RESEARCH ARTICLE
Acta Medica Marisiensis 2016;62(3):309-312 DOI: 10.1515/amma-2016-0031
Could Codeine Containing OTC Analgesics Sold in
Romania be Used as Recreational Drugs?
Croitoru Mircea Dumitru, Fogarasi Erzsébet*, Varga Erzsébet, Chelaru Adelina, Căliman Monica-Simina,
Fülöp Ibolya
University of Medicine and Pharmacy Tirgu Mures, Romania
Objective: Analgesic medicines containing combinations of nonsteroidal anti-inflammatory drugs and codeine are available without prescrip-
tion. Codeine, in these combinations can not be used recreationally due to the high toxicity profile of the nonsteroidal anti-inflammatory drugs.
However, methods for extracting codeine from these types of medication are available on the internet. The purpose of this work is to evaluate
if codeine can be extracted from codeine containing analgesics sold without prescription.
Methods: High Performance Liquid Chromatography (HPLC) with UV detection was used to measure the amounts of codeine and nonste-
roidal anti-inflammatory drugs recovered after applying an extraction method described on the internet.
Results: The results show that codeine can be very easily separated from NSAID as aspirin, acetaminophen, ibuprofen using the cold water
extraction method. However, very large differences (20 to 90%) were recorded for the recovery of codeine depending on the OTC product
that was used. That large difference increases the risk of potentially lethal overdoses when the user switches between “similar” products.
Conclusions: Our work shows that analgesic medication with codeine content can be recreationally used after the extraction of codeine. In
order to prevent this, the sell of this type of products should be regulated or products that do not allow the extraction of codeine should be
developed.
Keywords: codeine, recreational drugs, cold water extraction, HPLC
Received: 28 July 2016 / Accepted: 13 September 2016
Introduction
Pain is a serious disabling condition often associated with
worsening of the health condition. People in pain may
experience greater functional impairment, depression, de-
creased appetite, impaired sleep, social isolation than the
persons that do not experience pain [1]. Pain management
is considered an ethical issue due to the significant discom-
fort that is produced to the individual experiencing it and
every available measure should be taken in order to allevi-
ate pain, regardless that is chronic or acute in nature [2,3].
Most of the time, pain is the sign of an illness and fades
when efficient treatment is used. There are however cases,
when the health condition of the individual cannot be im-
proved or when the cause of the pain is not known as in the
case of many migraines. In such conditions, the only treat-
ment available are the substances able to reduce the ability
of an organism to feel pain: analgesics. There are analgesics
as non steroidal anti-inflammatory drugs (NSAID) and
opioids designed to reduce sensation of pain, but nowa-
days, even substances that were not designed as analgesics
(carbamazepine, antidepressant medication, etc) are some-
times tried [4,5].
One of the most efficient pain medications, used for
moderate to high intensity pain, are the opioids. Unfor-
tunate, even if efficient pain control can be attained, these
substances are prone to induce fearsome psychological and
physical addiction, effect that excludes their use as OTC
medication [6]. Another option to reduce pain intensity
are the NSAIDs, but these substances are also known to
have negative health effects (risk of myocardial infarction,
stroke, gastric bleeding, kidney failure, etc.) especially
when used in high doses for a long time. Due to the lack
of addictive properties, the NSAIDs with low toxicity pro-
file as acetylsalicylic acid, acetaminophen, ibuprofen, etc
are available as OTC pain medication. Combinations of
opioids and NSAIDs are, however, sold in most countries
worldwide as OTC pain medication. This combination has
the advantage of dosage reduction of both components and
high efficiency in reducing low intensity pain. The dosage
reduction greatly increases the safety of the combinations
since the toxicity of opioids and NSAIDs is not overlap-
ping. The presence of the NSAIDs, with high acute toxic-
ity in large doses, prevents the user to increase the dosage
until the recreational dose of the opioid is attained (it is
well known that the recreational dose of an opioid is sig-
nificantly larger than its analgesic dose) [7-9].
The opioid of choice for OTC analgesic combinations is
codeine phosphate, while the NSAID of choice is acetami-
nophen. The NSAID to codeine ratio is too high for a rec-
reational use in these products. However, drug users take
advantage of the low cold water solubility of the NSAID
compared with that of codeine phosphate in order to sepa-
rate the codeine from the NSAID. This way, extracted co-
deine can be recreationally used without the limitations
brought by the significant NSAID’s toxicity in high doses.
The extraction method described in detail on several inter-
net forums (named CWE from cold water extraction) is
* Correspondence to: Erzsébet Fogarasi
E-mail: fogarasi.erzsebet@umftgm.ro
