To the Editor.—
Among patients seen in recent months at the clinical service of a community mental health center, five young male patients (aged 14 to 19 years) gave a current or recent history of nonmedical parenteral use of a drug combination consisting of butorphanol and diphenhydramine hydrochloride. They described their intravenous (IV) drug self-administration practice as being of wide occurrence among young persons of east-central Mississippi. From multiple-dose (10-mL) vials of each drug, 1.5 mL of each solution (butorphanol, 2 mg/mL; diphenhydramine hydrochloride, 50 mg/mL) was mixed in a syringe and injected. Several such doses were commonly taken in succession until the desired state is achieved. For most patients, the first injection produced an "unusual sensation" in the abdomen. A second or third injection was usually required (ie, 6 to 9 mg of butorphanol with 150 to 225 mg of diphenhydramine hydrochloride).As tolerance developed, patients reported, it was
Smith SG, Davis WM. Nonmedical Use of Butorphanol and Diphenhydramine. JAMA. 1984;252(8):1010. doi:10.1001/jama.1984.03350080016009
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