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Atypical presentation of opioid withdrawal, an effect of adulteration


Brown sugar is the impure form of di-Acetyle Morphine with comparable pharmacological effect and withdrawal symptoms. Recent observation regarding the atypicality withdrawal symptomatology in opioid dependants stimulated the present study.


To study the abuse pattern and symptom profile in withdrawal state of brown sugar abusers.


Consecutive sampling method was used to collect patients with opioid dependence according to DSM IV TR. Abuse pattern was assessed through semi-structure proforma, withdrawal symptoms through clinical opioid withdrawal scale and also chemical analysis of the drug.


Among patients 43.396% had seizure, 26.086% developed confusion after seizure and 17.391% experienced psychotic symptoms. Longer duration and larger quantity of substance abuse leads to higher complications. Seizure episodes occurred between 11 to 92 hrs of last intake with a median of 30 hrs. The seizure frequency had strong correlation with daily doses (β-0.697) and frequency (r-0.527) but is weakly correlated with withdrawal severity (r-0.425). Chemical analysis of illicit drug revealed that caffeine constitutes greater proportion and opioid like substance a minor quantity.


Complications like seizure, delirium and psychosis are common in withdrawal. Complication is higher among high quantity and high frequency users. Delirium and psychosis might be a complication of seizure. Adulteration with toxic substance might be a cause for atypical symptoms which leads to a life threatening condition and warrants preventive cure from such illicit drug as opium substitution therapy.

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Correspondence to Supriya Kumar Mondal.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mondal, S.K., Borthakur, B., Deka, K. et al. Atypical presentation of opioid withdrawal, an effect of adulteration. BMC Infect Dis 12 (Suppl 1), P76 (2012).

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