Pentazocine ulceration

There has long been a need for a potent, nonaddicting analgesic for the treatment of certain patients who have intractable pain that cannot be controlled by the more commonly used oral analgesics. Pentazocine was introduced on the market in I967 and has been reported to be a potent analgesic, comparable to meperidine and morphine but without their addicting properties. Consequently, this drug has been used on a long-term basis, and on many occasions the injections have been given by the patient or by nonprofessionals. The result has been a few instances of misuse and overuse. We have seen 14 patients with extensive cutaneous ulcerations, subcutaneous fibrosis, and multiple fistulous tracts due to the abuse of parenterally administered pentazocine. The tissue changes have a characteristic appearance and course, and it has been our experience that conservative treatment results in a poor response. We have had the best results with aggressive excision of the involved areas and coverage of the resultant defect with split-thickness skin graft.