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Promethazine use among chronic pain patients
Kara L Lynch1, Brad J Shapiro2, Diana Coffa3
1Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.
Drug and Alcohol Dependence
|March 11, 2015
Summary
Nine percent of chronic pain patients using opioids tested positive for promethazine, often without a prescription. This suggests promethazine may be misused, potentially increasing risks for patients on opioid therapy.
Area of Science:
- Pharmacology and Toxicology
- Pain Management
- Public Health
Background:
- Concomitant use of opioids and promethazine is documented in specific groups.
- Promethazine is suspected to enhance opioid effects.
- Prevalence of promethazine use in chronic pain patients on opioids remains unquantified.
Purpose of the Study:
- To determine the prevalence of promethazine use among patients prescribed opioids for chronic pain.
- To identify factors associated with promethazine use in this population.
Main Methods:
- Analysis of urine samples from 921 chronic pain patients on opioid therapy for promethazine.
- Collection of demographic, toxicology, and opioid prescription data via medical record review.
- Statistical analysis (bivariable and multivariable) to assess prevalence and associated factors.
Main Results:
- Promethazine was detected in 9% of urine samples from chronic pain patients on opioids.
- Half of promethazine-positive patients lacked a prescription for the drug.
- Associated factors included concurrent benzodiazepine use without a prescription, methadone prescriptions (for pain or dependence), and longer-acting opioid prescriptions.
Conclusions:
- Significant promethazine use exists among chronic pain patients receiving opioid therapy.
- Promethazine warrants consideration as a substance of abuse in opioid-using populations.
- Potential for increased patient morbidity due to promethazine misuse should be recognized.
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