Cough, codeine and confusion

Reilly, David O; Thomas, Mathew; Moylett, Edina

doi:10.1136/bcr-2015-212727

Cited by 8 publications

(7 citation statements)

References 7 publications

(8 reference statements)

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“…The link between the use of codeine and life-threatening or fatal respiratory depression has been documented extensively in a series of case reports, which, by 2004, have begun to appear regularly in literature (Koren et al 2006;Lynn et al 1993;Nishtala, Salahudeen, and Sarah 2016;Yanai 2012). For many of these young persons, the cytochrome P-450 2D6 (CYP2D6) genotyping revealed functional duplication of the CYP2D6 allele, resulting in the UM phenotype (Reilly et al 2015). Along with the risk of death from acute poisoning due to respiratory depression, other common health risks related to a prolonged use of codeine are physical complications (perforated peptic ulcers, hepatotoxicity and gastrointestinal bleeding) and psychiatric sequelae (impulsivity, depression, compulsive behaviors and anxiety) (Wang, He, and Chen 2011;Yanai 2012).…”

Section: The Chemistry Of Purple Drankmentioning

confidence: 99%

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

Miuli

Stigliano

Lalli

et al. 2020

Journal of Psychoactive Drugs

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In the early 1990s, several studies reported the misuse of codeine and promethazine hydrochloride cough syrup. Since then, the combination of this pharmaceutical, together with sprite or alcohol, known on the streets as "purple drank" or "lean", has become a popular drug among rap singers who promote its tranquilizing and euphoric effects through their music and videos. This review examines the "purple drank" phenomenon, taking into consideration its clinical and social implications. The study was conducted using PubMed, Scopus, and Web of Science as search engines, applying several inclusion and exclusion criteria and the string "Purple AND drank", resulting in 138 records. Seven papers that met our criteria were found. The risk of bias assessment, when applicable, was also considered, resulting in a low level of risk. Epidemiological data highlighted a heterogeneous diffusion of the misuse of this mixture, which is not exclusively linked to a specific type of user (African-American teenagers, athletes, and rappers), as previously reported in American newspapers and in the social media. New digital tools should be taken into consideration for further social and medical evaluations of this phenomenon.

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Section: The Chemistry Of Purple Drankmentioning

confidence: 99%

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

Miuli

Stigliano

Lalli

et al. 2020

Journal of Psychoactive Drugs

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“…Confusion is described as an unusual adverse effect, however has been observed recently in a 14‐year‐old girl after treatment with a cough suppressant over 15 days with daily doses of 30–45 mg codeine/person (O'Reilly et al., ). The authors noted that the daily doses were within the recommended dose range but the maximum recommended duration of dosage of 3 days was exceeded (no genotyping for CYP2D6).…”

Section: Assessmentmentioning

confidence: 99%

Update of the Scientific Opinion on opium alkaloids in poppy seeds

Knutsen¹,

Alexander²,

Barregård³

et al. 2018

EFS2

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Poppy seeds are obtained from the opium poppy (Papaver somniferum L.). They are used as food and to produce edible oil. The opium poppy plant contains narcotic alkaloids such as morphine and codeine. Poppy seeds do not contain the opium alkaloids, but can become contaminated with alkaloids as a result of pest damage and during harvesting. The European Commission asked EFSA to provide an update of the Scientific Opinion on opium alkaloids in poppy seeds. The assessment is based on data on morphine, codeine, thebaine, oripavine, noscapine and papaverine in poppy seed samples. The CONTAM Panel confirms the acute reference dose (ARfD) of 10 lg morphine/kg body weight (bw) and concluded that the concentration of codeine in the poppy seed samples should be taken into account by converting codeine to morphine equivalents, using a factor of 0.2. The ARfD is therefore a group ARfD for morphine and codeine, expressed in morphine equivalents. Mean and high levels of dietary exposure to morphine equivalents from poppy seeds considered to have high levels of opium alkaloids (i.e. poppy seeds from varieties primarily grown for pharmaceutical use) exceed the ARfD in most age groups. For poppy seeds considered to have relatively low concentrations of opium alkaloids (i.e. primarily varieties for food use), some exceedance of the ARfD is also seen at high levels of dietary exposure in most surveys. For noscapine and papaverine, the available data do not allow making a hazard characterisation. However, comparison of the dietary exposure to the recommended therapeutical doses does not suggest a health concern for these alkaloids. For thebaine and oripavine, no risk characterisation was done due to insufficient data. However, for thebaine, limited evidence indicates a higher acute lethality than for morphine and the estimated exposure could present a health risk.

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“…We provide the first case of severe confessionals condition in a previously healthy 14-year-old girl, which was eventually linked to improper codeine usage. The use of codeine in the paediatric environment has come under scrutiny in recent years as a result of numerous reported deaths, most of which were caused by respiratory depression [10]. Increased sucrose association with our study improves codeine's ability to elicit analgesia.…”

Section: Alkaloids Compound Of Poppy Seedmentioning

confidence: 54%

Production of Poppy Seed in Afghanistan and its Composition Effects: A Review

Azizi

Hasam

Qarizada³

2022

AJOCS

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The mean aim of this study is poppy plant with two important compounds of that poppy seed and opium which those are produced and used by people of world especially in a poor country like Afghanistan, the poppy seed used in bakery products, in pastry filling in deserts and the production of edible oil, also opium used as a drug. These contain morphine, thebaine, papaverine, codeine and narcotic which 20%, 1%,1%, (5-8)% respectively. According to, Bozan, B., & Temelli, F. the proximate analysis of poppy seed shown the low content of moisture that is 5.3%, high content of crude fat 49.9% also it has ash, carbohydrate, and crude protein by parentage of 5.1%, 18.3%, and 21.6% respectively. As well as they include practically all essential amino acids, except for tryptophan, and are high in oil, carbs, calcium, and proteins. Poppyseed and opium as used for increasing the economic situation of the government of Afghanistan while surveys by (UNODC) from 2000 to 2020 in metric tons per year, the production of poppy seed increase from 3200 to 8200. The risk of addiction to opium smoking appears to be slightly lower than that of parenteral heroin use, but significantly higher than that of alcohol. Even in countries where its use is common, opium smoking poses significant health and social risks.

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Cough, codeine and confusion

Cited by 8 publications

References 7 publications

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

Update of the Scientific Opinion on opium alkaloids in poppy seeds

Production of Poppy Seed in Afghanistan and its Composition Effects: A Review

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