid valve vegetations and large abscess cavity. He developed septic shock with DIVC. He required inotropic support, and was treated with IV penicillin and gentamycin for four weeks. The patient then absconded from the hospital, and returned eight months later, presenting with persistent fever and chills. He continued to inject himself with Subutex and shared needles with other addicts. He had recurrent tricuspid valve endocarditis with multiple organisms isolated from the blood cultures that included Streptococcus mitis, Prevotella spp. and Acinetobacter spp. He was found stealing needles and injecting himself in the ward. He absconded from hospital after five weeks of antibiotics treatment.

Patient 8 was a 25-year-old man who abused Subutex for a few months. He presented with fever, breathlessness and lower limb swelling. Blood culture grew Pseudomonas spp. and Staphylococcus aureus. Echocardiogram showed mitral valve and tricuspid valve vegetations. Computed tomography of the thorax showed multiple pulmonary septic emboli. He was treated with IV cloxacillin, gentamycin and rifampicin. He failed to improve after antibiotic therapy and developed haemodynamic compromise after development of acute severe mitral regurgitation due to chordal rupture. He underwent emergency mitral valve replacement surgery and tricuspid vegetation debridement. He was treated with a prolonged course of IV antibiotics and stayed in hospital for six months. He recovered after surgery. Unfortunately, he was readmitted 12 months later for severe spontaneous intracranial haemorrhage due to warfarin overanticoagulation. He died during that admission.

Patient 9 was a 22-year-old man who abused both Subutex and Dormicum. He presented with prolonged fever. Echocardiogram showed large tricuspid valve vegetation. He was treated with IV cloxacillin after identification of positive Staphylococcus aureus growth on blood culture. He was non-compliant with treatment. He discharged himself against medical advice three times during the entire treatment period. His condition deteriorated. Echocardiogram one month later showed multiple enlarging tricuspid valve vegetations, severe tricuspid regurgitation, and impaired left ventricular ejection fraction from 65% to 45%. He developed pulmonary septic embolic, septic shock, brain abscess, seizures and kidney abscess. He was infected with hepatitis C, and developed hepatitis C-associated mesangial proliferative glomerulonephritis. Patient died from septic shock and multiorgan failure.

Patient 10 was a 35-year-old man who had a history of congenital bicuspid aortic valve with moderate aortic regurgitation. He had been abusing Subutex for months, despite warnings given by doctors regarding the high risk of infective endocarditis. He presented with fever, confusion and right hemiparesis for three days. He developed severe septic shock with multiple brain septic emboli. He was intubated and managed in the intensive care unit. He developed acute heart and renal failures. Transoesophageal echocardiogram revealed large aortic valve vegetations with severe aortic regurgitation (Figs. 7a&c). Blood culture grew Staphylococcus aureus and Corynebacterium spp. He underwent emergency aortic valve excision and replacement (Fig. 7d). He recovered from the infection, and had a fairly good functional return after two months of outpatient rehabilitation. Unfortunately, he continued to abuse Subutex and was readmitted 18 months later for prosthetic valve endocarditis and septic shock. He underwent prosthetic valve excision and died during the admission.

Patient 11 was a 24-year-old man who had been abusing Subutex for three months. He developed prolonged fever and chills for one month. He did not seek medical treatment. He was found collapsed at home by family members. He was intubated at the emegency department and transferred to the MICU. He presented with severe septic shock. His temperature was 41°C and blood pressure was 80/60 mmHg. Clinical examination revealed Osler’s nodes, splinter haemorrhage and a loud pansystolic murmur. Echocardiogram revealed large tricuspid valve vegetations. Blood culture grew Staphylococcus aureus. He was treated with IV cloxacillin and gentamycin, and later on converted to vancomycin and imipenum. He was given inotropic support with an intraaortic balloon counterpulsation pump. Despite intensive treatment, he continued to deteriorate and died on the fourth day after admission.

Patient 12 was a 23-year-old woman who had learnt to inject Subutex from her friends and had been abusing Subutex for three months. She presented with fever, chills and rigors for three weeks’ duration. Chest radiograph showed multiple pulmonary consolidations and abscess cavities. Echocardiogram showed tricuspid valve vegetation. Blood culture grew Staphylococcus aureus. She recovered after treatment with six weeks of IV cloxacillin.

We interviewed the patients and identified some of the reasons for abusing Subutex via IV injection:

(1) More rapid onset of action: euphoric response within 30 seconds with the IV route, compared to 10-20 minutes with the sublingual route.
(2) False belief that IV Subutex can enhance erection and sexual function.
(3) Combination usage with benzodiazepines, especially Dormicum and Erimin (Nimetazepam) in order to enhance euphoric effect.
(4) Psychological addiction to the habit of injecting drugs: habitual injection abuser.
(5) Peer pressure: especially among the Malay drug abusers. They tend to group together to inject drugs and share needles.
(6) To reduce cost: injection route often requires a smaller dosage compared to the sublingual route. Subutex tablets can be crushed into powder and dissolved in hot water. The insulin needle was used to inject the suspension into the veins of upper limbs. Occasionally, the patients injected blood vessels in the groin (femoral arteries was referred as "the highway") and neck. Few patients would clean the injection sites with soap and water.

[Beanie81]

The synopses of 12 cases of Subutex endocarditis are summarised in Table I. Patient 1 was a 28-year-old woman who had been abusing Subutex and Dormicum for three months. She presented with pneumonia and septic shock. She developed multiple pulmonary septic emboli (Fig. 1). Echocardiogram showed large tricuspid vegetation. Blood culture grew Staphylococcus aureus. She was treated with two weeks of intravenous (IV) gentamycin and eight weeks of IV cloxacillin. Despite completing the antibiotic regimen, she continued to experience septic symptoms. Repeat echocardiogram showed an impaired left ventricular systolic function, persistent vegetation and severe tricuspid valve destruction with resultant severe regurgitation. She underwent surgical vegetation excision and tricuspid valve replacement. She recovered after three months of hospitalisation.

Patient 2 was a 45-year-old man who had been abusing Subutex for six months. He injected Subutex powder into his arm veins in order to seek "a high". He was admitted to the vascular surgery unit for acute left arm ischaemia secondary to brachial artery thrombosis after Subutex injection (Fig. 2). He was found to have heart murmur and persistent fever for one week. Echocardiogram showed tricuspid valve vegetation. Blood culture grew Staphylococcus aureus. He was treated with two weeks of low molecular weight heparin (Clexane) for the upper limb ischaemia and six weeks of IV cloxacillin. He recovered from the illness without surgical intervention for the arm ischaemia.

Patient 3 was a 36-year-old man who had been injecting Subutex, and occasionally Dormicum, for one year. He presented with symptoms of fever, chills, rigors and weight loss for one month. A diagnosis of pyrexia of unknown origin (PUO) was made. Blood culture grew Staphylococcus aureus. Echocardiogram showed tricuspid valve vegetation. He was treated with IV cloxacillin and gentamycin for two weeks and further cloxacillin for a total of six weeks. He absconded from the hospital after being found guilty for injecting diazepam (Valium) powder in the ward.

Patient 4 was a 30-year-old man who bought and sold Subutex on the black market. This trade brought him extra money. He had been abusing Subutex for two years. He cut the 8 mg Subutex tablet into four portions and injected the crushed powder intravenously after mixing it with water. He was admitted for sepsis. He developed infective endocarditis involving both the mitral and tricuspid valves (Figs. 3a&c). There was no patent foramen ovale demonstrated in the echocardiogram. He had pulmonary septic emboli and disseminated intravascular coagulation (DIVC). He was treated with IV cloxacillin and IV gentamicin. Concurrently, he developed hepatitis C glomerulonephritis. He underwent a total of 60 days of IV antibiotic treatment in the hospital. He recovered from infective endocarditis, with residual tricuspid valve perforation and severe regurgitation.

Patient 5 was a 35-year-old man who was admitted to medical intensive care unit (MICU) for severe septic shock secondary to pneumonia and empyema. He had severe jaundice and was found positive for hepatitis C serology. Echocardiography showed vegetation in the tricuspid valves. Blood culture grew Staphylococcus aureus. He was treated with IV gentamicin and cloxacillin. Oral rifampicin was added on two weeks later. He required chest tube insertion for empyema drainage. He complained of severe low back pain. Magnetic resonance (MR) imaging of the spine showed discitis secondary to septic emboli (Fig. 4). He developed a few delirium episodes secondary to drug abuse in the ward. He received IV antibiotics for a total of 88 days and recovered from the illness.

[Beauteefullabeast]

People inject subutex because at one time they used to inject heroin. They wanted to quit but found even with treatment meds, their fixation with needles was there. When one injects, there is no waiting, BAM! You're high as a kite.
The problem with injecting subutex is that unlike heroin, which breaks down easily in water, subutex has fillers because it is prescribed in pill form.
The dangers of injecting subutex are numerous, number one being that the effects aren't immediate, it's often two months later that your thumb goes numb. Upon a visit to the doctor you may find gangrene has spread through your hand, and amputation is often the only option at this point. He needs to see a doctor while they can still pump him with drugs that will loosen up all the clogged blood veins in his hands.

Love,
An ex junkie

[katbell]

I Think your friend should get some medical advice..I know, the fact that he may lose his script will probably stop him  but it could be for the best.
I think certain people should keep quiet! Injecting can become an addiction all by its self. Its COMPULSIVE!!!


Katbell

[Bhoionbykke]

Subutex does not contain the blocker that suboxone does. It is an abusable alternative that is commonly given to pregnant patients.