Codeine: Prescription Drug Abuse & Testing

Introduction:

Codeine or methylmorphine is an opiate used for its analgesic, antitussive and antidiarrheal properties. It is marketed as the salts codeine sulfate and codeine phosphate. Codeine hydrochloride is more commonly marketed in continental Europe and other regions.

Codeine is an alkaloid found in opium in concentrations ranging from 0.3 to 3.0 percent. While codeine can be extracted from opium, most codeine is synthesized from morphine through the process of O-methylation. The chemical name of codeine phosphate is 7,8-Didehydro-4,5alpha-epoxy-3-methoxy-17-methyl morphinan-6alpha-ol phosphate (1:1) (salt) hemi-hydrate.

Codeine Dosage & Administration:

Each soluble tablet contains 30 mg (0.074 mmol) or 60 mg (0.15 mmol) of codeine phosphate. Codeine is safe at dosage from 10-60mg at once. However, when Codeine is used recreationally it is between 60mg to 400 mg in one shot. If an individual uses more than 400 mg in one shot, it exceeds the amount of drug the liver can metabolize at once which means that it will be wasted. Codeine is usually taken orally, rectally (via the anus) and is also given as a shot. It is never, however, be snorted, smoked or injected intravenously.

Codeine Prescription:

Codeine is medically prescribed for the relief of moderate pain and cough suppression. It is made into tablets either alone or in combination with aspirin or acetaminophen (i.e., Tylenol with Codeine,). As a cough suppressant, codeine is found in a number of liquid preparations. Codeine is also used to a lesser extent as an injectable solution for the treatment of pain.

Codeine Abuse:

Codeine products are largely diverted from legitimate sources to the illicit market where it forms the daily dose of a large chunk of drug abusers. Prescription drug abuse involves multi-billion dollar market in the US alone and codeine is a significant “contributor” to it!

Euphoric effects associated with opiates are one of the major reasons for wide spread codeine usage. Easy availability of codeine further promotes its use for recreational purposes. Codeine can be obtained either over the counter in low doses or through prescription combination drugs.

Effects of Codeine Abuse:

Just like any other prescription drug abuse, Codeine abuse is largely reflected in the physiological state of health of a drug abuser. There are many common adverse drug reactions that are associated with the use of codeine. These include - euphoria, itching, nausea, vomiting, drowsiness, dry mouth, miosis (pupil shortening), orthostatic hypotension, urinary retention and constipation. Compared to morphine, codeine produces less analgesia, sedation, and respiratory depression, and is usually taken orally. However, as with most other drugs, prolonged use of codeine results in development of tolerance to many of its effects and thus, abuser also becomes tolerant to its therapeutic effects.

Prescription Laws:

In the United States, Codiene is regulated by the Controlled Substances Act. It is a controlled substance for pain-relief products containing codeine alone or more than 90 mg per dosage unit. Preparations for cough or diarrhea containing small amounts of codeine in combination with two or more other active ingredients may be dispensed in amounts up to 4 fl. oz. per 48 hours without a prescription. In locales where dilute codeine preparations are non-prescription, anywhere from very few to perhaps a moderate percentage of pharmacists will sell these preparations without a prescription.

Codeine Testing:

There is diverse array of techniques available to test for drug abuse and codeine is no exception. It can be detected using any of the following methods:

•Urine based codeine testing
•Hair follicle based Codeine detection
•Gas Chromatography based Codeine detection
•Mass spectrometry based Codeine testing
•Codeine-specific Antibody based detection kits

Most of the codeine is excreted within 24 hours. However, 5% to 15% of codeine remains unchanged and some part may also exist as a product of glucuronide conjugates of codeine and its metabolites which may be detected by above said methods.