Deaths From Renal Failure in Abusers of Phenacetin‐containing Drugs

Since Feb. 1961 all phenacetin‐ and paracetamol‐conlaining drugs have in Sweden been subject to prescription and thus less easily obtained. In 1961 a report has been published on the abusers of phenacetin‐containing drugs who had died of uraemia at the Medical department of the Central County Hospital in Jönköping between the years 1954–1960. As a direct continuation the present study has been made of 208 patients, 146 men and 62 women, who died of uraemia in 1960–1970. Among them, 64 men and 22 women were very certainly heavy abusers of phenacetin‐containing analgesics. Although phenacetin had been subject to prescription, the deaths of abusers did not decrease but were even doubled in 1966 (13 patients). In 1968 there was a clear regress and in 1970 there were only 3 deaths. A comparison between the two studies shows no changes in either clinical symptoms or patho‐anatomical alterations of the kidneys. The male predominance (unlike all other investigations) is due to the severe abuse among the male workers at a factory in Huskvarna. On microscopic examination it is verified that the most common findings are contraction with chronic interstitial nephritis, tubular damage, especially in the lower nephrons, and papillary necrosis or necrobiosis. The present study confirms the risk of renal damage and ensuing fatal uraemia from daily, protracted abuse of phenacetin‐containing analgesics. It also appears that, although the drug consumption was interrupted, fatal uraemia could develop seven to eight years later. In this study no support has been obtained for the view that bacterial infection is required for the development of renal damage in abusers of analgesics. The fact that Huskvarna workers are now abusing the powder containing 0.50 g phenazone and 0.10 g caffeine, and that during the last few years the number of deaths from uraemia among them has decreased, supports the opinion that this powder does not lead to kidney damage.