Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bozinoff, Nikki; Tardelli, Vitor Soares; Rubin-Kahana, Dafna Sara; Le Foll, Bernard

doi:10.1186/s12954-022-00695-5

Harm Reduction Journal

Table 2 Studies discussing adverse events associated with intravenous buprenorphine use

From: Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Study citation	Location	Study population	Study design	Year data was collected	Buprenorphine formulation injected	Adverse event(s)	Quality Assessment [1–5]
Aboltins [96]	Melbourne, Australia	28 year old female	Case study		SL buprenorphine (spitbacks)	Fungal endophtalmitis	1
Aich [69]	Bhairahawa, Nepal	76 people with OUD	Quantitative descriptive	2003–2004	Buprenorphine ampoules	Thrombophlebitis, HIV, cellulitis, abscess	4
Alvarez [97]	Barcelona, Spain	32 year old male	Case study		SL buprenorphine	S. marcescens endopthalmitis resulting in blindness	1
Ambekar [28]	Multiple sites in India	902 male PWIDs at harm reduction centres	Quantitative descriptive		Buprenorphine ampoules	Abscess, blocked veins, overdose	3
Berson [61]	Clichy, France	33 year old male, 27 year old male, 28 year old male, 31 year old male	Case series	1996–1998	SL buprenorphine	Acute hepatitis in the context of chronic HCV	2
Boggs [98]	USA	29 year old female and 30 year old female	Case series		SL buprenorphine/BNX	Anaphylaxis and death	1
Bouquie [99]	Nantes, France	33 year old male	Case study	2014	SL buprenorphine	Livedo-like dermatitis with necrotic lesion	1
Boyd [100]	Helsinki, Finland	Records of 308 people with opioid overdose	Case series	1996–2002	SL buprenorphine	Overdose	3
Bruce [35]	Kuala Lumpur, Malaysia	41 people who use IV buprenorphine	Quantitative descriptive	2007	SL buprenorphine/BNX	Opioid withdrawal	3
Cassoux [101]	France	22 year old male, 25 year old male, 27 year old male, 30 year old male	Case series		SL buprenorphine (spitbacks, dissolved tabs in lemon juice)	Ocular candidiasis, septicemia, skin abscess, cervical lymphadenopathy, scalp nodules, wrist arthritis, folliculitis, chorioretinal lesion	2
Chai [102]	Singapore, Singapore	92 hospitalized patients	Case series	2003–2005	SL buprenorphine	Bacteremia, endocarditis, septic pulmonary emboli	2
Chew [103]	Singapore, Singapore	30 F, 35 M, 40 M, 60 M	Case series	2006	SL buprenorphine	Deep venous thrombosis, hand ischemia (thrombosis of brachial artery); epidural, limbs, and popliteal fossa abscesses	2
Chong [104]	Singapore, Singapore	12 clients aged 22–49	Case series	2005–2006	SL buprenorphine	Endocarditis, pneumonia, abscesses, septic shock, disseminated intravascular coagulation, acute heart and renal failure, among others	2
Chowdhury [74]	Guwahati, India	38 year old male	Case study		SL buprenorphine	Koro (acute anxiety due to the perception of intraabdominal penile retraction/shrinkage and fear of impending death)	1
Chua [105]	Singapore, Singapore	Mid-20 s male and mid-30 s female	Case series		SL buprenorphine	Cellulitis	1
DelGiudice [106]	Fréjus, France	13 clients aged 25–43	Case series	1996–2001	SL buprenorphine	Injection-site abscesses, cellulitis in multiple sites, thrombophlebitis in multiple sites, cutaneous necrosis	2
Eiden a [107]	Montpellier, France	31 clients (median age: 39)	Quantitative descriptive	2012–2013		Skin and soft-tissue infection, sepsis, endocarditis, spondylitis, meningitis, pulmonary abscess, candidemia	2
Eiden b [108]	Montpellier, France	192 clients (median age: 34)	Quantitative descriptive	2002–2012	SL buprenorphine	Cutaneous abscesses, osteoarticular infections, pulmonary infections, venous infections, endocarditis, hepatitis, sepsis, puffy hand syndrome	3
Eiden [109]	Languedoc-Roussillon region, France	198 people with extramedical use of buprenorphine	Quantitative descriptive	2002–2012	SL buprenorphine	Cutaneous abscess, venous infection, puffy hand syndrome, osteoarticular infections, endocarditis, pulmonary infections, sepsis, hepatitis	5
Espitia [110]	Nantes, France	33 year old male	Case study			Nicolau Syndrome (necrotic-centre lesion with nerve ischemia and motor deficiency)	1
Feeney [75]	Brisbane, Australia	24 year old female	Case study		SL buprenorphine	Femoral abscess with groin tissue necrosis	1
Gautschi [111]	Perth, Australia	30 year old male	Case study			Groin tissue abscess and myositis	1
Hakkinen [112]	Finland	225 postmortem toxicology cases with a urine sample positive for buprenorphine, norbuprenorphine or naloxone and background information supporting drug use	Quantitative descriptive	2010–2011		Fatal overdose	3
Ho [113]	Singapore, Singapore	131 people who use IV buprenorphine	Quantitative descriptive	2004–2006	SL buprenorphine	Cellulitis, abscess, necrotizing fasciitis, false aneurysms, thrombophlebitis, hematoma, lymphadenopathy, infection of specific site	4
Horyniak [76]	Melbourne, Australia	23 people who use IV buprenorphine	Mixed methods	2006	SL buprenorphine/BNX (mixed with saliva or lemon juice)	Nausea, vomiting, abscesses, vein damage	4
Jenkinson [62]	Melbourne, Australia	156 PWID	Quantitative descriptive	2002	SL buprenorphine	Overdose, abscesses/infections, scarring/bruising, thrombosis	4
Joethy [114]	Singapore, Singapore	29 year old male	Case study		SL buprenorphine	Mechanical nerve injury	1
Kintz [115]	Multiple sites in France	38 and 79 fatalities involving buprenorphine	Quantitative descriptive	1996–2000	SL buprenorphine	Fatal overdose	3
Kintz [116]	Strasbourg, France	13 fatalities involving buprenorphine	Quantitative descriptive	2000–2001	SL buprenorphine	Fatal overdose	2
Kluger [117]	Montpellier, France	31 year old male	Case study		SL buprenorphine	Penile and scrotal skin necrosis	1
Kriikku [63]	Finland	775 toxicology cases positive for buprenorphine upon death	Quantitative descriptive	2010–2014	SL buprenorphine/BNX	Overdose	5
Kulaksızoglu [77]	Antalya, Turkey	19 year old male	Case study	2018	SL BNX (dissolved in hot water)	Depressive symptoms	1
Kumar [50]	Madras, India	100 PWIDs	Quantitative descriptive	1998	SL buprenorphine	HCV, HIV, Hepatitis B	4
Lee [79]		mid-40 s female	Case study		SL buprenorphine (dissolved in hot water)	Blurred vision, bacterial endocarditis, mild cognitive impairment	1
Lee [118]	Singapore, Singapore	25 year old male	Case study		SL buprenorphine	Endocarditis, protein-losing enteropathy, tricuspid regurgitation, and heart failure	1
Lim [119]	Singapore, Singapore	7 males aged 28–53	Case series		SL buprenorphine	Loss of consciousness, left/right hemispheric syndrome (including hemianopia, gaze deviation, hemineglect, and aphasia), head injury, thrombophlebitis, arm cellulitis	2
Liu [80]	Multiple sites in China	1235 people with OUD and a history of buprenorphine use for at least three days	Quantitative descriptive	2000–2001	SL buprenorphine	Opioid withdrawal	4
Lo [44]	Singapore, Singapore	53 people with extramedical use of buprenorphine (mean age 34.5)	Case series	2005	SL buprenorphine	Skin infections; limb abscesses, ischaemia, and gangrene; necrotising fasciitis; septic arthritis; pseudoaneurysm of the femoral artery; infective endocarditis; withdrawal symptoms, hepatitis C; syncope/seizure; atypical chest pain; pulmonary tuberculosis	2
Loo [120]	Singapore, Singapore	4 males aged 22–55	Case series	2005	SL buprenorphine	Large thenar abscess, ischemic hand, subclavian vein thrombosis, sepsis, wet gangrene of the digits, paralysis of thenar muscles, carpal tunnel, amputation	2
Marka [121]	New Hampshire, USA	29 year old female and 37 year old male	Case series		SL BNX	Crospovidone reactions (skin foreign body reaction)	1
Nielsen [122]	Melbourne, Australia	250 people who had experience with OAT	Quantitative descriptive	2004–2005	SL buprenorphine	Overdose	3
Ojha [123]	Kathmandu, Nepal	300 PWIDs	Quantitative descriptive		SL buprenorphine	HIV infection	4
Partanen [124]	Helsinki, Finland	25 PWIDs ages 20–39	Case series	2000–2005	SL buprenorphine	Acute limb ischemia, limb infection (osteomyelitis), and amputation	2
Peyrière [60]	Montpellier, France	33 year old male and 50 year old male	Case series	2007	SL buprenorphine	Exacerbation of chronic HCV	2
Power [36]	Sydney, Australia	15,832 individuals who use IV buprenorphine	Quantitative descriptive	2001–2016	SL buprenorphine/BNX	Overdose	5
Prosser [125]	Sydney, Australia	32 year old male	Case study		Buprenorphine transdermal patch	Tubulo-interstitial nephritis	1
Puolakka [126]	Finland	6 men aged 16–21	Case series		SL buprenorphine	Cervical myelopathy and neck muscle rhabdomyolysis	1
Reynaud [127]	Alsace and Auvergne, France	6 cases of fatalities involving consumption of buprenorphine-benzodiazepine combinations	Case series	1996–1997	SL buprenorphine	Fatal overdose	1
Robinson [128]	Wellington, New Zealand	2 cohorts (54 and 44 people respectively) presenting for OUD treatment	Quantitative descriptive	1990–1992	SL buprenorphine/ BNX	Opioid withdrawal	3
Roux [47]	Multiple sites in France	111 clients receiving OAT with buprenorphine	Quantitative descriptive	2004–2005	SL buprenorphine	Overdose	5
Roux [57]	Multiple sites in France	371 PWID with OUD	Quantitative descriptive	2015	SL buprenorphine	Hand swelling, vein obstruction, rolling veins, cotton fever, and cutaneous abscesses	4
Seet^% [59]	Singapore, Singapore	18 year old male	Case study		SL buprenorphine (dissolved in water)	Diffuse cystic leukoencephalopathy	1
Seet^% [129]	Singapore, Singapore	27 year old male and 31 year old male	Case series		SL buprenorphine (dissolved in hot water)	Sciatic neuropathy, severe myositis, and rhabdomyositis	1
Seet^% [130]	Singapore, Singapore	51 people who use IV buprenorphine	Case series	2002–2005	SL buprenorphine	Cellulitis, endocarditis, myositis, abscesses; withdrawal, seizures, limb ischemia, respiratory failure, rhabdomyolysis, thrombosis, renal failure, leukoencephalopathy	3
Sharma [131]	Singapore, Singapore	32 year old male	Case study		SL buprenorphine (dissolved in hot water)	Myofasciitis (thighs) and polyneuritis	1
Singh [86]	India	24 year old male	Case study		Buprenorphine ampoules	Generalized tonic–clonic seizures; withdrawal; premature ejaculation	1
Singh [87]	Chandigarh, India	18 people with extramedical buprenorphine use	Case series	1987–1990	Buprenorphine ampoules	Concurrent use of benzodiazepines; pain, insomnia, nasal symptoms, irritability, restlessness, muscle twitching, diarrhea, palpitations (withdrawal); gastric antral erosions	3
Tan [132]	Singapore, Singapore	15 patients aged 25–58 who underwent surgery for pseudoaneurysms due to chronic injection drug use	Case series	2005–2008	SL buprenorphine	Infected pseudoaneurysm; gangrene; wound infection; rebleeding	3
Teo [133]	Singapore, Singapore	49 year old male	Case study		SL buprenorphine	Tetanus	1
Vicknasingam [90]	Multiple sites in Malaysia	276 people who use IV buprenorphine; for the second wave 77/276 were re-interviewed 77/276 and additional 171 new participants included	Mixed methods	2006–2007	SL buprenorphine for first survey, BNX in second survey	Weight loss, muscle fatigue, difficulty breathing, chest discomfort	3
Victorri-Vigneau [134]	Nantes, France	16 people who use IV buprenorphine	Case series		SL buprenorphine	Pain, burning, necrosis on injection site; thrombosis/livedo	2
White [91]	Multiple sites in Australia	16 people who inject BNX films	Qualitative	2012–2013	Buccal BNX (films; spitbacks)	Injection site problems; puffy hands; perceived heart disturbance; opioid withdrawal	5
Wilson [135]	Kentucky, USA	10 clients evaluated for ischemia of the hand or digits after injection of BNX	Case series	2011–2015	SL BNX	Hand ischemia; dry gangrene	2
Winslow [92]	Singapore, Singapore	120 people with extramedical use of buprenorphine, enrolled in treatment	Quantitative descriptive	2005–2006	SL buprenorphine	Skin and soft tissue infections, gangrene, thrombophlebitis, acute hepatitis, septicaemia with endocarditis, multiple lung abscesses, opioid withdrawal, embedded foreign body removal	3
Winslow [93]	Singapore, Singapore	106 PWIDs presenting to an addictions management programme	Quantitative descriptive	2005–2006	SL buprenorphine	HCV	5
Yang [136]	Singapore, Singapore	48 year old M and 30 year old female	Case series		SL buprenorphine	Septic sacroiliitis (progressive back pain, limitation of movement, fever)	1
Yeo [95]	Singapore, Singapore	8 clients aged 26–46	Case series	2005	SL buprenorphine (tablets; dissolved in hot water)	Arterial pseudoaneurysm, infective venous thrombus, venous thrombus, end arterial spasms, and sympathetic dystrophy; amputation of lower limb	2

BNX buprenorphine/naloxone, HCV Hepatitis C virus, HIV Human Immunodeficiency Virus, IV intravenous, OAT opioid agonist therapy, OUD opioid use disorder, PWID people who inject drugs, SL sublingual
% = Seet (2007) appears to contain data that is also presented in Seet (2005) and Seet (2006)

Back to article page

ISSN: 1477-7517

Contact us

Submission enquiries: journalsubmissions@springernature.com