The Role of Dihydrocodeine in Causing Death among Drug Users in the West of Scotland

Seymour, Alison; Black, Marjorie; Jay, Jane; Oliver, John S.

doi:10.1177/003693300104600506

Cited by 11 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,26 An increasing incidence of dihydrocodeine in the drug deaths in the Strathclyde region of Scotland has been found, possibly a result of its use as a substitute for methadone among general practitioners. 30 …”

Section: Specific Examplesmentioning

confidence: 99%

Recent Trends in Narcotic Deaths

Drummer¹

2005

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

The prevalence of overdose deaths from opioids is still generally increasing throughout the world. Heroin is still the predominant illicit opioid of interest to toxicology laboratories because of its continuing widespread availability and its ability to elicit respiratory depression and coma. In many countries methadone continues to play a major role in cases of drug toxicity because of its large-scale use to treat opioid dependency and its high potency and long duration of action. Increasingly, buprenorphine is being used as an alternative pharmacotherapy, and although apparently safer than methadone, it still has an inherent risk of toxicity when used with CNS depressants such as benzodiazepines or when injected. Morphine continues to be the dominant analgesic; however, oxycodone, hydromorphone, hydrocodone, and fentanyl are increasingly being used and will require increasing efforts by toxicology laboratories to ensure that these substances are adequately covered by testing programs.

show abstract

Section: Specific Examplesmentioning

confidence: 99%

Recent Trends in Narcotic Deaths

Drummer¹

2005

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

show abstract

“…On the other hand, it is an issue of concern that DHC prescription rates seem to be related to levels of DHC fatalities in both Scotland [13] and Germany [14]. This is possibly in relation to levels of disregard of the availability of supervised or interval dispensing of opioids, which in turn may increase the risk of diversion to the black market and hence their availability for recreational abuse [10].…”

Section: Introductionmentioning

confidence: 99%

“…Opiate analgesics in general, and DHC in particular, are often identified in studies focusing on drug‐related deaths in addicts [13, 14, 20–22]. It is thought that in recent years improvements have occurred in the quality of treatment of addiction, and DHC prescriptions for opiate management have dropped in several areas [23].…”

Section: Introductionmentioning

confidence: 99%

Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007

Zamparutti

Schifano

Corkery

et al. 2011

Brit J Clinical Pharma

View full text Add to dashboard Cite

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Dihydrocodeine (DHC) is an opioid analgesic sometimes prescribed as an alternative to other medications (e.g. methadone and buprenorphine) for opioid misuse. Its effectiveness is, however, still controversial. • DHC prescription rates seem to be related to levels of DHC fatalities, possibly in relation to levels of disregard of the availability of supervised or interval dispensing of opioids, but no large‐scale analysis of DHC fatalities has been carried out. • We analysed here involvement of DHC in fatalities that occurred between 1997 and 2007 among individuals with a history of opiate/opioid misuse reported to the National Programme on Substance Abuse Deaths (np‐SAD). WHAT THIS STUDY ADDS • DHC, either alone or in combination, was identified in 584 fatalities. Typical cases identified were males in their early thirties. In accidental overdoses, DHC, which had been prescribed to 45% of the victims, was typically identified in combination with other drugs, such as heroin/morphine, methadone and hypnotics/sedatives. Both paracetamol and antidepressants were more typically identified in combination with DHC in suicides. • Opiate/opioid misusers should be educated about risks associated with polydrug intake and prescribers should carefully consider a pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. AIMS Although its effectiveness is somewhat controversial, it appears that dihydrocodeine (DHC) is still prescribed in the UK as an alternative to both methadone and buprenorphine for the treatment of opiate addiction. METHODS Data covering the period 1997–2007 voluntarily supplied by coroners were analysed. All cases pertaining to victims with a clear history of opiate/opioid misuse and in which DHC, either on its own or in combination, was identified at post‐mortem toxicology and/or implicated in death, were extracted from the database. RESULTS Dihydrocodeine, either alone or in combination, was identified in 584 fatalities meeting the selection criteria. In 44% of cases it was directly implicated in the cause of death. These cases represented about 6.8% of all opiate/opioid‐related deaths during this period. Typical DHC cases identified were White males in their early thirties. Accidental deaths (96%) were likely to involve DHC in combination with other psychoactives, mainly heroin/morphine, hypnotics/sedatives and methadone. Both paracetamol and antidepressants were found in proportionately more suicide cases than in accidental overdoses. DHC had been prescribed to the decedent in at least 45% of cases. CONCLUSIONS Opiate/opioid misusers should be educated about risks associated with polydrug intake. More in particular, co‐administration of DHC with heroin, methadone and benzodiazepines may increase the risk of accidental fatal overdose. Prescribers should carefully consider pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. Mo...

show abstract

“…1), in drug prescriptions as substitutes and alternative drugs for the management of heroin in some European countries [4,5]. However, the presence of these drugs as a contributory factor in deaths from narcotic overdoses has also been reported [5,6].…”

Section: Introductionmentioning

confidence: 99%

Voltammetric Oxidation of Drugs of Abuse II. Codeine and Metabolites

Garrido¹,

Delerue–Matos²,

Borges

et al. 2004

Electroanalysis

View full text Add to dashboard Cite

The oxidation of codeine on glassy carbon electrodes has been studied in detail using differential pulse voltammetry. The results obtained using a glassy carbon electrode clearly show a much more complex oxidation mechanism than that previously reported when platinum and gold electrodes were used. To clarify the codeine oxidative profile, several metabolites and analogues of this alkaloid, codeine N-oxide, norcodeine, dihydrocodeine, acetylcodeine and 6-chlorodesoxycodeine, were synthesized and studied. It was deduced that the anodic waves observed in codeine oxidation are related to the presence of methoxy, hydroxy and tertiary amine groups. Due to the similarity of potentials at which these oxidative processes take place, at some pHs an overlap of peaks occurs and only one anodic wave is observed.

show abstract

The Role of Dihydrocodeine in Causing Death among Drug Users in the West of Scotland

Cited by 11 publications

References 15 publications

Recent Trends in Narcotic Deaths

Recent Trends in Narcotic Deaths

Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007

Voltammetric Oxidation of Drugs of Abuse II. Codeine and Metabolites

Contact Info

Product

Resources

About