Possible Causal Link Between Idiopathic Intracranial Hypertension and the Misuse of Codeine-Based Products

Donuk, Tuğba; Altıntoprak, Ayşe Ender; Tekin, Hande Gazeteci

doi:10.1089/cap.2015.0042

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Regarding the outcome, most cases recorded were associated with a full recovery after hospitalization, with treatment having been either supportive (32, [44][45][46]65) or symptomatic, with the latter consisting of benzodiazepines and antipsychotics (25, 27, 28, 43, 47, 49, 51, 54, 61, 67, 68, 71, 73-75, 79, 111, 115). A full detoxification procedure was recorded in cases of dependence and withdrawal (17,82,92,95,98,105,107,109,115); examples included buprenorphine 2 mg/day to treat a sudden opiate (codeine) withdrawal symptoms (114), naltrexone as a relapse prevention agent for DXM dependence (63), and topiramate for DXM craving (56). Some cases required specific actions in the Emergency Unit (80).…”

Section: Discussionmentioning

confidence: 99%

“…Chlorpheniramine is used as a cheap sleep aid and/or as an anxiolytic due to its antimuscarinic properties; its abuse has been related to pleasurable feelings, which reinforces the repetitive use and the possibility of developing drug dependence (Table 1). It may, however, be associated with psychotic symptoms in predisposed individuals [e.g., people with mental illnesses or individuals concomitantly abusing other drugs; (42,43,114,115)].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, codeine-related effects are associated with CYP2D6 metabolism, e.g., ultrarapid CYP2D6 metabolizers produce an unexpectedly large amount of morphine, with resulting life-threatening opioid toxicity. Its recreational use is related to the agonism at mu receptors and the subjective effects of euphoria, elation, analgesia, and "liking" (114,121). Codeine toxicity is characterized by respiratory depression and extreme somnolence progressing to stupor or coma (79); in severe overdosage cases, death may occur (121) (Supplementary Table 1 and Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Idiosyncratic codeine administration procedures have been recorded, e.g., a misuser learned online how the codeine base might be extracted through a process called cold water extraction (CWE) to be then injected. Regular use of codeine is described here together with the development of both tolerance (135) and dependence (80,114).…”

Section: Discussionmentioning

confidence: 99%

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Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

et al. 2021

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Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused.Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine.Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261).Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported.Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

et al. 2021

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“…Reports of harms associated with CWE have been published elsewhere [22,23], including reports of one fatality in which a pot and coffee filters were found near the fatality (toxicological analyses of blood and urine confirmed the presence of opioids) [24]. A case series of presentations at two London hospitals compiled data from six patients with self-reported ingestion of codeine or dihydrocodeine treated with CWE [13].…”

Section: Introductionmentioning

confidence: 99%

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

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Background Tampering of psychoactive medicines presents challenges to regulation and public health. However, little is currently known about what influences the decisions to treat codeine-containing medicines (CCM) with cold water extraction (CWE) from the perspective of individuals employing these techniques. The article identifies factors influencing utilisation of CWE to separate codeine from compounded analgesics, such as paracetamol and ibuprofen, found in CCM. Methods Purposive sampling of 27 participants residing in England who took part in a qualitative interview. Of these, 14 individuals (11 males and 3 females) reported tampering of psychoactive medicines, and the relevant transcripts were included in the analyses for the study. Participants were recruited from one addiction treatment service and from an online survey. The mean age of the participants was 31.5 years (range = 18–42 years). Qualitative data analysis followed the processes of iterative categorization (IC). The codes ‘harm reduction’, ‘information sources’ and ‘changes on the drug markets’ were grouped and summarised. The coding of the data was done in a Microsoft® Word document. Results Two groups of participants were identified in the data analysis: (i) individuals who used CCM (n = 5), and (ii) individuals who used CCM and heroin (n = 9). Participants in both groups used CWE due to concerns of paracetamol overdose from the use of excessive dosages of CCM. For both of them, information obtained from the internet encouraged the use of CWE. Participants using CCM described how the many steps involved in conducting CWE, including sourcing codeine boxes from pharmacies (over the counter), presented a barrier against using CWE. Participants using CCM and heroin explained how reduced availability in the local heroin supply influenced utilisation of CWE techniques to maintain their use of opioids and avoid withdrawal. Withdrawal symptoms and cravings outweighed the concerns about the quality of the extracted codeine mixtures in this participant group, especially the ability of CWE to remove paracetamol and tablet fillers. Conclusions Utilisation of CWE of codeine was influenced by several factors including drug market supply, the availability of detailed information on the internet about CWE and restrictions on codeine sourcing in pharmacies. Risks identified with CWE include consumption of unknown doses of paracetamol if the CWE techniques are not used correctly. Attempts at extracting codeine from CCM should be considered in risk assessments of opioid medicines.

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How Resistant to Tampering are Codeine Containing Analgesics on the Market? Assessing the Potential for Opioid Extraction

et al. 2016

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IntroductionMisuse of opioid analgesics, in combination with diversion, dependence, and fatal overdoses, presents a serious problem for public health, which affects many countries worldwide. Within this context, tampering with opioids has been associated with serious harm. The aim of the present study was to assess the tampering potential of codeine combination analgesics on the market (containing codeine/non-opioid analgesics) by the extraction of codeine.MethodsCodeine was extracted from three combination formulations sold lawfully from licensed pharmacies without a medical prescription in Denmark and the UK. Extraction of codeine followed tampering procedures available on the Internet. The amounts of codeine and accompanying non-opioid analgesics in tampering products were analysed with liquid chromatography and tandem mass spectrometry (LC–MS/MS).ResultsLC–MS/MS showed recoveries of the total amounts of codeine in tampering products of 81–84% from Product 1 (codeine/acetylsalicylic acid); 61–67% from Product 2 (codeine/ibuprofen); and 42–71% from Product 3 (codeine/paracetamol). Recoveries of non-opioid analgesics ranged between: 57–73% acetylsalicylic acid; 5.5–8.5% ibuprofen, and 5.0–9.2% paracetamol.ConclusionWith the tampering procedures used, high amounts of codeine were separated from the accompanying analgesics in some, but not in all of the codeine containing formulations. Evidence-based medicine regulation, treatment for opioid dependence, and information to minimise risks to the public are essential components of an effective public health strategy to address the harms of tampering and misuse.FundingMarie Pedersen and Jensine Heiberg Foundation.

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Possible Causal Link Between Idiopathic Intracranial Hypertension and the Misuse of Codeine-Based Products

Cited by 5 publications

References 7 publications

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

How Resistant to Tampering are Codeine Containing Analgesics on the Market? Assessing the Potential for Opioid Extraction

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