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A Case of Dependence on the Combination Use of Sublingual Buprenorphine, Scopolamine, and Promethazine

ObjectivesTo report the case of a patient, who were an ex-heroin-addict, developed addiction to the prescribed sublingual buprenorphine tablets, scopolamine and promethazine injection. MethodsClinical case description. ResultsThroughout the abuse of the drugs mentioned above with mental (eg, craving, euphoric, loss of control) and physical symptoms (eg, tolerance, withdrawal symptoms) appeared that fulfill the DSM-IV or ICD-10 criteria for dependence on psychoactive substance. However, the dependence was regarded not to be induced by buprenorphine itself because the patient reported an intense euphoria effect with these 3 drugs, whereas little sense of high was experienced if he only used buprenorphine. Moreover, the case study reports the short-term and long-term consequences of the combination of the 3 medications. ConclusionsThis case confirms that in the treatment of heroin addiction, some drug with a low abuse potential combined with other injectable scopolamine and promethazine may maximize risks of patient to develop a dependence on these medications, a number of the significant health harms, and long-lasting neuropsychologic impairment. The danger of coabuse of buprenorphine scopolamine and promethazine is highlighted.