Meperidine: a continuing problem.

Letter to the Editor regarding meperidine prescriptions in Queensland, Australia, 1999 to 2010.

Introduction

The State of Queensland, Australia has a population of about 4.5 million. The Drugs of Dependence Unit maintains a record of all non-hospital opioids dispensed at community (non-hospital) pharmacies.

Figure 1 shows the total number of meperidine prescriptions issued and distinct persons who received prescriptions from 1999 to 2010 as recorded at the Drugs of Dependence Unit.

Figure 1

Meperidine ampoules dispensed in Queensland, Australia, 1999–2010 (Prescriptions and Persons).

Although there has been a significant decline, there remains a concerning number of patients who continue to receive meperidine.

Discussion

Despite guidelines for chronic pain management, availability of many other more suitable opioids, and surveillance by government authorities, the prescribing of meperidine remains a concern.

The side-effect profile of repeated intramuscular meperidine injections, usually for chronic pain, is potentially more problematic compared to other opioids. To acquiesce to patient demand for meperidine may only support addictive behavior and risk other serious adverse consequences including seizures,1 serotonin syndrome,2 and fibrous myopathy.3

Individuals who receive or self-inject, meperidine by the intramuscular route will experience quick and effective “relief” from “suffering” that includes somatic symptoms, anxiety, or depression. Meperidine has been reported to cause more dizziness, higher elation, and a greater impairment of the ability to work when compared to morphine.4

Meperidine has been referred to as “the doctors’ and nurses’ addiction”. 186 of a total of 280 pethidine addicts (65%) admitted to a US psychiatric hospital were classified as health care workers.5 A 5-year study of drug addiction among Quebec physicians included 56% who preferred meperidine compared to 38% who preferred morphine.6

Given the significant addictive potential of meperidine and the availability of other effective opioids, has the time come for practitioners to eliminate meperidine when treating individuals with chronic pain?