ArticleBlood2017
A mechanistic investigation of thrombotic microangiopathy associated with IV abuse of Opana ER.
Article in Blood, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 37 citations in OpenAlex.
- Relative potency of intravenous oxymorphone compared to other µ opioid agonists in humans - pilot study outcomes.Psychopharmacology · 2021Trial
- Complete recovery of thrombotic microangiopathy with severe acute kidney injury due to intravenous use of modified release oxycodone.Clinical kidney journal · 2026Article
- Pathogenic cytokines in thrombotic microangiopathies: molecular insights and therapeutic targets.Molecular medicine (Cambridge, Mass.) · 2025Review
- Abuse-deterrent formulations and opioid-related harms in North Carolina, 2010-2018.American journal of epidemiology · 2025Article
- Article
- Postmarketing Research for Opioid Abuse-Deterrent Formulations: A Narrative Review.Journal of pain research · 2025Review
- Functional properties of thermally tampered poly(ethylene oxide).BioImpacts : BI · 2022Article
- Complement in Secondary Thrombotic Microangiopathy.Kidney international reports · 2021Review
- An Update in Drug-Induced Thrombotic Microangiopathy.Frontiers in medicine · 2020Article
- Diagnostic Testing for Differential Diagnosis in Thrombotic MicroangiopathiesTurkish journal of haematology : official journal of Turkish Society of Haematology · 2019Review
- Mitigation of IV Abuse Through the Use of Abuse-Deterrent Opioid Formulations: An Overview of Current Technologies.Pain practice : the official journal of World Institute of Pain · 2019Review
- Bilateral exudative retinal detachments due to thrombotic microangiopathy associated with intravenous abuse of Opana ER.American journal of ophthalmology case reports · 2018Article
- Thrombocytopenia in hospitalized patients: approach to the patient with thrombotic microangiopathy.Hematology. American Society of Hematology. Education Program · 2017Review
- Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone.BMJ case reports · 2017Article
- Thrombotic Microangiopathy Secondary to Intravenous Abuse of Opana® ER.Case reports in hematology · 2017Article
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Since 2012, a number of case reports have described the occurrence of thrombotic microangiopathy (TMA) following IV abuse of extended-release oxymorphone hydrochloride (Opana ER), an oral opioid for long-term treatment of chronic pain. Here, we present unique clinical features of 3 patients and investigate IV exposure to the tablet's inert ingredients as a possible causal mechanism. Guinea pigs were used as an animal model to understand the hematopathologic and nephrotoxic potential of the inert ingredient mixture (termed here as PEO+) which primarily contains high-molecular-weight polyethylene oxide (HMW PEO). Microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury were found in a group of 3 patients following recent injection of adulterated extended-release oxymorphone tablets. Varying degrees of cardiac involvement and retinal ischemia occurred, with TMA evident on kidney biopsy. A TMA-like state also developed in guinea pigs IV administered PEO+. Acute tubular and glomerular renal injury was accompanied by nonheme iron deposition and hypoxia-inducible factor-1α upregulation in the renal cortex. Similar outcomes were observed following dosing with HMW PEO alone. IV exposure to the inert ingredients in reformulated extended-release oxymorphone can elicit TMA. Although prescription opioid abuse shows geographic variation, all physicians should be highly inquisitive of IV drug abuse when presented with cases of TMA.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.