1. A case of the Codeine phosphate abuser, since the seven years
A case of the Codeine phosphate abuser, since the seven years Aslihan Okan Ibiloglu, Mehmet Gunes, Abdullah Atli, Mahmut Bulut, Mehmet Cemal Kaya, Suleyman Demir, Aytekin Sir
Department of psychiatry, Dicle medicine faculty, Dicle university, Diyarbakir
Objective
Psychoactive drugs are readily available both legally and illegally. Cough mixtures contain drugs that can lead to dependence, tolerance and withdrawal. Codeine phosphate is used primarily as a cough remedy (1). It's usually ingested. Tolerance develops to different degrees across classes of substances, such as opioid and amphetamine users may develop substantial tolerance (2). Withdrawal symptoms are most apparent for opioids, alcohol, and other central nervous system (CNS) depressants (i.e., sedative-hypnotics and anxiolytics). Careful history-taking and checking of medical records can help in identifying patients who may be misusing it. We report here, a codeine phosphate abuser WHO was used in addition to other cold mixtures, approximately seven years. This case study provides knowledge for all doctors in the detection, assessment and management of patients with cough mixture opioid dependence.
Case report
The case was a 24-year-old Turkish single man who was unemployment. He was brought to us by his sister due to the abused codeine phosphate 10 mg 6 times daily in addition to several other drugs for cold symptoms. He had tried other mixtures containing codeine, dextromethorphan, diphenhydramine and promethazine. The patient had started taking cough mixtures seven years ago for cough. He then started taking increasing amounts of cough mixture. He then went from one doctor to another to purchase these cough mixtures. He admitted to being a heavy smoker (3 to 4 packets of cigarettes a day), but denied alcohol, any other substance abuse or past psychiatric history. The patient also admitted to taking cough mixtures containing codeine phosphate in more than the prescribed dosage, but maintained that this was only for the purpose of relieving her cough.
On admission, the results of laboratory tests, physical examination and the findings of cranial magnetic resonance were normal. Although he denied any psychotic or mood symptoms, he appeared depressed with severely anxious but unaware of his addiction problem. Our patient claimed to have intentions to reduce his intake of cough mixture. His father with lower socioeconomic status had been poly-substance abusers in the past.
Conclusion
Action of codeine defined with the binds to opioid receptors in CNS. It may be causes to generalized CNS depression, decreases cough reflex, and reduces GI motility. It should be noted that, toxicity from codeine poisoning includes the triad of; pin-point pupils, depression of respiration, and loss of consciousness. Convulsions may occur. Also, chronic abuse of codeine phosphate could lead to permanent psychological problems such as depressive disorders, toxic psychosis. Early initiation of use of a given drug predicts later abuse of that and other drugs, especially prior to age 15 (3). In literature, a higher proportion of male adolescents use substances than female adolescents, especially at higher levels of use (4). As in our case, most of cough medicines, codeine phosphate’s effectiveness as an antitussive agent is, especially in adults. Therefore, efforts should be taken to raise awareness regarding the abuse potential and adverse effects of this seemingly safe cough suppressant among the general population.
References
1. Blum, K (1984). Handbook of abusable drugs. New York: Gardner Press, 721 pp.
2. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders city, state: publisher. (4th ed.). Washington, DC: Author.
3. Schuckit, MA (1995). Drug and Alcohol Abuse: A clinical guide to diagnosis and treatment (4 th.ed). Newyork. Plenum Medical.
4. Bukstein, OG (1995). Adolescent Substance Abuse: Assessment, Treatment, and Prevention. NY: John Wiley.