Kara L Lynch1, Brad J Shapiro2, Diana Coffa3, Scott P Novak4, Alex H Kral5. 1. Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States. Electronic address: kara.lynch@ucsf.edu. 2. Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States; Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States. 3. Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States. 4. RTI International, Behavioral Health Epidemiology, Research Triangle Park, NC, United States. 5. RTI International, Urban Health Program, San Francisco, CA, United States.
Abstract
BACKGROUND: Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the "high" from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. METHODS: Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. RESULTS: The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. CONCLUSIONS: The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.
BACKGROUND: Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the "high" from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. METHODS: Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. RESULTS: The prevalence of promethazine-positive urine samples among chronic painpatients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic painpatients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. CONCLUSIONS: The study provides compelling evidence of significant promethazine use in chronic painpatients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.
Authors: Bridget A Martell; Patrick G O'Connor; Robert D Kerns; William C Becker; Knashawn H Morales; Thomas R Kosten; David A Fiellin Journal: Ann Intern Med Date: 2007-01-16 Impact factor: 25.391
Authors: Brad J Shapiro; Kara L Lynch; Tab Toochinda; Alexandra Lutnick; Helen Y Cheng; Alex H Kral Journal: J Addict Med Date: 2013 Mar-Apr Impact factor: 3.702
Authors: Ronald Peters; George S Yacoubian; Warren Rhodes; Karry J Forsythe; Kameko S Bowers; Valencia M Eulian; Clemmie A Mangum; Jamie D O'Neal; Queen Martin; E James Essien Journal: J Psychoactive Drugs Date: 2007-09
Authors: Laura L Adams; Robert J Gatchel; Richard C Robinson; Peter Polatin; Noor Gajraj; Martin Deschner; Carl Noe Journal: J Pain Symptom Manage Date: 2004-05 Impact factor: 3.612
Authors: Jamie K Lim; Jeffrey P Bratberg; Corey S Davis; Traci C Green; Alexander Y Walley Journal: J Addict Med Date: 2016 Sep-Oct Impact factor: 3.702
Authors: Jaimie P Meyer; Gabriel J Culbert; Lyuba Azbel; Chethan Bachireddy; Ainura Kurmanalieva; Tim Rhodes; Frederick L Altice Journal: Harm Reduct J Date: 2020-10-31