Abstract

Buprenorphine is sublingually administered for the maintenance therapy of opioid addicts for the past three decades. We report a case of 45 year old male who presented with complaints of bloody discharge from wound over right groin. He was a chronic intravenous drug abuser with multiple substance abuse including buprenorphine. He was on substitution therapy with buprenorphine since 2015. He had injected the sublingual buprenorphine preparation after mixing it with distilled water into the Right femoral artery because of the thrombosis in the veins. Arterial Doppler of the right lower limb showed a large pseudoaneurysm arising from common femoral artery measuring 5.2 x 3.2 millimeter with yin-yang flow with neck approximately measuring 2 millimeter. The patient was started on intravenous antibiotic cefoperazone-sulbactam and right ilio-femoral bypass on the next day. This case report explores the misuse of sublingual buprenorphine maintenance dose which resulted in pseudoaneurysm and chemical arteritis due to the excipients present in the preparation. Motivation of such patients to refrain from such abuse through counseling or replacement of buprenorphine with buprenorphine-naloxone can help in avoiding such misuse