Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Ino, Hiroyasu; Nakazawa, Eisuke

doi:10.3390/pharmacy10060155

Cited by 4 publications

(2 citation statements)

References 40 publications

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“…First, the risk of OD from OTC medications is apparent, especially OD due to the use of antitussive OTC medications that include codeine, dihydrocodeine, and methylephedrine [ 6 , 8 , 31 ]. Indeed, our results show that SS Bron, which contains dihydrocodeine, is the most frequently administered OTC medication among individuals ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study

Hakariya,

Yokoyama,

Lee

et al. 2024

JMIR Form Res

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Background Nonmedical use of prescription drugs can cause overdose; this represents a serious public health crisis globally. In this digital era, social networking services serve as viable platforms for illegal acquisition of excessive amounts of medications, including prescription medications. In Japan, such illegal drug transactions have been conducted through popular flea market applications, social media, and auction websites, with most of the trades being over-the-counter (OTC) medications. Recently, an emerging unique black market, where individuals trade prescription medications—predominantly nervous system drugs—using a specific keyword (“Okusuri Mogu Mogu”), has emerged on X (formerly Twitter). Hence, these dynamic methods of illicit trading should routinely be monitored to encourage the appropriate use of medications. Objective This study aimed to specify the characteristics of medications traded on X using the search term “Okusuri Mogu Mogu” and analyze individual behaviors associated with X posts, including the types of medications traded and hashtag usage. Methods We conducted a cross-sectional study with publicly available posts on X between September 18 and October 1, 2022. Posts that included the term “Okusuri Mogu Mogu” during this period were scrutinized. Posts were categorized on the basis of their contents: buying, selling, self-administration, heads-up, and others. Among posts categorized as buying, selling, and self-administration, medication names were systematically enumerated and categorized using the Anatomical Therapeutic Chemical (ATC) classification. Additionally, hashtags in all the analyzed posts were counted and classified into 6 categories: medication name, mental disorder, self-harm, buying and selling, community formation, and others. Results Out of 961 identified posts, 549 were included for analysis. Of these posts, 119 (21.7%) referenced self-administration, and 237 (43.2%; buying: n=67, 12.2%; selling: n=170, 31.0%) referenced transactions. Among these 237 posts, 1041 medication names were mentioned, exhibiting a >5-fold increase from the study in March 2021. Categorization based on the ATC classification predominantly revealed nervous system drugs, representing 82.1% (n=855) of the mentioned medications, consistent with the previous survey. Of note, the diversity of medications has expanded to include medications that have not been approved by the Japanese government. Interestingly, OTC medications were frequently mentioned in self-administration posts (odds ratio 23.6, 95% CI 6.93-80.15). Analysis of hashtags (n=866) revealed efforts to foster community connections among users. Conclusions This study highlighted the escalating complexity of trading of illegal prescription medication facilitated by X posts. Regulatory measures to enhance public awareness should be considered to prevent illegal transactions, which may ultimately lead to misuse or abuse such as overdose. Along with such pharmacovigilance measures, social approaches that could direct individuals to appropriate medical or psychiatric resources would also be beneficial as our hashtag analysis shed light on the formation of a cohesive or closed community among users.

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Section: Discussionmentioning

confidence: 99%

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study

Hakariya,

Yokoyama,

Lee

et al. 2024

JMIR Form Res

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“…The availability of codeine-containing products varies by region and country. In some places, certain codeine-containing products are available over the counter without a prescription, while others require a prescription due to their potential for misuse and addiction [ 17 ]. Promethazine is a first-generation antihistamine that helps in alleviating allergy symptoms, such as sneezing, itching, and runny nose.…”

Section: Introductionmentioning

confidence: 99%

Codeine and promethazine: Exploratory study on “lean” or “sizzurp” using national survey data and an online forum

Ware,

Garcia-Romeu,

Zamarripa

et al. 2024

PLoS ONE

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Background The concoction known as "lean" containing codeine and promethazine, holds a prominent cultural presence and is often referenced in mass media platforms (e.g., music and social media). Surprisingly, there’s a scarcity of national data characterizing the use of lean. Therefore, the current study investigated the use of lean using national survey data and online forum participant input, and focused on identifying concurrent substance use, exploring co-administration with other substances (e.g., alcohol, cannabis), and determining lean-related experiences. Methods We analyzed data from the National Survey on Drug Use and Health (NSDUH) spanning 2007–2019, identifying persons who used lean (weighted N = 42,275). Additionally, we conducted a Reddit-based study to gather insights about lean consumtion (N = 192). Results The NSDUH data indicated that lean use was most prevalent among teenagers and young adults (ages 13–21), accounting for 66% of the sample. This trend was more pronounced in male respondents (75%) compared to females. Additionally, the use was predominantly observed among Black/African American (29%), Hispanic (28%), and White (33%) populations, with these groups also reporting higher levels of concurrent alcohol and cannabis use. Similarly, findings from Reddit showed that individuals who used lean were predominantly male (67%) and exhibited elevated concurrent rates of alcohol (83%) and cannabis (46%) use in the past 30 days. Moreover, approximately 66% of respondents met criteria for severe lean use disorder, and 37% acknowledged driving under its influence. Conclusion The NSDUH data found that mostly young adult males reported consuming lean in the past twelve months, though the racial/ethnic breakdown of persons who used lean was diverse. The Reddit data found that most individuals in the sample met the criteria for a substance use disorder pertaining to their lean consumption. These findings underscore the clinical significance and necessity for further controlled research on lean.

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Hospital admissions for paracetamol poisoning declined following codeine re-scheduling in Australia

Noghrehchi¹,

Cairns²,

Buckley³

2023

International Journal of Drug Policy

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Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Cited by 4 publications

References 40 publications

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study

Codeine and promethazine: Exploratory study on “lean” or “sizzurp” using national survey data and an online forum

Hospital admissions for paracetamol poisoning declined following codeine re-scheduling in Australia

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