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Graven-Nielsen CS, Knoph CS, Okdahl T, Høyer KL, Krogh K, Hellström PM, Drewes AM. Opioids in the Treatment of Chronic Idiopathic Diarrhea in Humans—A Systematic Review and Treatment Guideline. J Clin Med 2023; 12:jcm12072488. [PMID: 37048572 PMCID: PMC10094889 DOI: 10.3390/jcm12072488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
In patients with chronic idiopathic diarrhea resistant to standard treatment, opioids are often used as rescue therapy. This systematic review investigated opioid effects on gut function in chronic diarrhea. PubMed and Embase were searched regarding effects of opioid agonists on the gastrointestinal tract in humans with chronic or experimentally induced diarrhea. A total of 1472 relevant articles were identified and, after thorough evaluation, 11 clinical trials were included. Generally, studies reported a reduction in stool frequency and an increase in transit time during treatment with the opioid receptor agonists loperamide, asimadoline, casokefamide, and codeine compared with placebo. Loperamide and diphenoxylate significantly improved stool consistency compared with placebo, whereas asimadoline showed no such effects. Compared with placebo, loperamide treatment caused less abdominal pain and urgency. Asimadoline showed no significant subjective improvements, but fedotozine was superior to placebo in reducing abdominal pain and bloating in selected patients. Only two relevant studies were published within the last 20 years, and standardized endpoint measures are lacking. Most trials included few participants, and further evidence is needed from larger, prospective studies. Likewise, consensus is needed to standardize endpoints for stool frequency, transit time, and consistency to conduct future meta-analyses on opioids in management of chronic idiopathic diarrhea.
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Sales Cadena MR, Cadena PG, Watson MR, Sarmah S, Boehm Ii SL, Marrs JA. Zebrafish (Danio rerio) larvae show behavioral and embryonic development defects when exposed to opioids at embryo stage. Neurotoxicol Teratol 2021; 85:106964. [PMID: 33621603 DOI: 10.1016/j.ntt.2021.106964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Abstract
Opioid abuse continues to plague society, and in recent years, there has been an epidemic, leading to increased addiction and death. It is poorly understood how prenatal opioid use affects the lives of children. The aim of this work was to evaluate the effect of early embryonic codeine or morphine exposure in zebrafish (Danio rerio), examining gastrulation progression (epiboly), teratogenic effects, mortality and locomotor behavior response to light/dark cycles. Zebrafish embryos were exposed to codeine or morphine (designated C or M) at 1, 5 or 10 mg/L (designated 01, 05 or 10, respectively) from 3 to 24 h postfertilization (hpf) or from 3 to 48 hpf (designated -24 or - 48 for 1 or 2 days of exposure, respectively). The C10-24, C01-48, C05-48 and C10-48 groups showed significantly smaller eyes than control larvae at 7 days postfertilization (dpf). Locomotor behavior of control larvae in light/dark cycles showed greater swimming time and distance in dark cycles. Two-day codeine exposure produced strong effects, showing no significant response due to light/dark cycles in distance moved. Morphine exposed groups showed similar effects as observed in 2-day codeine exposed groups, showing less large movement activity and also no significant difference between inactive duration in response to light/dark cycles. In conclusion, we observed low teratogenic effects and mortality effects. Animals exposed to high levels and higher exposure times of opioids were hypoactive, relative to controls, in the dark period. Future studies will be needed to understand the neural defects producing behavior changes.
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Affiliation(s)
- Marilia R Sales Cadena
- Departamento de Biologia (DB), Universidade Federal Rural de Pernambuco, Av. Dom Manoel de Medeiros s/n, 52171-900, Dois Irmãos, Recife, PE, Brazil.
| | - Pabyton G Cadena
- Departamento de Morfologia e Fisiologia Animal (DMFA), Universidade Federal Rural de Pernambuco, Av. Dom Manoel de Medeiros s/n, 52171-900, Dois Irmãos, Recife, PE, Brazil
| | - Meredith R Watson
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202, USA
| | - Swapnalee Sarmah
- Department of Biology, Indiana University - Purdue University Indianapolis, 723 West Michigan Street, Indianapolis, IN 46202, USA
| | - Stephen L Boehm Ii
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, IN 46202, USA
| | - James A Marrs
- Department of Biology, Indiana University - Purdue University Indianapolis, 723 West Michigan Street, Indianapolis, IN 46202, USA.
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Fais P, Pigaiani N, Cecchetto G, Montisci M, Gottardo R, Viel G, Pascali JP, Tagliaro F. “Tampering to Death”: A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation. J Forensic Sci 2017; 62:1671-1673. [DOI: 10.1111/1556-4029.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Fais
- Department of Medical and Surgical Sciences - Unit of Legal Medicine; University of Bologna; Via Irnerio 49 40126 Bologna Italy
| | - Nicola Pigaiani
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Rossella Gottardo
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
| | - Guido Viel
- Legal Medicine and Toxicology; University-Hospital of Padova; Via Falloppio 50 35121 Padova Italy
| | - Jennifer Paola Pascali
- Forensic Toxicology Division; Department of Health Science; University of Florence; Italy
| | - Franco Tagliaro
- Department of Diagnostics and Public Health - Unit of Forensic Medicine; University of Verona; P.le L.A. Scuro 10 Verona Italy
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Frost J, Løkken TN, Helland A, Nordrum IS, Slørdal L. Post-mortem levels and tissue distribution of codeine, codeine-6-glucuronide, norcodeine, morphine and morphine glucuronides in a series of codeine-related deaths. Forensic Sci Int 2016; 262:128-37. [DOI: 10.1016/j.forsciint.2016.02.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
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Roxburgh A, Hall WD, Burns L, Pilgrim J, Saar E, Nielsen S, Degenhardt L. Trends and characteristics of accidental and intentional codeine overdose deaths in Australia. Med J Aust 2015; 203:299. [DOI: 10.5694/mja15.00183] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/31/2015] [Indexed: 01/27/2023]
Affiliation(s)
| | - Wayne D Hall
- University of New South Wales, Sydney, NSW
- University of Queensland, Brisbane, QLD
| | | | | | - Eva Saar
- Monash University, Melbourne, VIC
- National Coronial Information System, Melbourne, VIC
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Lynch KL, Shapiro BJ, Coffa D, Novak SP, Kral AH. Promethazine use among chronic pain patients. Drug Alcohol Depend 2015; 150:92-7. [PMID: 25754939 PMCID: PMC4389782 DOI: 10.1016/j.drugalcdep.2015.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/24/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the "high" from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. METHODS Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. RESULTS The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. CONCLUSIONS The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.
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Affiliation(s)
- Kara L. Lynch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA,Address Correspondence to this author at: University of California San Francisco, San Francisco General Hospital, 1001 Potrero Ave. NH2M16, San Francisco, CA 94110 Phone: 415-206-5477, Fax: 415-206-3045,
| | - Brad J. Shapiro
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA,Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Diana Coffa
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA
| | - Scott P. Novak
- RTI International, Behavioral Health Epidemiology, Research Triangle Park, NC
| | - Alex H. Kral
- RTI International, Urban Health Program, San Francisco, CA
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Van Hout MC. Kitchen chemistry: A scoping review of the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions. Drug Test Anal 2014; 6:778-87. [DOI: 10.1002/dta.1622] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Marie Claire Van Hout
- School of Health Sciences; Waterford Institute of Technology; Cork Road Waterford City Co. Waterford Ireland
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Agnich LE, Stogner JM, Miller BL, Marcum CD. Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures. Addict Behav 2013; 38:2445-9. [PMID: 23688907 DOI: 10.1016/j.addbeh.2013.03.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/05/2013] [Accepted: 03/27/2013] [Indexed: 11/29/2022]
Abstract
A mixture of codeine cough syrup with alcohol and/or a soft drink known as "purple drank" has gained media attention in recent years as a drug associated with professional athletes and southern rap music. The existing research on purple drank consumption has primarily utilized samples of African Americans residing in the Houston, Texas area. This is the first scholarly study of purple drank use outside of the Houston, Texas area among a general population of young adults, and indicates that purple drank use is not limited to African American males. The findings depict higher odds of the use of purple drank among other racial and ethnic groups, males, and homosexual, bisexual, and transgender college students from urban areas.
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Affiliation(s)
- Laura E Agnich
- Department of Criminal Justice and Criminology, Georgia Southern University, P.O. Box 8105, Statesboro, GA 30460-8105, United States.
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Tormey WP, Sabah M, Moore TM. Methadone, codeine and acute haemorrhagic necrotising pancreatitis: which came first? Forensic Sci Int 2013; 226:e52-3. [PMID: 23395525 DOI: 10.1016/j.forsciint.2013.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/09/2013] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
Acute haemorrhagic necrotising pancreatitis lead to the death at home of a young female who was on a methadone maintenance programme. Toxic levels of codeine with potentially lethal levels of methadone and morphine were found at post-mortem. Whether opiates caused the pancreatitis or were the consequence of self-medication for pain is impossible to differentiate. Forensic toxicology may pose the question but be unable to provide the answer.
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Häkkinen M, Launiainen T, Vuori E, Ojanperä I. Comparison of fatal poisonings by prescription opioids. Forensic Sci Int 2012; 222:327-31. [DOI: 10.1016/j.forsciint.2012.07.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/11/2012] [Accepted: 07/22/2012] [Indexed: 10/28/2022]
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Abstract
A variety of neuropathological findings has been described in illicit drug abusers. The majority of these alterations result from the consequences of hypoxia-ischemia and from cerebrovascular diseases. Within the last few years, widespread morphological alterations of the cellular elements of the brain have been detected. These changes consist of neuronal loss, a numerical reduction of astrocytes, widespread axonal damage with concomitant microglial activation and reactive and degenerative changes of the cerebral microvessels. Based on various studies there is also concern that drug abusers develop neurodegeneration or Parkinsonism as they age. However, whether or to what extent neurodegeneration occurs in human drug abusers remains to be established. In the present paper a brief overview on the neuropathological changes in drug abuse is presented for the forensic pathologist/toxi-cologist with reference to the most pertinent literature.
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Affiliation(s)
- Andreas Büttner
- Forensic Pathology and the Director and Chair of the Institute of Legal Medicine at the Medical University of Rostock, Germany. Ethical Commission at the Medical University of Rostock
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12
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Frost J, Helland A, Nordrum IS, Slørdal L. Investigation of morphine and morphine glucuronide levels and cytochrome P450 isoenzyme 2D6 genotype in codeine-related deaths. Forensic Sci Int 2012; 220:6-11. [DOI: 10.1016/j.forsciint.2012.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/03/2012] [Accepted: 01/06/2012] [Indexed: 10/14/2022]
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Gerostamoulos D, Beyer J, Staikos V, Tayler P, Woodford N, Drummer OH. The effect of the postmortem interval on the redistribution of drugs: a comparison of mortuary admission and autopsy blood specimens. Forensic Sci Med Pathol 2012; 8:373-9. [DOI: 10.1007/s12024-012-9341-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
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Hersh EV, Pinto A, Moore PA. Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther 2008; 29 Suppl:2477-97. [PMID: 18164916 DOI: 10.1016/j.clinthera.2007.12.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eight analgesic preparations with approved indications for acute pain were among the top 200 drugs prescribed in the United States in 2006. In addition, an estimated 36 million Americans use over-the-counter (OTC) analgesics daily. Given this volume of use, it is not surprising that a number of drug interactions involving analgesic drugs have been reported. OBJECTIVES This article examines the pharmacologic factors that enhance the clinical relevance of potential drug interactions and reviews the literature on drug interactions involving the most commonly used analgesic preparations in the United States. METHODS A PubMed search was conducted for English-language articles published between January 1967 and July 2007. Among the search terms were drug interactions, acetaminophen, aspirin, ibuprofen, naproxen, celecoxib, NSAIDs, hydrocodone, oxycodone, codeine, tramadol, OTC analgesics, alcohol, ethanol, antihypertensive drugs, methotrexate, warfarin, SSRIs, paroxetine, fluoxetine, sertraline, citalopram, serotonin syndrome, MAOIs, and overdose. Controlled clinical trials, case-control studies, and case reports were included in the review. RESULTS A number of case reports and well-controlled clinical trials were identified that provided evidence of the relatively well known drug-drug interactions between prescription/OTC NSAIDs and alcohol, antihypertensive drugs, high-dose methotrexate, and lithium, as well as between frequently prescribed narcotics and other central nervous system depressants. In contrast, the ability of recent alcohol ingestion to exacerbate the hepatotoxic potential of therapeutic doses of acetaminophen is not supported by either case reports or clinical research. Use of ibuprofen according to OTC guidelines in patients taking cardioprotective doses of aspirin does not appear to interfere with aspirin's antiplatelet activity, whereas chronic prescription use of ibuprofen and other NSAIDs may interfere. Low-dose aspirin intake appears to abolish the gastroprotective effects of cyclooxygenase-2-selective inhibitors, including celecoxib. There is evidence of other less well known and potentially clinically significant drug-drug interactions, including the ability of selective serotonin reuptake inhibitors to inhibit the analgesic activity of tramadol and codeine through inhibition of their metabolic activation, to induce serotonin syndrome when used chronically in the presence of high doses of tramadol through synergistic serotonergic action, and to increase the potential for gastrointestinal bleeding associated with NSAID therapy through additive or supra-additive antiplatelet activity. CONCLUSIONS Considering the widespread use of analgesic agents, the overall incidence of serious drug-drug interactions involving these agents has been relatively low. The most serious interactions usually involved other interacting drugs with low therapeutic indices or chronic and/or high-dose use of an analgesic and the interacting drug.
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Affiliation(s)
- Elliot V Hersh
- Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania 19104-6030, USA.
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Peters R, Yacoubian GS, Rhodes W, Forsythe KJ, Bowers KS, Eulian VM, Mangum CA, O'Neal JD, Martin Q, Essien EJ. Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) use and addiction among multi-ethnic college students. J Psychoactive Drugs 2007; 39:277-82. [PMID: 18159781 DOI: 10.1080/02791072.2007.10400614] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this study a qualitative approach is used to investigate relevant beliefs and norms concerning the consumption, initiation, and perceived addiction of codeine and promethazine hydrochloride cough syrup (CPHCS) among 61 college-age students who identified themselves as current CPHCS users. In general, a majority of students stated that doctors and pharmacists were the greatest facilitators of CPHCS acquisition. A majority of students believed that their friends felt codeine promethazine use was "normal" and "cool" among college students their age, and that reinforcing factors, such as peer pressure and curiosity, contributed to initial CPHCS use.
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Affiliation(s)
- Ronald Peters
- University of Texas School of Public Health, 7000 Fannin Suite 2618, Houston, TX 77030, USA.
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Voronov P, Przybylo HJ, Jagannathan N. Apnea in a child after oral codeine: a genetic variant - an ultra-rapid metabolizer. Paediatr Anaesth 2007; 17:684-7. [PMID: 17564651 DOI: 10.1111/j.1460-9592.2006.02182.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism.
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Affiliation(s)
- Polina Voronov
- Department of Anesthesiology, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Abstract
Conducting toxicology on post-mortem specimens provides a number of very significant challenges to the scientist. The range of additional specimens include tissues such as decomposing blood and other tissues, hair, muscle, fat, lung, and even larvae feeding on the host require special techniques to isolate a foreign substance and allow detection without interference from the matrix. A number of drugs of abuse are unstable in the post-mortem environment that requires careful consideration when trying to interpret their significance. Heroin, morphine glucuronides, cocaine and the benzodiazepines are particularly prone to degradation. Moreover, redistributive process can significantly alter the concentration of drugs, particularly those with a higher tissue concentration than the surrounding blood. The designer amphetamines, methadone and other potent opioids will increase their concentration in blood post-mortem. These processes together with the development of tolerance means that no concentration of a drug of abuse can be interpreted in isolation without a thorough examination of the relevant circumstances and after the conduct of a post-mortem to eliminate or corroborate relevant factors that could impact on the drug concentration and the possible effect of a substance on the body. This article reviews particular toxicological issues associated with the more common drugs of abuse such as the amphetamines, cannabinoids, cocaine, opioids and the benzodiazepines.
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Affiliation(s)
- Olaf H Drummer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 57-83 Kavanagh Street, Southbank, 3006 Melbourne, Australia.
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Büttner A, Weis S. Central Nervous System Alterations in Drug Abuse. FORENSIC PATHOLOGY REVIEWS 2004. [DOI: 10.1007/978-1-59259-786-4_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Peters RJ, Kelder SH, Markham CM, Yacoubian GS, Peters LA, Ellis A. Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) onset and perceived addiction among urban Houstonian adolescents: an addiction trend in the city of lean. JOURNAL OF DRUG EDUCATION 2003; 33:415-425. [PMID: 15237866 DOI: 10.2190/nxj6-u60j-xty0-09mp] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In the current study, we used a qualitative approach to investigate relevant beliefs and norms associated with codeine and promethazine hydrochloride cough syrup (CPHCS) consumption, initiation, and perceived addiction among 48 alternative school students who identified themselves as current CPHCS users. In general, both boys and girls believed that CPHCS addiction started during an individual's initial consumption. A majority of both groups reported that their second CPHCS event was initiated during the same or next day after their first event. Our findings suggest that friends and an innovative form of hip-hop music called "screw" are strong reinforcers of CPHCS use.
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Affiliation(s)
- Ronald J Peters
- University of Texas Health Science Center at Houston, School of Public Health, 77030, USA.
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Abstract
A study of fatal poisoning due to alcohol and drugs was carried out, to examine the mortality resulting from alcohol and drugs in the Greater Amman County, Jordan. A retrospective review of all autopsy records and certified deaths issued by the Department of Forensic Medicine at Jordan University Hospital in the greater Amman county was undertaken. During the 18 years (1978-1996) 6109 postmortem cases were performed in our department. A total of 60 cases were identified and analyzed according to age, race, sex, manner of death of the victims along with blood alcohol concentration, the drug detected at autopsies, the scene circumstances, and the geographic location of the accident and death.
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Affiliation(s)
- S Y Abu-al Ragheb
- Forensic Medicine and Toxicology Division, Faculty of Medicine, University of Jordan, Amman
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