The impact of the addition of naloxone on the use and abuse of pentazocine

Abstract

An epidemic of abuse with "T's and blues" began in the late 1970's in which pentazocine-Talwin tablets ("T")--and the antihistamine tripelennamine (known as blues) were crushed, dissolved together, filtered, and injected intravenously. The resulting high was reported to be similar to that of heroin. In 1981, the manufacturer and the Food and Drug Administration met to discuss a possible solution. As a result, 0.5 mg of naloxone hydrochloride, a narcotic antagonist that is pharmacologically inactive at that dose orally but active if administered parenterally, was added to the tablet formulation. The reformulated product, Talwin Nx, was approved for marketing in late 1982 and introduced in the second quarter of 1983. Distribution of Talwin tablets in the United States was discontinued. The Drug Abuse Warning Network (DAWN) of the National Institute of Drug Abuse and IMS America's National Prescription Audit were used to review the use and abuse patterns of pentazocine before and after the naloxone intervention. The number of prescriptions dispensed quarterly for pentazocine products remained fairly stable from 1981 through the first quarter of 1983 and increased after the introduction of Talwin Nx. In contrast, DAWN emergency room and medical examiner mentions decreased after the product reformulation. The rates of both emergency room and medical examiner mentions per million prescriptions were substantially lower in the 2 years following the introduction of Talwin Nx (decreases of 70 percent by emergency rooms and 71 percent by medical examiners), indicating that the product reformulation successfully reduced pentazocine abuse.