Clinical and pathologic characteristics of intranasal abuse of combined opioid‐acetaminophen medications. Issue 10 (18th August 2014)

• Record Type: Journal Article
• Authors: Vosler, Peter S.; Ferguson, Berrylin J.; Contreras, Jorge I.; Wang, Eric W.; Schaitkin, Barry M.; Lee, Stella
• Is Part Of: International forum of allergy & rhinology. Volume 4:Issue 10(2014:Oct.)
• Page Start: 839
• Page End: 844
• Publication Date: 2014-08-18
• Subjects: 617.51005
• DOI: 10.1002/alr.21355
• Languages: English
• ISSNs: 2042-6976

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="alr21355-sec-0010" sec-type="section"> <title>Background</title> <p>The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid‐acetaminophen abuse and outline optimal therapy.</p> </sec> <sec id="alr21355-sec-0020" sec-type="section"> <title>Methods</title> <p>This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid‐acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review.</p> </sec> <sec id="alr21355-sec-0030" sec-type="section"> <title>Results</title> <p>Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement.</p> </sec> <sec id="alr21355-sec-0040" sec-type="section"> <title>Conclusion</title> <p>Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.</p> </sec> </abstract>