Severe Upper Limb Complications from Parenteral Abuse of Subutex®

Introduction: Subutex® is a sublingual formulation of buprenorphine that is used to treat opioid dependency. It may be abused parenterally with disastrous consequences. Clinical Presentation: We present 4 cases of parenteral abuse of Subutex® resulting in severe upper limb complications. Treatment: Two vascular complications were treated with combinations of anticoagulants, vasodilators, brachial plexus bock and iloprostol. One severe hand abscess required surgical debridement, and 1 median nerve injury required neurolysis. Outcome: All patients had a poor outcome. Both patients with vascular complications required multiple amputations, the patient with a thenar abscess had severely impaired thumb function, and the patient with median nerve injury has ongoing neuralgic pain, numbness and thenar weakness. Conclusion: The incidence of complications of parenteral abuse of Subutex® is increasing in Singapore. These complications have a poor outcome despite adequate management, and are best prevented by education or legal means.