Pregnancy Category None

Uses. This substance has no authorized medical use in the United States. Elsewhere, since the 1950s it has been used as a pain reliever for surgery, cancer, and other conditions. Figures for total legal usage of opioids/opiates in Denmark from 1981 to 1993 showed only morphine and methadone were used more than ketobemidone.

In an experiment ketobemidone caused less breathing difficulty than did buprenorphine (another opioid used for pain relief). Patients who receive morphine chronically may develop muscle twitches and experience more pain rather than less. After studying that problem one group of researchers recommended that such patients be switched to ketobemidone, methadone, sufentanil, or fentanyl. A case report indicates ketobemidone works in such a switch. Despite the drug's usefulness for pain relief, test results conflict on whether it is better than a placebo for easing anxiety before surgery.

Drawbacks. Unwanted effects include shivering, coughing, nausea, and vomiting. Pain may cause vomiting, so paradoxically ketobemidone can also prevent vomiting through pain relief. A study noted that ketobemidone lowers blood pressure, but not as much as morphine does.

Abuse factors. Although illicit use of this drug has received little attention in the United States, ketobemidone has been a prominent substance in the abuse scenes of Scandinavian countries. The drug is available in a pharmaceutical intravenous format, but some illicit users crush oral tablets containing ketobemidone and inject the powder. That practice is suspected of harming eyesight. The same practice can cause skin to harden around injection sites and also break open into sores. In one report of several such cases medical personnel expressed puzzlement that the ketobemidone users acted like they felt no discomfort and were unconcerned about skin conditions that would prompt most persons to seek immediate medical aid. Such indifference about

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