Tampering of opioid analgesics: a serious challenge for public health?

Kimergård, Andreas; Breindahl, Torben; Hindersson, Peter; Deluca, Paolo

doi:10.1111/add.13436

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…One study found that extracting codeine with the use of simple techniques and household appliances can yield different amounts of codeine and non-opioid analgesics in the extracted mixtures making it difficult to control the doses (Kimergård, Deluca, Hindersson, & Breindahl, 2016b). Understanding risk factors associated with medicine tampering may help implement harm reduction interventions and deliver treatment to specific populations of polysubstance users where the risk of harm is disproportionately great (Kapitány-Fövény et al, 2015;Kimergård et al, 2016a;Talu et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Respondents were asked if they had ever tampered with codeine‐containing medicines. In context of this study, tampering included methods used to enhance drug effects (Kimergård et al, ), investigated through a series of questions constructed for the study about (a) drinking codeine cough syrups with soft drinks, juice, or alcohol; (b) extracting codeine from tablets containing codeine and non‐opioid analgesics such as paracetamol or ibuprofen; (c) taking codeine rectally; (d) snorting crushed codeine tablets; (e) injecting dissolved codeine tablets; and (f) consuming morphine or heroin manufactured from codeine.…”

Section: Methodsmentioning

confidence: 99%

“…Whilst heroin remains a principal drug in drug‐related deaths in Europe, other opioids have become more prominent in national data (EMCDDA, ; Office for National Statistics, ). Tampering of medicines to enhance drug effects (Kimergård, Breindahl, Hindersson, & Deluca, ) and transitions from weak to more toxic opioids and to heroin highlight unique concerns with misused medicines (Conroy & Hill, ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The challenge of complex drug use: Associated use of codeine‐containing medicines and new psychoactive substances in a European cross‐sectional online population

Kimergård

Foley

Davey

et al. 2017

Human Psychopharmacology

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The challenge of complex drug use: Associated use of codeine‐containing medicines and new psychoactive substances in a European cross‐sectional online population

Kimergård

Foley

Davey

et al. 2017

Human Psychopharmacology

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“…Upon inhalation, these products will undergo hepatic metabolism and the resulting metabolites may be difficult to distinguish from food components, traces of environmental pollutants, products from tobacco smoking and endogenous compounds. Increased reliance upon specialised laboratories in addiction treatment settings may facilitate development of methods to detect new substances reported and biomarkers relevant to specific types of reported tampering, such as fentanyl smoking . A retrospective toxicological investigation of hair samples, collected from 24 victims of drug‐facilitated crime, demonstrate the value of segmental hair analysis to determine fentanyl concentrations and confirm exposure, and may represent another important area of drug analysis development.…”

Section: Perspectivementioning

confidence: 99%

Characteristics of opioid‐maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini‐review

Kimergård

Dunne

Bøgen

et al. 2018

Drug Testing and Analysis

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The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose, and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigation due to reports of overdose and death. We report a case series of 14 drug addiction treatment entrants, who entered treatment in a service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches. Clients presented with difficulties breathing and pains in the lungs. The clients had a history of past opioid use, including heroin. Relapses resulted in treatment disengagement. Immunoassays for fentanyl were used in the service. In some cases, false negative results occurred. Clients' urine samples were subsequently analysed in a collaborating laboratory. Seven clients tested positive for fentanyl. One client was positive for both fentanyl and heroin. Analyses were also positive for other opioids and metabolites in 6 clients, predominantly codeine and oxycodone. Results from confirmatory analysis contributed to clearer insights into clients' drug histories, which facilitated personalised care plans consisting of opioid agonist therapy informed by confirmed drug use. In Denmark, prescription levels of fentanyl are high, which has been accompanied by observations of diversion and smoking in a smaller population. In addition to revision of inappropriate prescribing to reduce diversion, we recommend increased reliance upon confirmatory drug analysis in the addiction treatment sector in Denmark.

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“…Tampering of psychoactive medicines represents a challenge for the pharmaceutical industry, medicine regulators, community pharmacies and prescribers to prevent opioid-related harms such as overdose and dependence. Medicine tampering involves a range of procedures to manipulate different types of psychoactive medicines in order to enhance their psychoactive effects [1,2]. Reports of harm following intravenous injection of crushed oxycodone and morphine tablets highlight the risk of pulmonary granulomatosis from deposition of talc and other fillers used in the manufacturing of medicines [3,4].…”

Section: Introductionmentioning

confidence: 99%

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

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

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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.

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Tampering of opioid analgesics: a serious challenge for public health?

Cited by 8 publications

References 18 publications

The challenge of complex drug use: Associated use of codeine‐containing medicines and new psychoactive substances in a European cross‐sectional online population

The challenge of complex drug use: Associated use of codeine‐containing medicines and new psychoactive substances in a European cross‐sectional online population

Characteristics of opioid‐maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini‐review

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

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