Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?

Croitoru Mircea Dumitru 1 , Fogarasi Erzsébet 1 , Varga Erzsébet 1 , Chelaru Adelina 1 , Căliman Monica-Simina 1  and Fülop Ibolya 1
  • 1 University of Medicine and Pharmacy Tirgu Mures, Romania

Abstract

Objective: Analgesic medicines containing combinations of nonsteroidal anti-inflammatory drugs and codeine are available without prescription. Codeine, in these combinations can not be used recreationally due to the high toxicity profile of the nonsteroidal anti-inflammatory drugs. However, methods for extracting codeine from these types of medication are available on the internet. The purpose of this work is to evaluate if codeine can be extracted from codeine containing analgesics sold without prescription.

Methods: High Performance Liquid Chromatography (HPLC) with UV detection was used to measure the amounts of codeine and nonsteroidal anti-inflammatory drugs recovered after applying an extraction method described on the internet.

Results: The results show that codeine can be very easily separated from NSAID as aspirin, acetaminophen, ibuprofen using the cold water extraction method. However, very large differences (20 to 90%) were recorded for the recovery of codeine depending on the OTC product that was used. That large difference increases the risk of potentially lethal overdoses when the user switches between “similar” products.

Conclusions: Our work shows that analgesic medication with codeine content can be recreationally used after the extraction of codeine. In order to prevent this, the sell of this type of products should be regulated or products that do not allow the extraction of codeine should be developed.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Malec M, Shega JW. Pain Management in the Elderly. Med Clin North Am. 2015;99(2):337-350. doi: 10.1016/j.mcna.2014.11.007.

  • 2. Pappagallo M, Heinberg LJ. Ethical issues in the management of chronic nonmalignant pain. Semin Neurol. 1997;17:203-211.

  • 3. Lome B. Acute pain and the critically ill trauma patient. Crit Care Nurs Q. 2005;28:200-207.

  • 4. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016; doi: 10.1002/14651858.CD005220.pub2.

  • 5. Buescher JJ. Carbamazepine for Acute and Chronic Pain. Am Fam Physician. 2006;73:1549-1550. doi: 10.1002/14651858.CD005451.

  • 6. Huber E, Robinson RC, Noe CE, Van Ness O. Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk. Healthcare (Basel). 2016;4(2). doi: 10.3390/healthcare4020029.

  • 7. Sweetman SC (ed): Martindale, The Complete Drug Reference. London. Pharmaceutical Press. 2009.

  • 8. Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;(9):CD008659.

  • 9. Pfaffenrath V, Diener HC, Pageler L, Peil H, Aicher B. OTC analgesics in headache treatment: open-label phase vs randomized double-blind phase of a large clinical trial. Headache. 2009;49:638-645.

  • 10. Nielsen S, Van Hout MC. Over-the-Counter Codeine-from Therapeutic Use to Dependence, and the Grey Areas in Between. Curr Top Behav Neurosci. 2016. doi: 10.1007/7854_2015_422.

  • 11. Hamer AM, Spark MJ, Wood PJ, Roberts E. The upscheduling of combination analgesics containing codeine: the impact on the practice of pharmacists. Res Social Adm Pharm. 2014;10:669-678. doi: 10.1016/j.sapharm.2013.08.004.

  • 12. Van Hout MC, Norman I. Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies. Int J Drug Policy. 2016;27:17-22. doi: 10.1016/j.drugpo.2015.09.007.

  • 13. Barkin RL. Acetaminophen, aspirin, or Ibuprofen in combination analgesic products. Am J Ther. 2001;8:433-442.

  • 14. *** Cold Water Extraction of Opioids available at: https://drugs-forum.com/forum/showwiki.php?title=Cold_Water_Extraction_of_Opioids, accessed on 15.06.2016.

  • 15. Van Hout MC. Nod and wave: an Internet study of the codeine intoxication phenomenon. Int J Drug Policy. 2015;26:67-77. doi: http://dx.doi.org/10.1016/j.drugpo.2014.06.016.

  • 16. Alves EA, Soares JX, Afonso CM, et al. The harmful chemistry behind “krokodil”: Street-like synthesis and product analysis. Forensic Sci Int. 2015;257:76-82. doi: 10.1016/j.forsciint.2015.07.042.

OPEN ACCESS

Journal + Issues

Search