Codeine popularity

The medicinal, or therapeutic, uses of codeine are to relieve pain, to suppress cough, and to control diarrhea (see Chapters 2 and 3). Because of its usefulness and availability as an oral medication (as opposed to an injectable medication), codeine may be the single most commonly dispensed prescription medicine in the United States. In 2004, the last full year for which data are available, more than 157 million prescriptions were written for codeine. This number of prescriptions was the highest of the 20 most-prescribed therapeutic categories. Prescriptions for codeine, and codeine-containing medicines, accounted for 3.3 billion dollars of pharmaceutical sales in the United States in 2004. Preliminary data show that the number of prescriptions for codeine for the nine-month period January to September 2005 is more than 164 million, so the drug continues to gain in popularity. 

The isolation of morphine from opium and the recognition of the significance of its physiological effects by F. W. A. Sertiirner in 1803-1817 as well as the first definition of the term alkaloid by Meissner in 1819-1821 have led to a rapid progress in the research of alkaloids (1). In the beginning of the past century, much attention was paid to the cultivated poppy plant Papaver somniferum L., which has been used since time immemorial in popular medicine. Of the so-far known 41 opium alkaloids, only morphine, codeine, and papaverine have found... 

Codeine is an analgesic that is effective in the treatment of mild to moderate pain. It is often combined with other analgesic products and enjoys a popularity that makes it the standard for other oral opioids. Unfortunately, codeine has the same propensity to produce tolerance, dependence, and constipation as morphine. Hydrocodone, a derivative of codeine, also is seen most often in combination products and has pharmacologic properties similar to those of morphine. Oxycodone has a similar potency to morphine and is an excellent oral analgesic for moderate to severe pain. This is especially trne when the product is used in combination with nonopioids however, its predilection for causing tolerance and dependence, along with its basic opioid characteristics, likens it to morphine. It shonld be noted that sustained-release oxycodone is also available. 

The wide popularity of propoxyphene is largely a result of unrealistic overconcem about the addictive potential of codeine. 

EC is currently the most popular method for the determination of morphine in body fluids, since morphine contains a phenol group which is easily oxidized (Tagliaro et al. 1989). The detection limit of morphine typically varies from a few tens of picograms to several hundred. Other opiates contain a tertiary alicyclic amine, and can best be detected using a neutral or slightly alkaline eluent and about a 0.3-0.4 V higher potential than for morphine (Schwartz and David 1985). For the nonphenolic alkaloids, codeine has been detected by EC in body fluids at the nanogram level. However, EC has seldom been used for the determination of opium alkaloids in plant material. 

Similar reaction with PFP anhydride can be employed for the derivatization of opiates, such as morphine and codeine [133) and benzoylecgonine [134], an indicator of ctxaine abuse. The mass spectra obtained are all highly suitable for confirmation work by GC-MS, leading to the popularity of this derivative type in the forensic laboratory. 

Age The popularity of codeine in pediatric anesthesia has been questioned [67 ]. Codeine is associated with a number of adverse events—constipation, nausea and vomiting, euphoria, itching, dry mouth, drowsiness, meiosis, urinary retention, hypotension, and respiratory depression. Intravenous codeine can cause profound hypotension and tonic-clonic seizures. It should be avoided in breast feeding. Using codeine concomitantly with other drugs, such as antitussives, can result in serious harm. Despite such evidence, codeine remains a popular choice. 

Phenacetin was very popularly used in medicines like headache cures for many years. It was commonly combined with codeine (see p347) in medications. Following severe injuries in a plane crash in 1946, the American business magnate and aviator Howard Hughes was heavily dependent upon painkillers and it has been suggested that their phenacetin content may have caused kidney failure. 

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