Codeine abuse

Wrong patient, wrong drug for an aspirin-allergic patient, and codeine abuse because the patient is also on Tylenol 3... 

In the United States and other countries, some cough syrups and tablets containing codeine are available without prescription, usually those with less than 10 mg of codeine. Houston, Texas, has been called the city of syrup because of the city s high rates of codeine abuse (see sidebar). In France, 95 percent of the consumption of a codeine-containing cough... 

Health professionals (doctors, nurses, dentists, veterinarians, etc.) and their staff may be at risk for codeine abuse because of their ready access to the drug. On the other hand, one would expect health care workers to be at less risk due to their training and knowledge of the effects of drug abuse. In fact, health care workers do not appear to have rates of codeine or other opioid abuse much different from the rest of the population. 

Since most codeine is dispensed as part of a compound preparation, potential side effects of the other drug(s) must also be considered. For instance, someone with stomach ulcers should not take codeine that is combined with a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Another type of risk from a compound preparation relates to codeine abuse. For instance, a person who abuses codeine might routinely take a dose of 100-200 mg of codeine to produce noticeable euphoria. Using Tylenol 3 to obtain this dose would also mean ingesting 1,000-2,000 mg of acetaminophen. Taking that amount of acetaminophen for any extended period presents a risk for liver damage, especially in combination with alcohol. 

In some cases, when the codeine-to-morphine ratio is higher than one, codeine abuse shall be considered as highly probable in association with heroin addiction whether 6-acetylmorphine has been detected or not. Finally, in all cases of chronic heroin abuse, 6-acetylmorphine, despite its very short plasma life, predominated over morphine and codeine in head and nonhead hair samples as well. The 6-acetylmorphine concentrations were approximately two- to threefold greater than metabolite morphine whatever the anatomical origin of the hair tested. 

This study suggests that codeine dependence may be more common in the general population than has been previously thought. The authors suggested that it is important to identify those with codeine abuse or codeine dependence, since they may be using substantial doses of codeine for apparently little benefit compared to the risks. Furthermore, there are also health risks of associated chronic use of paracetamol and a potential for analgesic rebound headache. 

CAS 469-62-5. C LySlO.,. The a-diastereoisomers are optically active and are preferred for their greater pain-relieving ability. The drug has about the same analgesic effect as codeine. Abuse can cause addiction, and overdosage can be fatal. Its use has been restricted by FDA. 

Kathiramalainathan K, Kaplan HL, Romach MK et al (2000) Inhibition of cytochrome P450 2D6 modifies codeine abuse liabihty, J Clin Psychopharmacol 20 435 44 Khan AM, Hashmi SR, Elahi F, Taiiq M, Ingrams DR (2006) Laryngopharyngeal reflux A literature review. Surgeon 4 221-225... 

Codeine, like morphine, is isolated from the opium poppy. However, the low yield of 0.7—2.5% does not provide sufficient material to meet commercial demands. The majority of marketed codeine is prepared by methylating the phenolic hydroxyl group of morphine. Morphine yields from opium poppy are 4—21%. When prescribed for cough, the usual oral dose is 10—20 mg, three to four times daily. At these doses, adverse side effects are very few. Although the abuse potential for codeine is relatively low, the compound can substitute for morphine in addicts (47). 

Tramadol is a pain reliever (analgesic). Its action is similar to opioid narcotics such as codeine and morphine, but it does not depress breathing the way the others can, and less often leads to abuse and addiction. 

Medium abuse potential with possible medical value in U.S. Acetaminophen (Tylenol) with codeine, some barbiturates... 

Roslyn Monroe is taking Tylenol 3, which contains codeine, since 7/7/ 95. Probably the codeine preparation is being abused, and Dr. Rogers should be informed. 

Schedule II—The drug or other substance has (1) a high potential for abuse, (2) a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions, and (3) abuse of the drug or other substances may lead to severe psychological or physical dependence. Examples cocaine, PCP, morphine, fentanyl and meperidine, codeine, amphetamine and methamphetamine, Ritalin . 

Drug abuse and dependence In recommended doses, diphenoxylate has not produced addiction and is devoid of morphine-like subjective effects. At high doses, it exhibits codeine-like subjective effects therefore, addiction to diphenoxylate is possible. A subtherapeutic dose of atropine may discourage deliberate abuse. 

Schedule V (c-v) - Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain c-v drugs may be purchased without a prescription... 

Morphine and cocaine Morphine is medically the most important alkaloid present in opium. Opium itself consists of the dried milky exudate extracted from unripe capsules of the opium poppy (Papaver somniferum), which is grown mainly in Asia, but also in some parts of India and China. Morphine is a powerful analgesic and has been used to treat severe pain. However, its addictive properties complicate its long-term medical use and it is also a drug of abuse. In addition to morphine, opium also contains codeine, which has similar, but weaker, actions. 

Codeine 2-3 15 Acts by conversion to morphine. Around 7% of the population with slow hydroxylation phenotype do not convert codeine into morphine. Low risk of abuse... 

Dextromethorphan hydrobromide is the D-isomer of levorphanol. It lacks CNS activity but acts at the cough center in the medulla to produce an antitussive effect. It is half as potent as codeine as an antitussive. Anecdotal reports of abuse exist, but studies of abuse potential are lacking. It has few side effects but does potentiate the activity of monoamine oxidase inhibitors, leading to hypotension and infrequently coma. Dextromethorphan is often combined in lozenges with the local anesthetic benzocaine, which blocks pain from throat irritation due to coughing. 

Hydrocodone is a widely prescribed (and abused) pharmaceutical designed as a pain-reliever. The drug works by converting into a form of morphine once it enters the body. Hydrocodone can be derived from either codeine or thebaine and is three times more powerfiil than codeine. Hydrocodone has various trade names. 

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