A Case of Necrotizing Fasciitis – Tapentadol Abuse Via Intravenous Route

INTRODUCTION: Tapentadol is a centrally acting synthetic opioid analgesic which has partial opioid agonist and norepinephrine reuptake inhibitor action with a relatively higher μ-affinity. It has abuse potential, and classified as scheduled drug, yet currently it is not known to be an opioid which is widely misused in India. CASE REPORT: A 22yr old male was introduced to Tablet tapentadol by his friends. Initially he started taking 2-3 tablets(50mg) per day orally. Later he was suggested by his friend to try intravenous route and as it was more pleasurable he continued to use the drug intravenously. His opioid use gradually increased from 5 tablets per day to a maximum of 10 tablets per day(max dose upto 600mg) with craving, tolerance, withdrawal symptoms, loss of control within the initial 1-2yrs.He also occasionally used heroin whenever he got access to it. History of occasional use of alcohol, tobacco and cannabis was present. He presented to OPD with withdrawal symptoms and a blister in the left forearm which within few days became an abscess and he was referred to a surgeon and was diagnosed as Necrotizing fasciitis, which was surgically corrected and split skin grafting was done. He was later started on opioid substitution therapy with tablet buprenorphine and is currently maintaining abstinence.