The Scars of Syringes: A Case Report on Tramadol Dependence & Injection Site Complications

Abstract

Introduction: Tramadol, a synthetic opioid analgesic, is widely used for moderate to severe pain. Although opioid dependence affects about 2% of the global population, its use in India is reportedly three times higher than the global average. Easy accessibility through over-the-counter sale, online sources, and illicit channels contributes to widespread misuse. Despite their therapeutic value, opioids are associated with significant adverse effects, including dependence, organ damage, and even death. Injection-related complications are rarely reported but can be severe.

Aim & Objective: This case report aims to highlight a rare but serious complication of tramadol dependence ulceration at injection sites and to emphasize the need for strict monitoring and rational opioid prescribing practices.

Case Presentation: A 48-year-old male farmer with uncontrolled diabetes and low socioeconomic status developed tramadol dependence after receiving it for chronic pain. He escalated self-administration from 1–2 to 8 ampules daily, also misusing chlorpheniramine maleate tablets to enhance effects. He presented with multiple infected, tender, indurated ulcers on both thighs and legs at injection sites. Laboratory findings showed leukocytosis and hyperglycemia.

Result: The patient was managed with insulin therapy, appropriate antibiotics, and opioid substitution therapy using buprenorphine–naloxone. Significant clinical improvement and wound healing were observed over a two-month follow-up period.

Conclusion: This case highlights the risk of opioid dependence and severe injection-related complications. It underscores the need for improved pain management training, early identification of substance misuse, and stricter regulatory control over opioid distribution and monitoring systems to prevent abuse.