title: [Severe distal ischemic syndrome after buprenorphine volunteer intra-arterial injection].
abstract: High dosage buprenorphine (HDB) is a sublingual maintenance treatment of opioid dependence which have proved its substantial Public Health results, but it is also known to be frequently abused and diverted, in particular for intravenous injection, with deleterious consequences. Intra-arterial use is more rarely reported with this substance, just like its complications, mainly ischemic, potentially necrotic, phenomena. We report here such a case, with a 30 years-old man suffering from severe ischemia of the thumb, the forefinger and the middle finger few hours after direct injection of a suspension of buprenorphine crushed tablets in right radial arteria. A treatment combining surgery (video-thoracoscopic thoracic sympathectomy) and medicines (heparin, iloprost and piribedil mesilate), permitted a semi-complete digital rehabilitation (only forefinger pulp necrosis persisted and required a distal amputation), and the patient was discharged after 2 weeks.
authors.affiliation: Centre AntiPoison et de Toxicovigilance, Hôpital Salvator, AP-HM, Marseille, France. mathieu-glaizal@ap-hm.fr
authors.forename: Mathieu
authors.initials: M
authors.lastname: Glaizal
authors.forename: Joseph
authors.initials: J
authors.lastname: Lucciardi
authors.forename: Lucia
authors.initials: L
authors.lastname: Tichadou
authors.forename: Michel
authors.initials: M
authors.lastname: Spadari
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hayek-Lanthois
authors.forename: Joëlle
authors.initials: J
authors.lastname: Micallef
authors.forename: Luc
authors.initials: L
authors.lastname: de Haro
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D015819:Substance Abuse, Intravenous / Q000150:complications
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine