title: Promethazine misuse among methadone maintenance patients and community-based injection drug users.
abstract: OBJECTIVE
  Promethazine has been reported to be misused in conjunction with opioids in several settings. Promethazine misuse by itself or in conjunction with opioids may have serious adverse health effects. To date, no prevalence data for the nonmedical use of promethazine have been reported. This study examines the prevalence and correlates of promethazine use in 2 different populations in San Francisco, California: methadone maintenance clinic patients and community-based injection drug users (IDUs).
  
  
  METHODS
  We analyzed urine samples for the presence of promethazine and reviewed the clinical records for 334 methadone maintenance patients at the county methadone clinic. Separately, we used targeted sampling methods to recruit and survey 139 community-based opioid IDUs about their use of promethazine. We assessed prevalence and factors associated with promethazine use with bivariate and multivariate statistics.
  
  
  RESULTS
  The prevalence of promethazine-positive urine samples among the methadone maintenance patients was 26%. Only 15% of promethazine-positive patients had an active prescription for promethazine. Among IDUs reporting injection of opiates in the community-based survey, 17% reported having used promethazine in the past month; 24% of the IDUs who reported being enrolled in methadone treatment reported using promethazine in the past month.
  
  
  CONCLUSIONS
  The finding that one-quarter of methadone maintenance patients in a clinic or recruited in community settings have recently used promethazine provides compelling evidence of significant nonmedical use of promethazine in this patient population. Further research is needed to establish the extent and nature of nonmedical use of promethazine.
authors: Department of Psychiatry and Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA. brad.shapiro@ucsf.edu
authors: Brad J
authors: BJ
authors: Shapiro
authors: Kara L
authors: KL
authors: Lynch
authors: Tab
authors: T
authors: Toochinda
authors: Alexandra
authors: A
authors: Lutnick
authors: Helen Y
authors: HY
authors: Cheng
authors: Alex H
authors: AH
authors: Kral
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006634:Histamine H1 Antagonists / Q000652:urine; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000652:urine; D015995:Prevalence; D011398:Promethazine / Q000652:urine*; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000188:drug therapy* / Q000453:epidemiology / Q000652:urine; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006634:Histamine H1 Antagonists; D011398:Promethazine; D008691:Methadone
references: Subst Use Misuse. 2010 Mar;45(4):515-27
references: 20141462
references: Pharmacol Res. 2009 Nov;60(5):429-37
references: 19497368
references: Ann Surg. 1956 Nov;144(5):861-4
references: 13373271
references: Am J Addict. 2000 Spring;9(2):145-53
references: 10934576
references: Expert Opin Drug Saf. 2008 Nov;7(6):739-48
references: 18983220
references: Drug Alcohol Rev. 2011 Jul;30(4):388-96
references: 21355918
references: Europace. 2007 Sep;9 Suppl 4:iv4-15
references: 17766323
references: J Subst Abuse Treat. 1998 Nov-Dec;15(6):589-93
references: 9845872
references: Pain Pract. 2007 Dec;7(4):352-6
references: 17986163
references: J Foot Surg. 1992 Jul-Aug;31(4):378-80
references: 1357024
references: J Forensic Sci. 2007 Nov;52(6):1389-95
references: 18093068
references: Addiction. 1999 Oct;94(10):1533-40
references: 10790905
references: QJM. 2009 Feb;102(2):123-31
references: 19042969
references: Am J Addict. 2004 May-Jun;13(3):321-3
references: 15370954
references: Indian J Psychiatry. 1999 Apr;41(2):160-2
references: 21455380
references: Am J Health Syst Pharm. 2009 May 1;66(9):825-33
references: 19386945
references: J Urban Health. 2010 Sep;87(5):839-50
references: 20582573