Atypical presentation of opioid withdrawal, an effect of adulteration

Background

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.

Purpose

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

Methodology

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.

Results

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.

Conclusion

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.