possible codeine overdose

[Juicewrldfan]

It appears that many opioids will cause seizures at sufficient doses but it's only the very weak ones where people won't die due to respiratory arrest long before a plasma level sufficient to produce seizures is reached.

Dextropropoxyphene is the infamous example and it's a known problem with pethidine (the latter due to accumulation of a metabolite). Tramadol is another one

African-Americans represent one group who are statistically much more likely to be super metabolizers. Codeine produces what is termed a 'depot' effect. Most people cannot slowly dose on codeine over hours. The body quickly stops producing the enzyme that converts it to morphine except in such groups. It's worth noting that quite a few quite famous African-Americans have died due to overdoses of codeine and/or hydrocodone (lean) or tramadol.

Ahhh that makes much more sense. Thank you for taking the time to explain it. I never realized that about opiates but it makes sense why I never seen anyone seize from opioids/opiates before.

 

[AlsoTapered]

Yeah, in a strange way the weaker opioids pose a significant risk because people are mostly unaware.

There have been various conspiracy theories concerning people like Lester Bangs, ODB and others along the lines of 'well, I've taken LOADS of <insert name of drug(s)> and I'm FINE' which is what is technically referred to, ironically, as 'survivorship bias'.

That's why I will never inform a fellow BLer that a drug will not harm them. I may state (and provide evidence for) the risk being statistically low but again and again I see that same bias with people posting 'well I did X and I'm fine' without considering that people who weren't fine are often no longer in a position to point out the fact.

 

[chippermonk]

Note that on average the ceiling dose of codeine is somewhere between 300-400mg. Beyond that dose, no more will be metabolized,

So those rare cases of fatal overdoses were people who were super-metabolizers, people who mixed codeine with other CNS depressants OR people who took doses sufficient to cause seizures. Above 600mg seizures become a hazard but the references I found detailing fatal codeine overdoses were talking about very large doses indeed.

As a side-note, Doriden (gluetehimide), an old hypnotic medication was found to a CYP2D6 inducer (a VERY rare action) and if taken with codeine, it increased metabolism from 8% to about 50%. Doriden was removed from the market because '4s and Dors' (Tylenol #4 taken with glutethimide) was responsible for a lot of accidental overdoses.

If someone were able to find a CYP2D6 inducer that itself had no psychoactive effects, it would be of great utility in medicine and an extremely interesting RC. Glutethimide is chiral and identifying which enantiomer is the more potent CYP2D6 inducer would be of value.

I have a couple ancient doridens around and have been wondering how I might put them to use without self-harming. I have read that glutethimide but can't really figure what that would mean for me in practical terms. I have no opioid tolerance so I am cautious. My understanding is that the way codeine gets you high is strictly by it being converted by the CYP2D6 into morphine, which Doriden induces. I'm sure it isn't as simple as this, but how much morphine results from a 30 mg codeine tab if you take doriden? The other complicating factor is that Doriden is a fairly potent downer, I gather, which is a risky thing in and of itself when combined with opioids. I actually used to dislike things like barbituates and quaaludes because they made me sedated for 24 hours, not a sensation I am looking for. I'm thinking perhaps to just take 1/4 a Doriden with some codeine but that's just a guess on my part. Also, does it work with oxycodone or hydrocodone?
The other factor is that I think I must naturally be pretty good at metabolizing codeine because in the past it gave me a pretty nice buzz.
Thanks

 

[emkee_reinvented]

I have a couple ancient doridens around and have been wondering how I might put them to use without self-harming. I have read that glutethimide but can't really figure what that would mean for me in practical terms. I have no opioid tolerance so I am cautious. My understanding is that the way codeine gets you high is strictly by it being converted by the CYP2D6 into morphine, which Doriden induces. I'm sure it isn't as simple as this, but how much morphine results from a 30 mg codeine tab if you take doriden? The other complicating factor is that Doriden is a fairly potent downer, I gather, which is a risky thing in and of itself when combined with opioids. I actually used to dislike things like barbituates and quaaludes because they made me sedated for 24 hours, not a sensation I am looking for. I'm thinking perhaps to just take 1/4 a Doriden with some codeine but that's just a guess on my part. Also, does it work with oxycodone or hydrocodone?
The other factor is that I think I must naturally be pretty good at metabolizing codeine because in the past it gave me a pretty nice buzz.
Thanks

How bout taking the Doriden/ Glutethimide by itself.

Then we have an actual experience on its sedative effect's. Which I am very curious about. But according to AlsoTapered 30 mg Codein with Doriden will yield around 15 mg Morphine. Don't forget the sedative effect's of Glutethimide will also be there.

 

[AlsoTapered]

I've never tried Doriden but as I understand it, it's action is similar phenobarbitone but onset and duration are much shorter.

What is a shame is that their is very little information on the class. Ciba developed glutethimide (Doriden) in the 1950s but the named inventors (Hoffmann K, Tagmann E) only published about the class for two years. I suggest it's because they discovered that one of the 3-substituents had to be a benzene ring thus their was very limited scope for analogues.

Helvetica Chimica Acta vol. 35 iss. 4 pp.1235—1249 Über Alkylenimin-Derivate. 1. Mitteilung. Über in 3-Stellung basisch substituierte Pyrrolidin-, Piperidin- und Hexamethylenimin-Derivate DOI: 10.1002/hlca.19520350420 a a	E. Tagmann; E. Sury; K. Hoffmann		1952 Kann 02		German;English
	Helvetica Chimica Acta vol. 35 iss. 5 pp.1541—1548 Über Alkylenimin-Derivate. 2. Mitteilung DOI: 10.1002/hlca.19520350516 a a	E. Tagmann; E. Sury; K. Hoffmann		1952 August 01		German;English
	Helvetica Chimica Acta vol. 35 iss. 6 pp.2016—2022 Über die Darstellung von basischen Estern V DOI: 10.1002/hlca.19520350631 a a	K. Scholz; M. Spillmann; E. Tagmann; K. Hoffmann		1952 August 01		German;English
	Helvetica Chimica Acta vol. 36 iss. 7 pp.1809—1815 Über Aklylenimin-Derivate. 3. Mitteilung. 2,6-Dioxo-tetrahydro-pyridine DOI: 10.1002/hlca.19530360718 a a	E. Urech; E. Tagmann; E. Sury; K. Hoffmann		1953		German;English
	Helvetica Chimica Acta vol. 37 iss. 1 pp.185—190 Über Alkylenimin-Derivate. 6. Mitteilung. Über die partielle Reduktion von cyclischen Imiden DOI: 10.1002/hlca.19540370122 a a	E. Tagmann; E. Sury; K. Hoffmann		1954		German;Englis

They even tried the 3,3-diphenyl homologue but evidently they were tasked with finding a reasonable Seconal alternative, did so and did no further research.

I was truly amazed to discover how limited the patent was and that no further patents were issued. I suggest that glutethimide as a drug represents an 'island of activity' ALTHOUGH I strongly suspect that replacing the ethyl with an allyl in an analogous manner to:

Phenobarbitone --> Phenallylal

Would be active ALTHOUGH glutethimide is chiral and nobody has ever compared the two isomers for relative activity. It COULD be the case that one isomer of glutethimide is inactive. Certainly the isomers are metabolized differently and at different speeds but their is just SO LITTLE research.

It's very frustrating!

 

[paranoid android]

I got the hives once from taking to much codeine. I thought i was going to have to go to the er but i was fine after some antihistamines

 

[AlsoTapered]

Indeed - codeine is noted for producing a histamine response.

I believe that it why it's considered very dangerous to IV codeine.

Codeine induces human mast cell chemokine and cytokine production: involvement of G-protein activation

Activation of mast cells and the systemic release of histamine are common side effects of opiates such as codeine and morphine. In some individuals, codeine not only elicits a sizable early response due to mast cell degranulation, but can also lead to ...

www.ncbi.nlm.nih.gov

Some people mix antihistamines with codeine to increase the subjective effects but it's not without it's own risks.

 

[Toon Army]

As others have said, It is very unlikely that you are in the not in the clear. I understand that codeine is a prodrug so maybe takes some time to hit but man it’s been hours right?

I’m sure you’re good.

Also, my statement that you referenced was in regards to what took out juice wrld. And I didn’t think you were intentionally trying to OD at all or at any point.

Just wanted to clarify that

Edit: also codeine is such a weak opi. If it’s not working for you kratom will if that’s currently where your tolerance is.

Kratom is stronger than morphine and codeine converts to morphine so I would think that Kratom might actually work better for you in this circumstance. But this is just conjecture. Much safer too. Uses. Different pathway to activate the opioid receptors so very very extremely unlikely to cause respiratory depression AKA classic OD. Usually what happens when ppl die from OD on opioids/opiates.

Idk. Just saying if you’re in extreme pain again which I gather you will be, maybe give kratom a shot? I don’t always recommend kratom but man if my tolerance was at where codeine got me right I’d be all over kratom.

Hi Juicewldfan, Yep there is different levels of pain, I had to go out yesterday and do christmas shopping and I know today is going to be bloody awful. I have never heard of Krakom, is this forum just in the UK? Anyway, I didn't wake up dead, but I've never been so scared. Thanks for replying

 

[AlsoTapered]

https://www.rcpsych.ac.uk/docs/default-source/events/2023/faculties/addictions-faculty-2023/posters-2023/calc---dr-c-cross-poster---addictions-2023.pdf?sfvrsn=f93c06b1_4

As the article notes - kratom is technically illegal in the UK under the PSA act although I don't think anyone has ever been charged for possession because it's arguable that it would fall within the 'Medicinal Product' loophole and would then fall through the 'Medicinal Products Act' by being defined as a 'Traditional Herbal Medicine'.

I don't think simple possession is a crime anyway but kratom contains opiates. Opiates can make useful servants but terrible masters.

 

[crazyhairman]

Did the tablets also contain Tylenol? If so you run a very serious risk of liver failure at those doses.

I used to take Tylenol 4 tablets and use the cold water extraction to limit the amount of stress on my liver. I'd make a batch of 10 . So roughly 600 mg in a bottle. Sip on that throughout a weekend. Throw back a few benzodiazepines. I was a wreck for that whole year and a half. I cannot tell you the amount of times I woke up gasping for air knowing I wasn't breathing.

Why we do the things we do to is beyond me.