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Intranasal Self-Administration of Remifentanil as the Foray into Opioid Abuse by an Anesthesia Resident

Levine, Adam I. MD; Bryson, Ethan O. MD

doi: 10.1213/ANE.0b013e3181c5f069
Patient Safety: Case Report

Remifentanil is a potent μ-opioid receptor agonist that produces intense analgesia. This anilidopiperidine analog of fentanyl was approved by the United States Food and Drug Administration and became commercially available in the United States in 1997. Because of its unique chemical structure, remifentanil must be reconstituted; it has a rapid onset, and because of ester hydrolysis, it has a rapid rate of degradation. Although remifentanil's package insert warns against the potential for addiction, because of its rapid rate of degradation there was little concern that health care workers would abuse this drug. Herein, we report a case of intranasal remifentanil abuse by an anesthesiology resident.

Published ahead of print November 16, 2009 Supplemental Digital Content is available in the text.

From the Department of Anesthesiology, Mount Sinai Hospital, New York, New York.

Accepted for publication September 30, 2009.

Published ahead of print November 16, 2009

Supported by institutional and departmental sources.

Address correspondence and reprint requests to Ethan O. Bryson, MD, Department of Anesthesiology, Mount Sinai Hospital, One Gustave L Levy Place, New York, NY 10029. Address e-mail to

© 2010 International Anesthesia Research Society