Codeine alcohol
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Codeine and Alcohol: Interactions, Misuse, and Implications
Codeine and Alcohol Absorption
Codeine's Impact on Alcohol Absorption
Research has shown that codeine phosphate syrup can significantly reduce the absorption of alcohol in the bloodstream. In a study involving six subjects, pretreatment with codeine phosphate syrup led to lower maximum blood alcohol levels and a reduced area under the blood concentration-time curve, suggesting that codeine's pharmacological action on the stomach diminishes ethanol absorption1.
Codeine Misuse and Alcohol
Social Media and Codeine Misuse
The misuse of codeine, particularly in combination with alcohol, has been widely documented on social media platforms like Instagram. Analysis of posts revealed that codeine is often consumed with soda (known as "lean" or "purple drank") and alcohol, glamorizing its use and potentially normalizing this dangerous behavior4. This trend is further perpetuated by its association with hip-hop culture and mainstream media, which can increase the risk of misuse and overdose5.
Demographics of Codeine and Alcohol Misuse
Studies indicate that the misuse of codeine cough syrup mixed with alcohol is not confined to a specific demographic. While initially associated with African American communities in Houston, Texas, recent research shows that this practice is prevalent among various racial and ethnic groups, including males and LGBTQ+ college students from urban areas7.
Clinical Implications of Codeine and Alcohol Use
Addiction and Recovery
The use of codeine in individuals recovering from addiction, including alcoholism, poses significant risks. Codeine can sustain addiction or trigger relapse in recovering addicts. Therefore, it is crucial to consider alternative treatments for pain or cough in these patients and to prescribe codeine cautiously if necessary, ensuring robust support from the patient's recovery network2.
Effects on Cognitive and Motor Functions
The combination of codeine and alcohol can severely impair cognitive and motor functions. Studies on simulated driving have shown that codeine increases the number of collisions and neglected instructions, with alcohol exacerbating these effects. This combination poses a significant risk to activities requiring alertness and coordination, such as driving3.
Conclusion
The interaction between codeine and alcohol has multifaceted implications, from reduced alcohol absorption to increased risks of misuse and addiction. The glamorization of codeine-alcohol mixtures on social media and their widespread misuse across diverse demographics highlight the need for targeted public health interventions. Clinicians must exercise caution when prescribing codeine to individuals with a history of addiction, and further research is essential to fully understand and mitigate the risks associated with codeine and alcohol use.
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Most relevant research papers on this topic
The effect of codeine phosphate on the absorption of ethyl alcohol.
Codeine phosphate syrup significantly reduces alcohol absorption, potentially due to its pharmacological action on the stomach.
Non-RCTSafe Use of Codeine in the Recovering Alcoholic or Addict
Codeine use in recovering addicts may sustain addiction or increase the risk of relapse, so cautious prescribing and reliance on recovery support networks are crucial.
Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving
Codeine 50 mg and diazepam 10 mg increase collisions and neglectfulness in simulated driving, with diazepam enhancing the effect of alcohol.
Non-RCT
Highly CitedRepresentations of Codeine Misuse on Instagram: Content Analysis
Codeine misuse on Instagram is often glamorized, combined with alcohol, cannabis, and benzodiazepines, and linked to mainstream popular culture imagery.
Observational Study“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications
"Purple drank" is a popular drug among rap singers, with a heterogeneous diffusion and is not exclusive to African-American teenagers, athletes, and rappers.
Systematic ReviewNovel analgesics and molecular rearrangements in the morphine-thebaine group. 3. Alcohols of the 6,14-endo-ethenotetrahydrooripavine series and derived analogs of N-allylnormorphine and -norcodeine.
Demethylation of codeine derivatives to morphine analogs can produce extremely potent analgesics, up to 12,000 times that of morphine.
Highly CitedPurple drank prevalence and characteristics of misusers of codeine cough syrup mixtures.
Purple drank use is not limited to African American males, but is more prevalent among other racial and ethnic groups, males, and homosexual, bisexual, and transgender college students from urban areas.
Observational StudyHighly CitedOrofacial antinociceptive effects of perillyl alcohol associated with codeine and its possible modes of action.
Perillyl alcohol combined with codeine shows orofacial antinociceptive activity, potentially due to its interaction with glutamate receptors.
RCT
Animal StudyThe chemistry of Anderson’s test for codeine
The Anderson test for codeine involves a complex series of reactions, involving salt formation, nitrate formation, molecular rearrangement, and methylamine evolution.
A prospective cohort study evaluating the impact of upscheduling codeine in Australia among frequent users of codeine.
Rescheduling codeine in Australia significantly reduced codeine use and opioid use disorder prevalence rates without adverse impacts on pain or anxiety and depression.
Observational Study
Rigorous Journal