Injected Opana Causes Blood Disorder

thrombotic thrombocytopenic purpura

As a reminder, I wanted to re-run this post from over a year ago, about an unusual blood disorder seen in a handful of opioid addicts in Northeastern Tennessee in late 2012.

The brand name opioid Opana, which contains oxymorphone, is one of the most popular illicitly used prescription opioids in my area of Western North Carolina. Per milligram, oxymorphone is a little more potent than oxycodone. Opana became more popular with addicts as OxyContin became harder to find on the black market. Then in 2012, OxyContin was re-formulated to make it harder to inject. In 2011, Opana was also re-formulated to make the tablets crush-resistant.

However, the addicts I’ve admitted into addition treatment sometimes describe how they defeat the crush resistance of Opana ER, and those IV users are at risk for developing this disease of TTP. So far, there are no reports of TTP in patients who take the medication by mouth or by snorting it.

TTP, which stands for thrombotic thrombocytopenic purpura, is a blood disorder where platelets don’t function normally. They clump together in some places, like small blood vessels, where they can cause strokes, heart attacks, and kidney failure. In other areas of the body, bleeding can be seen, because the platelets aren’t available to help blood clot normally. The bleeding often occurs under the skin, causing the purpura which gives the disease its name.

Since the early 1990’s, patients with TTP have been successfully treated with plasma exchange. With this process, somewhat like dialysis, the patient’s plasma is replaced with donor plasma. This procedure usually needs to be repeated every day until a response is seen, which may take weeks. Sometimes an immunosuppressant medication must also be prescribed. The mortality is very high (more than 80%) if not treated.

For now, it’s not known what component of the Opana ER tablets causes TTP. Patients have told me they add various substances to help the tablet dissolve, which I’m not going to describe here, and I wonder if these agents could play a role.

Oral tablets are not sterile. They contain fillers and stabilizing agents that wreak havoc when injected into the blood vessels of the body. Some addicts feel that pharmaceutical grade tablets are safer than other illicit opioids, but a non-sterile tablet can cause all kinds of damage. TTP is just the latest in a long list of medical problems that occur with intravenous drug use.

If you are injecting tablets, be kind to yourself: get treatment.

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