title: Analysis of Intensive Care Unit Admission and Sequelae in Patients Intravenously Abusing Extended-Release Oral Oxymorphone.
abstract: Prescription drug abuse is a major public health problem in the United States, with the rate of opioid-related deaths nearly quadrupling between 2000 and 2014. Extended-release oral oxymorphone hydrochloride (Opana ER) is a long-acting opioid prescribed for chronic pain; however, it also has the potential to be abused via intravenous injection. This retrospective review sought to analyze specific complications and sequelae requiring intensive care unit resources for patients intravenously abusing extended-release oral oxymorphone.
  
  
  
  We retrospectively reviewed the medical records of patients identified for drug abuse between January 2012 and December 2015, identifying patients who intravenously abused extended-release oral oxymorphone. Medical charts were reviewed to identify associated sequelae and patients requiring an intensive care unit level of care.
  
  
  
  We identified 53 patients who required treatment in an intensive care unit setting as a consequence of intravenously abusing extended-release oral oxymorphone. Twenty-eight patients (52.8%) required endotracheal intubation with mechanical ventilation for either acute hypoxic respiratory failure or protection of airway. Acute kidney injury developed in 48 patients (90.6%); 28.3% of these patients failed to regain renal function and required renal replacement therapy. Bacteremia was diagnosed in 36 patients (67.9%) and 30 patients (56.6%) were diagnosed as having acute infective bacterial endocarditis.
  
  
  
  Our patients demonstrated a great need for critical care resources and severe sequelae related to intravenous drug abuse. Clinicians should be vigilant for the possibility for clinical decompensation when initially evaluating patients reporting intravenous abuse of extended-release oral oxymorphone.
authors.affiliation: From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Wilson
authors.affiliation: From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Bonnecaze
authors.affiliation: From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Ajay
authors.initials: A
authors.lastname: Dharod
authors.affiliation: From the Departments of Internal Medicine and Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Miller
mesh_terms: D000038:Abscess / Q000139:chemically induced / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D016470:Bacteremia / Q000453:epidemiology; D002481:Cellulitis / Q000139:chemically induced / Q000453:epidemiology; D003692:Delayed-Action Preparations; D004697:Endocarditis, Bacterial / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000150:complications / Q000453:epidemiology*; D010111:Oxymorphone / Q000009:adverse effects*; D010343:Patient Admission / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000628:therapy; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010111:Oxymorphone