Mustafa ÖZCAN, Faruk AŞICIOĞLU, Mustafa OKUDAN, Sefa SAYGILI, Latif İLHAN, Mustafa IRAZ

KODEİN VE KODEİN İÇEREN TIBBİ MÜSTAHZARLAR HAKKINDAUZMAN GÖRÜŞÜ

Kodein (3 metil morfin) bir opiatolup analjezik, antitüssiv, antidiareikve diğer bazı tıbbi amaçlariçin kullanılabilmektedir. Afyonda(Papaver somniferum) bulunanalkoloidler içerisinde morfindensonraki en baskın opioiddir ve%3 oranında bulunur. Ülkemizdeanaljezik olarak paracetamol(Aferin kapsül, Geralgine K tablet),asetilsalisilik asit (Dolvirantablet) ve nonsteroidantienflamatuarlarla(Nurofen Plus) birliktekombine olarak kullanılmaktadır.Birleşmiş Milletler TekSözleşmesi'nin eki listelerden IInolu listede (UN 61 Single Convention- Schedule II ) yer almaktadır.Bu nedenle tıbbi kullanımıhariç, sözleşmeye tarafher ülkede üretimi, ithali, ihracı,bulundurulması ve kullanımı yasaklanmıştır.İllegal olarak tabletveya toz formunda, tek başınaveya diğer uyuşturucu ve uyarıcımaddelerle birlikte satılmaktadır.Kodein içeren medikal preparatlarda suiistimal edilmektedir.Kodeinli öksürük şurubu, enerjiiçeceği ve şeker ile hazırlananve özellikle hip hop camiası arasındayaygın olan argo kullanımda"Purple Drunk" adlı içecek enönemli suistimal maddelerindendir.Kodein ile ilişkili ölümler konusundayapılmış 107 olguluk birçalışmada, vakaların 101 adedinintoksikolojik analizinde kodeine%62 oranında asetaminophen,%20 oranında salisilatın eşliketmekte olması kodein içerenilaçların suiistimalini ortaya koymaktadır.Tıbbi müstahzarlarıniçerisinde yer alan kodeinin kö-tüye kullanımında, preparatlarıniçerisindeki kodein miktarının azolması nedeni ile ilaç fazla miktardaiçilmektedir. Bu durumbireyi söz konusu müstahzarıniçerisinde bulunan parasetamol,asetil salisilik asit gibi diğer ilaçetken maddelerinin toksik etkisiile karşı karşıya bırakmakta vegastrointestinal kanama, renaltubüler asidoz ve sensorinöralişitme kaybına neden olmaktadır.Bu yan etkilerden kaçınmayı bilendeneyimli kullanıcılar, sosyalmedya aracılığı ile tıbbi müstahzarlardabulunan diğer maddelerdenkodeinin nasıl kolayca ayrılacağınıaçıklayarak deneyimsizdiğerlerini bilgilendirmektedir.Önerilen metot soğuk su ekstraksiyonuolarak adlandırılmaktadır.

EXPERT OPINION ON CODEINE AND CODEINE CONTAINING DRUGS

Codeine (3-methylmorphine) isan opiate used for analgesic, antitussive,antidiarrheal and someother medical purposes. It is thesecond-most predominant alkaloidin Papaver somniferum, at up tothree percent. Codeine is used asan analgesic in a combinated formwith paracetamol (Aferin capsule,Geralgine K tablet), acetylsalicylicacid (Dolviran tablet), andnonsteroidal anti-inflammatorydrugs (Nurofen Plus) in Turkey.Codeine is listed at appendixSchedule II under the 1961 UnitedNations Single Convention onNarcotic Drugs. For this reasonit's production, manufacture, export,import, possession or useexcept for medical purposes isprohibited at all signatory countries.It is illegally sold pure or incombination with other psychotropicsubstances at the form oftablet or powder. Medical preparationscontaining codeineare also abused. "Purple Drunk"slang termed drink which is especiallypopular in hip hop communityand prepared with codeinecontaining cough syrup, energydrink and candy is one of the mostimportant recreational drugs.The fact that codein was detectedin toxicological analysis of 101 casestogether with acetaminophen(62%) and salicylate (20%) in a researchof 107 cases on codeinerelateddeaths reveals the abuseof codein containing medical preparations.In the abuse of codeinecontaining medical drugs, largeamounts are ingested due to lowcodein concentration of preparations.This fact confronts the individualwith toxic effects of otheractive medical substances suchas paracetamol or acetylsalicylicacid found in these preparationsand causes gastrointestinalbleeding, renal tubular acidosis,and sensorineural hearing loss.The experienced users who knowto avoid these side effects informthe less experienced others bymeans of social media, explaininghow to easily separate codeinefrom other ingredients of medicalpreparations. The recommendedmethod is called "cold water extraction".

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