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35th AM (2025) - Poster Session
Tapentadol Toxicity and Dependence A Case Series o ...
Tapentadol Toxicity and Dependence A Case Series on An Emerging Drug of Abuse in Adolescents
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This case series reports on four adolescent patients (aged 16-18) presenting to a New Orleans pediatric emergency department between late 2024 and mid-2025 with tapentadol misuse, toxicity, and dependence. Tapentadol is a Schedule 2 analgesic drug combining partial mu opioid receptor agonism with norepinephrine reuptake inhibition, marketed for pain relief since 2009 under brands like Nucynta. Although initially considered to have lower abuse potential than traditional opioids, recent clinical cases, media reports, and government data indicate rising misuse, especially among youth.<br /><br />The four patients—a mix of male and female adolescents with varied psychiatric and substance use histories—presented with symptoms including agitation, panic, suicidal ideation related to withdrawal, lethargy, aggression, and seizure-like events following intentional overdose. Their clinical courses often required ICU admission and behavioral management with multiple medications. Toxicity symptoms reflected a complex toxidrome combining opioid-like effects (sedation, respiratory depression, miosis), noradrenergic sympathomimetic signs (tachycardia, hypertension, hyperreflexia), and serotonergic features (rigidity, clonus). Withdrawal symptoms resembled classic opioid withdrawal, presenting as chills, anxiety, gastrointestinal upset, and irritability.<br /><br />Laboratory testing showed inconsistent urine drug screens, though one patient's blood confirmed tapentadol presence. Parents provided pill photographs, suggesting community or online acquisition. Polysubstance use including THC, benzodiazepines, stimulants, and other prescription drugs complicated clinical presentation and management.<br /><br />This emerging pattern highlights significant safety risks of tapentadol abuse in adolescents, with potentially life-threatening consequences and psychiatric complications. The dual-action pharmacology produces overlapping toxidromes complicating diagnosis and treatment. The authors emphasize the need for increased clinical awareness to screen for tapentadol use, educate patients and families, and tailor management strategies. They call for further rigorous research to better understand tapentadol’s abuse potential, toxic effects, and withdrawal management, especially in vulnerable youth populations. Prescribing practices may also need adaptation to reduce diversion. This series signals a growing public health concern of tapentadol misuse as a novel drug of abuse among adolescents.
Keywords
tapentadol misuse
adolescent opioid toxicity
tapentadol dependence
pediatric emergency cases
opioid withdrawal symptoms
dual-action analgesic abuse
polysubstance use in youth
tapentadol toxidrome
opioid and noradrenergic effects
public health adolescent drug abuse
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