Cold water extraction of codeine/paracetamol combination products: a case series and literature review

Harnett, James T; Dines, Alison; Wood, David M.; Archer, John R. H.; Dargan, Paul I.

doi:10.1080/15563650.2019.1612069

Cited by 6 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The solution was then pipetted into an LC vial for storage and analysis. A sample of pure codeine was obtained via cold water extraction 6 from a pharmaceutical grade co-codamol table obtained from a local pharmacy. Direct infusion screening mass spectra were recorded by nanospray on a Synapt G2S (Waters, Manchester, UK) fitted with a Triversa Nanomate chip-based nanospray system (Advion Biosciences, Norwich, UK). Samples were diluted in methanol : water (50 : 50) and 5 μL aspirated through a nanomate 400 chip by the nanospray robot at 1.5 kV nanospray voltage, and 1.5 psi gas pressure.…”

Section: Methodsmentioning

confidence: 99%

An LC-MS/MS analysis of opiate residues on Thomas Chatterton's (1752–1770) memorandum book – Did he die from a laudanum overdose?

Gates

Doble²

2020

Analyst

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

An LC-MS/MS analysis of opiate residues on Thomas Chatterton's (1752–1770) memorandum book – Did he die from a laudanum overdose?

Gates

Doble²

2020

Analyst

View full text Add to dashboard Cite

show abstract

“…The definition includes 'misuse' of CCM amongst pain patients who develop codeine dependence as well as people taking excessive codeine doses recreationally. Both groups have been found to make use of CWE procedures [13,19,30]. Patterns of use to establish eligibility were examined for each potential participant according to their responses on the online survey or during part of the initial screening prior to the interviews.…”

Section: Recruitment and Samplingmentioning

confidence: 99%

“…However, indicators of high-risk drug taking that may possibly involve tampering of psychoactive medicines such as intravenous injections of crushed and dissolved tablets reveal that a majority of addiction service treatment entrants for opioids are male (2017/2018) [49]; a majority of drug-related deaths occurred amongst male in 2018 [50]. In a case series reporting patients presenting to Emergency Departments in England with reported consumption of codeine and dihydrocodeine extracted from CWE all six patients were male [13]. As such, the sample included in our analyses may indeed reflect the characteristics of subpopulations engaging in this form of tampering of psychoactive medicines.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…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]. The number of tablets used for CWE of codeine ranged from 15 to 70 containing either 8 mg codeine or 12.8 mg codeine per tablet.…”

Section: Introductionmentioning

confidence: 99%

“…As one of the major consumers globally [25], codeine is widely available for use in the UK (sold OTC, prescribed, and dispensed as take-home boxes from Emergency Departments [26]), and therefore susceptible to tampering in the form of CWE amongst people who wish to consume excessive doses of codeine. As the literature suggests, people who consume codeine treated with CWE are at risk from exposure to unknown quantities of both codeine and accompanying analgesics (such as paracetamol, ibuprofen, and acetylsalicylic acid) [13,14]. However, a better understanding of the experiences of CWE, and how CWE produces and reduces risk would contribute to evidence for risk assessments of opioid medicines and for the design of appropriate and effective public health responses.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

View full text Add to dashboard Cite

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.

show abstract

Mitochondria-Targeted Ratiometric Chemdosimeter to Detect Hypochlorite Acid for Monitoring the Drug-Damaged Liver and Kidney

et al. 2022

View full text Add to dashboard Cite

Liver and kidney injury caused by drug toxicity is a serious threat to human health. Acetaminophenol (APAP), as a common antipyretic and analgesic drug, inevitably causes injury. When it is overused, hypochlorous acid (HClO) is excessively generated due to metabolic abnormalities, resulting in the accumulation of HClO in the mitochondria of liver and kidney tissues and causing damage. In this study, we designed a series of HClO responsive ratiometric chemdosimeter NRH-X (NRH-O, NRH-S, and NRH-C) to evaluate liver and kidney injury, and found that NRH-O has a specific sensitive response to HClO. NRH-O can not only monitor the variations of endogenous HClO content of living cells by fluorescence ratio changes in the mitochondria but also detect the upregulation of HClO induced by APAP. In addition, NRH-O can also be used for anatomic diagnosis of liver and kidney injury by fluorescence ratio imaging of HClO in the tissues of inflammatory mice.

show abstract

Cold water extraction of codeine/paracetamol combination products: a case series and literature review

Cited by 6 publications

References 20 publications

An LC-MS/MS analysis of opiate residues on Thomas Chatterton's (1752–1770) memorandum book – Did he die from a laudanum overdose?

An LC-MS/MS analysis of opiate residues on Thomas Chatterton's (1752–1770) memorandum book – Did he die from a laudanum overdose?

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

Mitochondria-Targeted Ratiometric Chemdosimeter to Detect Hypochlorite Acid for Monitoring the Drug-Damaged Liver and Kidney

Contact Info

Product

Resources

About