Kitchen chemistry: A scoping review of the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions

Drug Testing and Analysis (Impact Factor: 2.51). 07/2014; 6(7-8). DOI: 10.1002/dta.1622


Misuse of pharmaceuticals is of increasing drug policy and public health concern. A scoping review was conducted on the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions. The research question was broad: What is known from the existing literature about the diversion of pharmaceuticals for non-medicinal use and for home production of drug solutions? The scoping process centred on the systematic selection, collection, and summarization of extant knowledge within this broad thematic remit. One hundred and thirty-four records were grouped into discrete thematic categories namely: non medicinal use and tampering with pharmaceuticals, oral misuse of codeine cough syrups, homemade drug solutions, and home-produced drug-related harms in the narrative review design. Forms of abuse of codeine cough syrup include mixtures with alcohol or soft drinks (‘Purple Drank’), with kratom leaves (‘Kratom cocktails’), or chemically altered to extract dextromorphan (‘Lemon Drop’). Production of homemade opiates (‘Cheornaya’, ‘Kolyosa’, Himiya’, ‘Braun’, ‘Krokodil’), methamphetamine (‘Vint’, ‘Pervitin’), methcathinone (‘Jeff’), and cathinone (‘Boltushka’) are described. Displacement patterns between the non-medical use of pharmaceuticals, commercial, and homemade drugs appear dependent on availability of opiates, prescribing practices, supervision of substitution drug dosing, availability of cheap ingredients, policing, and awareness of harms. Adverse health and social consequences relate to the use of unknown and contaminated (end) substances, injecting practices, redosing, medical complications, and death. The review highlights a public health imperative requiring a multidisciplinary approach to quantify potential impact and required integrated policy responses incorporating international regulation, enforcement, health surveillance and service delivery. Copyright © 2014 John Wiley & Sons, Ltd.

Download full-text


Available from: Marie-Claire van Hout, May 15, 2014
270 Reads
  • Source
    • "Strategies to improve pharmacist counseling and enhance customer engagement in health care advice, screening and brief intervention processes are warranted (Puspitasari, Aslani, & Krass, 2010). Building on codeine specific health care advice, screening and brief interventions, a further expansion in the role of community pharmacies to include harm reduction participation and provision of detoxification programmes for codeine dependents could be considered (Hughes, McElnay, Hughes, & McKenna, 1999; Van Hout et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Misuse of opioid analgesics is an emergent global public health concern. Codeine has an identified abuse liability, given its effect and development of tolerance within a short timeframe on regular or excessive use. Estimation and management of misuse of over the counter (OTC) codeine containing products are hampered by widespread and easy availability and the heterogeneous and hidden nature of misuse. Continued debate around availability centre on increasing evidence of misuse, dependence and adverse health effects associated with presence of non-opioid agents (paracetamol, ibuprofen) in combination products, and lack of evidence of a significant clinical analgesic benefit of combining low dose codeine in OTC products. Limited up scheduling that still enables purchase of codeine products without a prescription, and varied measures of pharmacist intervention at point of sale have not succeeded in curtailing therapeutic and non-therapeutic forms of misuse. This commentary broadly discusses the concepts of medication misuse, codeine's potential for misuse and dependence, characteristics of codeine misuse in general, harms from OTC codeine products in particular, 'unique issues' with OTC codeine products, the problems with scheduling solutions and pharmacy based interventions targeting users, along with the supports needed for these interventions. The recent introduction of new OTC combinations of non-opioid agents which provide greater analgesic efficacy than OTC codeine combination analgesics with no risk of opioid dependence provides a satisfactory alternative to these widely misused products.
    The International journal on drug policy 09/2015; DOI:10.1016/j.drugpo.2015.09.007 · 2.54 Impact Factor
  • Source
    • "The author offers an insightful reminder that the misuse, diversion, tampering, home manufacture, and injecting use of over-the-counter and prescribed medicine are an emerging issue of global importance. [74] Adding to the complexity of the market in 'legal highs' and 'research chemicals' is the sale of new substances as 'dietary supplements'. [5] [6] These products are often widely available on popular e-commerce sites, online health food shops, as well as in fitness equipment shops. "
    Drug Testing and Analysis 07/2014; 6(7-8). DOI:10.1002/dta.1686 · 2.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: "Krokodil" is the street name for the homemade injectable mixture that has been used as a cheap substitute for heroin. Its use begun in Russia and Ukraine and nowadays is being spread over several other countries. Desomorphine is the semi-synthetic opioid claimed to be the main component of krokodil and considered to be responsible for its psychoactive characteristics. The starting materials for desomorphine synthesis are codeine tablets, alkali solutions, organic solvent, acidified water, iodine and red phosphorus, all of which are easily available in retail outlets, such as supermarkets, drugstores, etc. The resulting product is a light brown liquid that is called krokodil. People who inject krokodil present a great variety of serious signs and symptoms, including thrombophlebitis, ulcerations, gangrene, and necrosis, quickly evolving to limb amputation and death. These effects are thought to result from the toxic components produced as byproducts during the homemade drug synthesis. In this work, we reviewed several aspects of krokodil use, including its epidemiology, pharmacology and the chemical properties of the main active ingredient (desomorphine). To enhance our understanding of the clinical and toxic effects and to support the implementation of harm reduction measures, we also describe the "bathtub chemistry" of krokodil and the content of the final solution. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    02/2015; DOI:10.1016/j.forsciint.2015.02.001