Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: A case report


  • Paul A. Sloan, MD
  • Oksana Klimkina, MD



intranasal opioid use, drug abuse, hydrocodone


Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.

Author Biographies

Paul A. Sloan, MD

Department of Anesthesiology, University of Kentucky Medical Center, Lexington, Kentucky.

Oksana Klimkina, MD

Department of Anesthesiology, University of Kentucky Medical Center, Lexington, Kentucky.


Sloan PA, Babul N: Extended-release opioids for the management of chronic non-malignant pain. Expert Opin Drug Deliv. 2006; 3: 489-497.

Zacny J, Bigelow G, Compton P, et al.: College on problems of drug dependence taskforce on prescription opioid nonmedical use and abuse: Position statement. Drug Alcohol Depend. 2003; 69: 215-232.

Helie F, Fournier J: Destructive lesions of the median line secondary to cocaine abuse. J Otolaryngol. 1997; 26: 67-69.

Greene D: Total necrosis of the intranasal structures and soft palate as a result of nasal inhalation of crushed OxyContin. Ear Nose Throat J. 2005; 84: 512-516.

Davis WR, Johnson BD: Prescription opioid use, misuse, and diversion among street drug users in New York City. Drug Alcohol Depend. 2008; 92: 267-276.

Yewell J, Haydon R, Archer S, et al.: Complications of intranasal prescription narcotic abuse. Ann Otol Rhinol Laryngol. 2002; 111: 174-177.

Manchikanti KN, Manchikanti L, Damron KS, et al.: Increasing deaths from opioid analgesics in the United States: An evaluation in an interventional pain management practice. J Opioid Manage. 2008; 4: 271-283.

Sloan PA, Slatkin NE, Ahdieh H: Effectiveness and safety of oral extended-release oxymorphone for the treatment of cancer pain: A pilot study. Support Care Cancer 2005; 13: 57-65.

Sloan PA: Oxymorphone in the management of pain. Ther Clin Risk Manage. 2008; 4: 1-11.

Chou R, Fanciullo GJ, Fine PG, et al.: Opioid Treatment Guidelines: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10: 113-130.

Cicero TJ: Prescription drug abuse and its relationship to pain management. Adv Pain Manage. 2008; 2: 17-29.

Reisfield GM, Wilson GR: Are some physicians unwitting enablers of prescription opioid abuse? J Opioid Manage. 2009; 5: 71-73.

Michna E, Jamison RN, Pham LD, et al.: Urine toxicology screening among chronic pain patients on opioid therapy: Frequency and predictability of abnormal findings. Clin J Pain. 2007; 23: 173-179.

Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool. Pain Med. 2005; 6: 432-442.




How to Cite

Sloan, MD, P. A., and O. Klimkina, MD. “Intranasal Abuse of Prescription hydrocodone/Acetaminophen Results in Oronasal Fistula: A Case Report”. Journal of Opioid Management, vol. 5, no. 6, Jan. 2018, pp. 383-5, doi:10.5055/jom.2009.0039.



Case Studies