Surgical complications in parenteral Subutex abusers

There were anecdotal reports of an increase in the admissions of parenteral Subutex abusers to our hospital over the past five months. This case study aimed to analyse the surgical complications related to parenteral Subutex abuse and describe the demographics of this group of patients.

We reviewed all admissions to our hospital between July and November 2005. Only parenteral Subutex abusers were included in this case study.

A total of 53 parenteral Subutex abusers were admitted during this period. 31 had surgical complications, while 22 presented with medical ones. Of the surgical patients, 12 had cellulitis and thrombophlebitis, six developed abscesses of the limbs, ten were patients with ischaemia and gangrene of the digits and limbs, one had septic arthritis, one had necrotising fasciitis, and one had a pseudoaneurysm of the femoral artery. There were no reported mortalities. Only nine patients needed surgical interventions. Most of the patients are young with a mean age of 34.2 years. There was a male predominance of 92.4 percent (49 out of 53). Malays are more frequently affected (72 percent, n=38), followed by Indians (15 percent, n=8), and Chinese (13 percent, n=7).

Parenteral Subutex abuse is a rising concern in Singapore. Many patients present to the surgical and orthopaedic departments for limb and vascular complications. Surgery has a limited role in their management, and most are treated conservatively and expectantly. The solution to this emerging trend requires inter-hospital and ministerial collaboration.