Beliefs and Social Norms About Codeine and Promethazine Hydrochloride Cough Syrup (CPHCS) Use and Addiction Among Multi-Ethnic College Students

Peters, Ronald J.; Yacoubian, George S.; Rhodes, Warren A.; Forsythe, Karry J.; Bowers, Kameko S.; Eulian, Valencia M.; Mangum, Clemmie A.; O'Neal, Jamie D.; Martin, Queen; Essien, E. James

doi:10.1080/02791072.2007.10400614

Cited by 34 publications

(30 citation statements)

References 7 publications

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“…In follow-up debriefs, many describe being profoundly disoriented and incapacitated during the period of concomitant use. The combination of opioids and promethazine has been reported to be highly addictive (Peters et al, 2007). Promethazine could enhance the addiction potential of opioids prescribed for chronic pain, contributing to the increasingly common and dangerous problem of prescription drug misuse.…”

Section: Discussionmentioning

confidence: 99%

“…Over the last two decades, there have been sporadic reports of concomitant use of opioids with promethazine (Wairagkar et al, 1994; Lam et al, 1996; Mattoo et al, 1997; Sharma and Mattoo, 1999; Elwood, 2001; Shek and Lam, 2006; Peters et al, 2007; Clatts et al, 2010; Agnich et al, 2013; Shapiro et al, 2013). Promethazine, a phenothiazine derivative, is routinely prescribed for the treatment of nausea, vomiting, and motion sickness.…”

Section: Introductionmentioning

confidence: 99%

“…It is also FDA approved for the treatment of allergic conditions and for pre- and post-operative sedation (Sharma and Hamelin, 2003; Page et al, 2009). Starting in the late 1990’s, there were reports that teenagers in Texas were drinking cough syrup containing codeine and promethazine to get “high” (Mattoo et al, 1997, 1999; Elwood, 2001; Peters et al, 2003, 2007). In one study, 25% of at-risk youth reported lifetime illicit use of cough syrup containing codeine and promethazine (Peters et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Promethazine use among chronic pain patients

Lynch¹,

Shapiro²,

Coffa³

et al. 2015

Drug and Alcohol Dependence

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Background Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the “high” from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. Methods Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. Results The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. Conclusions The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Promethazine use among chronic pain patients

Lynch¹,

Shapiro²,

Coffa³

et al. 2015

Drug and Alcohol Dependence

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“…Within trajectories of codeine misuse and dependence, a wide ranging profile of codeine user exists; for example, the elderly (Roumie & Griffin, 2004;Agaba et al 2004); youth (Elwood, 2001;Peters et al 2003Peters et al , 2007aPeters et al , 2007bPeters et al , 2007cFord, 2009;Lao et al 2010;Wilson et al 2010;Tang et al 2012;Agnich et al 2013); parents (Allotey et al 2004); students (Acocella, 2005); pharmacy customers (Sweileh et al 2004;Albsoul-Younes et al 2010); drug and psychiatric treatment patients (Agyapong et al 2013); addiction treatment patients (Akram & Roberts, 2003;Myers et al 2003;Yang & Yuan, 2008;Cohen et al 2009;Thekiso & Farren, 2010;Cooper, 2013b) and internet drug forum users (Van Hout, 2015) each with their own motives, patterns and outcomes for use. However, there is a lack of consensus around a definition of misuse of pharmaceutical opioid narcotics (Barrett et al 2008;Casati et al 2012;Cooper, 2013a) with broad misuse of pharmaceutical definitions including incorrect but legitimate use for medical purposes; use outside of acceptable medical guidelines when self-medicating at higher doses and for longer than advised; use for reasons other than for the instructions on the label or the intended purpose; recreational use for intoxication purposes; and where risks and adverse consequences outweigh the benefits (Nielsen et al 2008;Casati et al 2012).…”

Section: Introductionmentioning

confidence: 99%

‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland

Hout

Horan

Santlal³

et al. 2015

Ir. j. psychol. Med.

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Objectives. Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland's 2010 guidelines for restricted supply of non-prescription codeine containing products.Methods. In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n = 21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were 'emotional pain and user self-legitimization of use' and 'entrapment into habit-forming and invisible dependent use'. These concepts were reported in different ways by a majority of participants.Results. Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences.Conclusions. There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.

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“…It is generally used for pain control and as an antitussive agent in cough syrups (Peters et al 2007). Safety concerns around the misuse of non-prescription medicinal products containing codeine are well established.…”

Section: Introductionmentioning

confidence: 99%

Use of codeine-containing medicines by Irish psychiatric inpatients before and after regulatory limitations on their supply

Agyapong

Singh

Savage

et al. 2013

Ir. j. psychol. Med.

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BackgroundIn recent years, concerns have been highlighted in several jurisdictions, including Ireland, regarding abuse of over-the-counter codeine-containing medicines. On the 1st of August 2010, national regulatory guidelines aimed at limiting the supply of these medicines in Ireland came into force.AimsTo study the effects of the new regulations on the use of non-prescribed codeine-containing medicines by psychiatric patients admitted to an Irish university teaching hospital before (n = 117) the regulations came into effect and 6 months afterwards (n = 126).MethodsParticipants completed a brief self-administered survey questionnaire about their use of over-the-counter codeine-containing medicines in the preceding 3 months.ResultsCompared with before the introduction of the new regulations, there was a large decline in the reported ‘often’ or ‘regular’ use of codeine-containing medicines in the 3 months before admission (33.3% v. 17.4%, χ2 = 6.354, p = 0.01) and there was a reduction in the proportion of patients for whom others had expressed concerns about their frequency of use of such medications (15.5% v. 4.8%, χ2 = 7.29, p = 0.03). There was also a decline in the proportion of patients who stated that they would use codeine-containing medicines for either a ‘feel-good’ effect or to curb cravings (15.9% v. 1.9%, p < 0.01, two-tailed Fisher's exact test).ConclusionWe conclude that tight regulations on the supply of non-prescription codeine-containing medicines have the potential to reduce the use and abuse of such medicines in patient populations availing of admission to psychiatry hospitals.

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Beliefs and Social Norms About Codeine and Promethazine Hydrochloride Cough Syrup (CPHCS) Use and Addiction Among Multi-Ethnic College Students

Cited by 34 publications

References 7 publications

Promethazine use among chronic pain patients

Promethazine use among chronic pain patients

‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland

Use of codeine-containing medicines by Irish psychiatric inpatients before and after regulatory limitations on their supply

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