Trauma and Substance Abuse: Deadly Consequences of Intravenous Percocet Tablets

Background: The prevalence of drug or alcohol addiction among trauma patients approaches 40%, yet many require narcotics during admission for adequate pain control. Provider awareness is the most reasonable option to avoid the devastating consequence of narcotic tablet injection. Objective: To illustrate the misuse of oral narcotics and to heighten provider awareness of a potential cause for acute respiratory failure in recently discharged patients. Case Report: A 20-year-old man was admitted to the hospital after an assault to the head and face. He was discharged from the hospital with 30 oral Percocet® (Endo Pharmaceuticals, Newark, DE) tablets after 24 h of observation. The day after discharge, emergency medical services were called to his residence for a decreased level of consciousness. During transport to the Emergency Department, he went into cardiac arrest with pulseless electrical activity. He could not be resuscitated. Postmortem biochemical and anatomical evidence suggested that the patient had attempted to inject crushed Percocet® tablets, which resulted in acute foreign body pulmonary microembolism and death. Conclusion: Patients with a history of substance abuse may be inclined to crush and inject oral narcotics. Narcotic injection should be considered in recently discharged patients who present with pulmonary failure. Patients with suspected narcotic addiction should be counseled before discharge on the risks of misusing oral medications in this fashion.