Intravenous tapentadol abuse in treatment-seeking youngrural adults: a case series

Abstract

Background: Tapentadol is a centrally acting opioid analgesic with m-opioid receptor agonism and norepinephrine reuptake inhibition. Although approved for the management of moderate to severe pain, emerging reports suggest increasing misuse of tapentadol in India, particularly through tampering of oral tablets for intravenous use. Limited data are available regarding the clinical profile and complications associated with this pattern of use.

Case series: We describe 13 treatment-seeking young adults with intravenous tapentadol abuse who presented to a tertiary care center between January and December 2025. All patients were male, aged 16–29 years, and from rural backgrounds. The duration of intravenous tapentadol use ranged from 6 months to 6 years, with maximum daily doses ranging from 500 mg to 4000 mg. Alcohol (46.2%) and cannabis (38.5%) were the most common primary substances used before tapentadol initiation. Eight patients fulfilled the ICD-10 criteria for opioid dependence syndrome, while five had harmful opioid use. At presentation, Clinical Opiate Withdrawal Scale (COWS) scores ranged from 12 to 30, indicating mild-to-moderately severe withdrawal. Patients also exhibited psychiatric features, including low mood, aggressive behavior, suicidal ideation, and deliberate self-harm behavior. Injection-related complications, including abscess, cellulitis, and thrombophlebitis, were observed in three patients, while four patients tested positive for hepatitis B.

Conclusion: Intravenous tapentadol use among young adults from rural backgrounds represents an emerging public health concern in India. Early identification, harm-reduction strategies, and strengthening of regulatory measures are essential to address the growing misuse of prescription opioids.