“T's and B's”-Midwestern Heroin Substitute

Abstract

“T's and B's” is the street name for the combination of pentazocine and tripelennamine. This combination of drugs has emerged as a major intravenous substitute for heroin in recent years, especially in the Midwest. 104 cases involving 82 patients over a 9-month period were seen at St. Elizabeth Medical Center in Dayton, Ohio. Abscesses and cellulitis were seen in 39% of cases. A characteristic drug reaction involved 38% of cases, and consisted of chest pain, agitation, anxiety, muscle spasms, dizziness, diaphoresis, and nausea as well as other symptoms. Seizures, syncope, and near-syncope were seen in 15% of cases, and a previously described pulmonary syndrome was seen in 4% of cases.