Skip to main content
SpringerLink
Log in

Injection of Pharmaceuticals Designed for Oral Use: Harms Experienced and Effective Harm Reduction Through Filtration

  • Chapter
  • First Online:
Non-medical and illicit use of psychoactive drugs

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 34))

Abstract

Several pharmaceutical products are liable to ‘abuse’ or use outside their prescription, which frequently involves their injection. Examples are slow-release forms of morphine and oxycodone, and sublingual buprenorphine. During injection preparation, the drug is extracted into water, after crushing and heating the tablet if considered necessary. Since these products are designed for oral administration, they can contain excipients (ingredients other than the drug) which are poorly soluble, resulting in suspension of particles in the injection solution. Injected particles are able to produce medical complications such as the blockage of small blood vessels leading to ischaemia (inadequate blood flow) and tissue damage. Filtration can be used to remove particles from the suspension; including bacteria if the porosity is small enough (0.2 μm). However, filters are liable to blockage when overloaded, especially if the pore size is small. This problem can be minimised by using a larger pore size (e.g. 5–10 μm), but the resulting filtrate will contain many residual small particles. The use of two filters, coarse and fine, either sequentially or in a double membrane device, enables removal of the majority of particles as well as bacteria, although not quite meeting pharmaceutical standards for safe injection. Although not yet evaluated by a clinical trial, this highly effective filtration process would be expected to greatly reduce the risk of vascular and related complications, as well as non-viral infections. Careful technique ensures that drug is not lost by filtration, a priority for most drug consumers. Practical issues that affect acceptability of filtration by injecting drug users, including ease of use and cost, will need to be considered. However, given the laboratory evidence demonstrating the effectiveness of filters it is time to consider these tools as essential for safe injection as sterile needles/syringes for the world’s approximately 16 million people who inject drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Arnett EN, Battle WE, Russo JV, Roberts WC (1976) Intravenous-injection of talc-containing drugs intended for oral use—cause of pulmonary granulomatosis and pulmonary-hypertension. Am J Med 60:711–718

    Article  CAS  PubMed  Google Scholar 

  • Bassetti S, Battegay M (2004) Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies. Infection 32:163–169

    Article  CAS  PubMed  Google Scholar 

  • Boylan JC, Fites AL, Nail SL (1996) Parenteral products. In: Banker GS, Rhodes CT (eds) Modern pharmaceutics. Marcel Dekker, New York, pp 441–487

    Google Scholar 

  • British Pharmacopoeia Commission (2005) British pharmacopoeia formula preparation: general monographs. The Stationery Office, London

    Google Scholar 

  • Caflisch C, Wang J, Zbinden R (1999) The role of syringe filters in harm reduction among injection drug users. Am J Public Health 89:1252–1254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cherubin CE, Sapira JD (1993) The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later. Ann Intern Med 119:1017–1028

    Article  CAS  PubMed  Google Scholar 

  • Chiang W, Goldfrank L (1990) The medical complications of drug abuse. Med J Aust 152:83–88

    CAS  PubMed  Google Scholar 

  • Darke S, Ross J, Kaye S (2001) Physical injecting sites among injecting drug users in Sydney. Aust Drug Alcohol Depend 62:77–82

    Article  CAS  Google Scholar 

  • Darke S, Duflou J, Torok M (2015) The health consequences of injecting tablet preparations: foreign body pulmonary embolization and pulmonary hypertension among deceased injecting drug users. Addiction 110:1144–1151

    Article  PubMed  Google Scholar 

  • Davis MA, Taube RA (1978) Pulmonary perfusion imaging—acute toxicity and safety factors as a function of particle size. J Nucl Med 19:1209–1213

    Google Scholar 

  • Decuzzi P, Pasqualini R, Arap W, Ferrari M (2009) Intravascular delivery of particulate systems: does geometry really matter? Pharm Res 26:235–243

    Article  CAS  PubMed  Google Scholar 

  • Del Giudice P (2004) Cutaneous complications of intravenous drug abuse. Br J Dermatol 150:1–10

    Article  PubMed  Google Scholar 

  • Del Giudice P, Vandenbos F, Boissy C, Cua E, Marion B, Bernard E et al (2005) Cutaneous complications of direct intra-arterial injections in drug addicts. Acta Derm Venereol 85:451–452

    Article  PubMed  Google Scholar 

  • Dettmeyer RB, Verhoff MA, Brueckel B, Walter D (2010) Widespread pulmonary granulomatosis following long time intravenous drug abuse—a case report. Forensic Sci Int 197:E27–E30

    Article  CAS  PubMed  Google Scholar 

  • Dwyer R, Topp L, Maher L, Power R, Hellard M, Walsh N et al (2009) Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users. Drug Alcohol Depend 100:9–16

    Article  CAS  PubMed  Google Scholar 

  • Ebright JR, Pieper B (2002) Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am 16:697–712

    Article  PubMed  Google Scholar 

  • Ganesan S, Felo J, Saldana M, Kalasinsky VF, Lewin-Smith MR, Tomashefski JF (2003) Embolized crospovidone (poly N-vinyl-2-pyrrolidone) in the lungs of intravenous drug users. Mod Pathol 16:286–292

    Article  PubMed  Google Scholar 

  • Gordon RJ, Lowy FD (2005) Current concepts—bacterial infections in drug users. N Engl J Med 353:1945–1954

    Article  CAS  PubMed  Google Scholar 

  • Gotway MB, Marder SR, Hanks DK, Leung JWT, Dawn SK, Gean AD et al (2002) Thoracic complications of illicit drug use: an organ system approach. Radiographics 22:S119–S135

    Article  PubMed  Google Scholar 

  • Griffith CC, Raval JS, Nichols L (2012) Intravascular talcosis due to intravenous drug use is an underrecognized cause of pulmonary hypertension. Pulm Med 2012:617531

    Article  PubMed  PubMed Central  Google Scholar 

  • Haywood A, Glass BD (2011) Pharmaceutical excipients—where do we begin? Aust Prescriber 34:112–114

    Article  Google Scholar 

  • Hind CRK (1990) Pulmonary complications of intravenous drug misuse. 2. Infective and HIV related complications. Thorax 45:957–961

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hope V (2010) Neglected infections: real harms: a global scoping of injection-related bacterial infections and responses. In: Cook C (ed) The global state of harm reduction 2010 key issues for broadening the response. International Harm Reduction Association, London, pp 89–95

    Google Scholar 

  • Illum L, Davis SS, Wilson CG, Thomas NW, Frier M, Hardy JG (1982) Blood clearance and organ disposition of intravenously administered colloidal partciles—the effects of particle size, nature and shape. Int J Pharm 12:135–146

    Article  CAS  Google Scholar 

  • Jorens PG, Van Marck E, Snoeckx A, Parizel PM (2009) Nonthrombotic pulmonary embolism. Eur Respir J 34:452–474

    Article  CAS  PubMed  Google Scholar 

  • Kanke M, Simmons GH, Weiss DL, Bivins BA, Deluca PP (1980) Clearance of 14Ce-labelled microspheres from blood and distribution in specific organs following intravenous and intraarterial administration in beagle dogs. J Pharm Sci 69:755–762

    Article  CAS  PubMed  Google Scholar 

  • Kaushik KS, Kapila K, Praharaj AK (2011) Shooting up: the interface of microbial infections and drug abuse. J Med Microbiol 60:408–422

    Article  PubMed  Google Scholar 

  • Keijzer L, Imbert E (2011) The filter of choice: filtration method preference among injecting drug users. Harm Reduction J 8

    Google Scholar 

  • Kumar V, Abbas AK, Fausto N (2005) Robbins and Cotran pathological basis of disease. Elsevier Saunders, Philadelphia

    Google Scholar 

  • Kuramoto K, Shoji T, Nakagawac Y (2006) Usefulness of the final filter of the IV infusion set in intravenous administration of drugs—contamination of injection preparations by insoluble microparticles and its causes. Yakugaku Zasshi-J Pharm Soc Jpn 126:289–295

    Article  CAS  Google Scholar 

  • Lim CCT, Lee SH, Wong Y-C, Hui F (2009) Embolic stroke associated with injection of buprenorphine tablets. Neurology 73:876–879

    Article  CAS  PubMed  Google Scholar 

  • Low SU, Nicol A (2006) Talc induced pulmonary granulomatosis. J Clin Pathol 59:223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA et al (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 372:1733–1745

    Article  PubMed  Google Scholar 

  • McLean S, Bruno R, Brandon S, de Graaff B (2009) Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets. Harm Reduction J 6

    Google Scholar 

  • Miller DA, DiNunzio JC, Williams RO (2008) Advanced formulation design: improving drug therapies for the management of severe and chronic pain. Drug Dev Ind Pharm 34:117–133

    Article  CAS  PubMed  Google Scholar 

  • Murphy EL, DeVita D, Liu H, Vittinghoff E, Leung P, Ciccarone DH et al (2001) Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clin Infect Dis 33:35–40

    Article  CAS  PubMed  Google Scholar 

  • Ng H, Patel RP, Bruno R, Latham R, Wanandy T, McLean S (2015) Filtration of crushed tablet suspensions has potential to reduce infection incidence in people who inject drugs. Drug Alcohol Rev 34:67–73

    Article  PubMed  Google Scholar 

  • Orangio GR, Pitlick SD, Dellalatta P, Mandel LJ, Marino C, Guarneri JJ et al (1984) Soft-tissue infections in parenteral drug-abusers. Ann Surg 199:97–100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ott MC, Khoor A, Scolapio JS, Leventhal JP (2003) Pulmonary microcrystalline cellulose deposition from intravenous injection of oral medication in a patient receiving parenteral nutrition. J Parenter Enteral Nutr 27:91–92

    Article  Google Scholar 

  • Pare JA, Fraser RG, Hogg JC, Howlett JG, Murphy SB (1979) Pulmonary ‘mainline’ granulomatosis: talcosis of intravenous methadone abuse. Medicine 58:229–239

    Article  CAS  PubMed  Google Scholar 

  • Patel P, Patel RP, Brandon S, McLean S, Bruno R, de Graaff B (2012) Effects of filtration on the presence of particulate and oxycodone content of injections prepared from crushed OxyContin tablets. Curr Drug Saf 7:218–224

    Article  CAS  PubMed  Google Scholar 

  • Roux P, Carrieri MP, Keijzer L, Dasgupta N (2011) Reducing harm from injecting pharmaceutical tablet or capsule material by injecting drug users. Drug Alcohol Rev 30:287–290

    Article  PubMed  Google Scholar 

  • Rowe RC, Sheskey PJ, Cook WG, Quinn ME (2012) Handbook of pharmaceutical excipients. The Pharmaceutical Press, London, p 1033

    Google Scholar 

  • Sameer HK (2010) Porosity measurements of cellulose acetate filters for some brands of cigarette using mercury porosimeter. Al-Mustansiriyah J Sci 21:57–66

    Google Scholar 

  • Saydain G, Singh J, Dalal B, Yoo W, Levine DP (2010) Outcome of patients with injection drug use associated endocarditis admitted to an intensive care unit. J Crit Care 25:248–253

    Article  PubMed  Google Scholar 

  • Schneider P, Duong TA, Ortonne N, Bagot M, Bouaziz JD (2010) Livedoid and necrotic skin lesions due to intra-arterial buprenorphine injections evidenced by maltese cross-shaped histologic bodies. Arch Dermatol 146:208–209

    Article  PubMed  Google Scholar 

  • Schoenberger SD, Agarwal A (2013) Talc retinopathy. N Engl J Med 368:852

    Article  PubMed  Google Scholar 

  • Scott J (2005) Laboratory study of the effectiveness of filters used by heroin injectors. J Subst Use 10:293–301

    Article  Google Scholar 

  • Scott J, Kennedy EJ, Winfield AJ, Bond C (1998) Investigation into the effectiveness of filters for use by intravenous drug users. Int J Drug Policy 9:181–186

    Google Scholar 

  • Seeley RR, Stephens TD, Tate P (2006) Anatomy and physiology. McGraw Hill, New York

    Google Scholar 

  • Shargel L, Wu-Pong S, Yu ABC (2005) Applied biopharmaceutics and pharmacokinetics. McGraw-Hill, New York

    Google Scholar 

  • Sigdel S, Gemind JT, Tomashefski JF Jr (2011) The Movat pentachrome stain as a means of identifying microcrystalline cellulose among other particulates found in lung tissue. Arch Pathol Lab Med 135:249–254

    Article  PubMed  Google Scholar 

  • Smith ME, Robinowitz N, Chaulk P, Johnson KE (2015) High rates of abscesses and chronic wounds in community-recruited injection drug users and associated risk factors. J Addict Med 9:87–93

    Article  PubMed  PubMed Central  Google Scholar 

  • Sousa C, Botelho C, Rodrigues D, Azeredo J, Oliveira R (2012) Infective endocarditis in intravenous drug abusers: an update. Eur J Clin Microbiol Infect Dis 31:2905–2910

    Article  CAS  PubMed  Google Scholar 

  • Stafford J, Burns L, Trends Australian Drug (2014) Findings from the Illicit Drug Reporting System (IDRS). National Drug and Alcohol Research Centre, Australian Drug Trend Series Australia, p 2015

    Google Scholar 

  • Sweeney R, Conroy AB, Dwyer R, Aitken CK (2009) The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis). Aust N Z J Public Health 33:352–357

    Article  PubMed  Google Scholar 

  • TGA (2011) Australian Public Assessment Report for Buprenorphine/Naloxone. In: DOHA (ed). Canberra

    Google Scholar 

  • Tomashefski JF Jr, Hirsch CS (1980) The pulmonary vascular lesions of intravenous drug abuse. Hum Pathol 11:133–145

    Article  PubMed  Google Scholar 

  • Tung M (2015) Evolving epidemiology of injecting drug use-associated infective endocarditis: a regional centre experience. Drug Alcohol Rev 34:412–417

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the individuals that have contributed to this programme of work, including Susan Brandon, Barbara de Graaff, Heng Guo, Roger Latham, Nathan Murray, Huei Ng, Pankaj Patel, and Troy Wanandy.

Author information

Authors and Affiliations

  1. School of Medicine, University of Tasmania, Hobart, Australia

    Stuart McLean, Rahul Patel & Raimondo Bruno

Authors
  1. Stuart McLean
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raimondo Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raimondo Bruno .

Editor information

Editors and Affiliations

  1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

    Suzanne Nielsen

  2. University of Tasmania School of Psychology, Launceston, Tasmania, Australia

    Raimondo Bruno

  3. Victoria University of Wellington School of Psychology, Wellington, New Zealand

    Susan Schenk

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

McLean, S., Patel, R., Bruno, R. (2016). Injection of Pharmaceuticals Designed for Oral Use: Harms Experienced and Effective Harm Reduction Through Filtration. In: Nielsen, S., Bruno, R., Schenk, S. (eds) Non-medical and illicit use of psychoactive drugs. Current Topics in Behavioral Neurosciences, vol 34. Springer, Cham. https://doi.org/10.1007/7854_2016_470

Download citation

Publish with us

Policies and ethics

Search

Navigation