Why is opioid addiction almost absent in countries with OTC opioids but rampant in the west?

[Deleted member 545227]

Yeah, I haven't had any codeine to get high on in forever, but I always found it to be very euphoric. Worse headache afterwards by a long shot than other opi pills, though

Don’t

 

[4DQSAR]

Yeah I heard they kept a log just bc they were worried ppl were changing the codeine syrup to krokodil somehow..but yeah..my mom n pop store caught on quickly, especially after covid when no one could wear a mask anymore lol. They were like, we will need a note from your doc...

For a 4 fluid oz of cherry syrup codeine gtfo! I would continue looking but forget it, I want the OTC tablets to become available like forever ago damnit!!@

As I mentioned, I'm unsure how one would isolate the codeine phosphate from the syrup. Was there a second active drug in that syrup or is the glycrol that make the syrup syrupy considered to be a second active (to make it a 'compound medication').

I'm sure it's possible if one were able to smurf enough syrup but a sacond active and especially one that is basic (amine containing) would pose a challange.

I seem to recall that the case report suggested that it was likely the classic (but terrible) RP/I route was used. It CAN be used as long as you clean your product but on the scales involved, I suggest mechanical losses would have made purification unattractive.

The brighter people figured out that it was the RP that results in phosphoramides being side-products so avoid it.

 

[helpingout]

As I mentioned, I'm unsure how one would isolate the codeine phosphate from the syrup. Was there a second active drug in that syrup or is the glycrol that make the syrup syrupy considered to be a second active (to make it a 'compound medication').

I'm sure it's possible if one were able to smurf enough syrup but a sacond active and especially one that is basic (amine containing) would pose a challange.

I seem to recall that the case report suggested that it was likely the classic (but terrible) RP/I route was used. It CAN be used as long as you clean your product but on the scales involved, I suggest mechanical losses would have made purification unattractive.

The brighter people figured out that it was the RP that results in phosphoramides being side-products so avoid it.

Amazing

Managed to kick my 7oh habit. I think. It’s been five long days.

 

[Opana313]

Well I was just gulping the whole thing down but yeah also had that expectorant that starts with a g...which had shit side effects but this was back in the day like maybe 7 years back.
I think you need a script for that weak ass bottle nowadays.

 

[chippermonk]

Well I was just gulping the whole thing down but yeah also had that expectorant that starts with a g...which had shit side effects but this was back in the day like maybe 7 years back.
I think you need a script for that weak ass bottle nowadays.

You get side effects from guafensin? I never realized that

 

[4DQSAR]

Guaifenesin doesn't contain a basic nitrogen so that would not be problematic.

I suggest that fact that it is, well, syrupy that would make it a bit of a mess to work with.

I checked and codeine freebase is insoluble in cold water.

Which poses a bit of a conundrum. You need to heat the syrup to make it thinner so you can filter it, but codeine freebase is slightly soluble in boiling water.

The more I learn, the more I recognize that likely someone has figured out a way to do it... and sensibly aren't telling others.

 

[gymguy30]

This is something I’ve thought about a lot. I’ve been to several different countries — not the whole world, but enough to get a good look at how things work elsewhere — and it honestly blew my mind how in some places, you can walk into a pharmacy and get Tramadol, Codeine, Oxycodone, Percocet, Xanax, Valium, Klonopin — you name it. They got it. No script, no interrogation. Just right there on the shelf.


And I’m not just saying that from something I read online — I’ve seen it firsthand in multiple countries. Let’s just say I was… thoroughly observant. And despite all of that access, they’re not dealing with the insane levels of overdose deaths like we are in the U.S. It’s night and day.


So what’s the difference?



1. Culture plays a massive role


In a lot of those countries, people don’t treat these meds like party drugs. They use them responsibly, for actual pain, anxiety, or sleep issues. They’re not taking 6 bars and washing it down with liquor or snorting 80s for fun. There’s less of that reckless attitude around substances in general.


2. The U.S. has deeper problems — economic and emotional


Let’s be real. When you’ve got entire regions that’ve been stripped of jobs, purpose, and community, people are going to self-medicate. It’s not just about getting high — it’s about trying to feel normal in a life that feels unbearable. That desperation doesn’t hit the same way in a lot of other countries.


3. The system here created the demand, then criminalized it


Doctors handed out opioids and benzos like they were Tylenol for years. Then when everything hit the fan, they yanked them back — no tapering, no support, nothing. So people turned to the streets. And what they got was fentanyl, pressed pills, and overdoses.


4. Over-regulation made things worse


Banning access doesn’t erase the need. It just makes people desperate. Meanwhile, in other places where the real thing is cheap and easy to get, you don’t see fentanyl-laced everything. There’s no black market problem because there’s no reason to make one.


And I’ll be real with you — I 100% believe that some people genuinely need daily opioids or daily benzos.


Not everybody, not most people — but some. Whether it’s for severe chronic pain, panic disorders, trauma, or whatever else — there are people out there who need these meds just to function. The system acting like anyone who takes them daily is automatically an addict is part of the problem.


Bottom line: It’s not the drugs. It’s how they’re used, why they’re used, and the environment people are in. The U.S. has a cultural, economic, and medical mess that goes way deeper than pills. That’s what’s killing people — not just the meds themselves.

 

[Opana313]

You get side effects from guafensin? I never realized that

Well for the fuck hard head naive ignorant kids just lurking. I wasn't always able to get straight dextromethorphan when it came to dxm syrup trippin neither or..but yeah of course this guaifenesin is just something we have to tolerate, but you know this already.. I don't know why you pressing me anyway fool. Because I'm a fool, SHIT we all are. Anyway yeah just like promethazine sum asses thought that was WHAT YA WANTED flaunt that promethazine!

Guaifenesin doesn't contain a basic nitrogen so that would not be problematic.

I suggest that fact that it is, well, syrupy that would make it a bit of a mess to work with.

I checked and codeine freebase is insoluble in cold water.

Which poses a bit of a conundrum. You need to heat the syrup to make it thinner so you can filter it, but codeine freebase is slightly soluble in boiling water.

The more I learn, the more I recognize that likely someone has figured out a way to do it... and sensibly aren't telling others.

Yeah I'm way out the loop but I recall a tweaker back in like early year 2000 saying if you tie a rope round bottle neck of robotussin and spin the fuck out of it, to seperate? Somehow?(maybe more to this as well, I don't know, could be bs) soo is this what they call centrifuge? Maybe idk shit for chemistry, or if this relates to codeine syrup or anything at all.

I'm not trying to figure out a recipe hope nobody gets pissed..I don't even give a f*** lol but I like your enthusiasm.

 

[Opana313]

This is something I’ve thought about a lot. I’ve been to several different countries — not the whole world, but enough to get a good look at how things work elsewhere — and it honestly blew my mind how in some places, you can walk into a pharmacy and get Tramadol, Codeine, Oxycodone, Percocet, Xanax, Valium, Klonopin — you name it. They got it. No script, no interrogation. Just right there on the shelf.


And I’m not just saying that from something I read online — I’ve seen it firsthand in multiple countries. Let’s just say I was… thoroughly observant. And despite all of that access, they’re not dealing with the insane levels of overdose deaths like we are in the U.S. It’s night and day.


So what’s the difference?



1. Culture plays a massive role


In a lot of those countries, people don’t treat these meds like party drugs. They use them responsibly, for actual pain, anxiety, or sleep issues. They’re not taking 6 bars and washing it down with liquor or snorting 80s for fun. There’s less of that reckless attitude around substances in general.


2. The U.S. has deeper problems — economic and emotional


Let’s be real. When you’ve got entire regions that’ve been stripped of jobs, purpose, and community, people are going to self-medicate. It’s not just about getting high — it’s about trying to feel normal in a life that feels unbearable. That desperation doesn’t hit the same way in a lot of other countries.


3. The system here created the demand, then criminalized it


Doctors handed out opioids and benzos like they were Tylenol for years. Then when everything hit the fan, they yanked them back — no tapering, no support, nothing. So people turned to the streets. And what they got was fentanyl, pressed pills, and overdoses.


4. Over-regulation made things worse


Banning access doesn’t erase the need. It just makes people desperate. Meanwhile, in other places where the real thing is cheap and easy to get, you don’t see fentanyl-laced everything. There’s no black market problem because there’s no reason to make one.


And I’ll be real with you — I 100% believe that some people genuinely need daily opioids or daily benzos.


Not everybody, not most people — but some. Whether it’s for severe chronic pain, panic disorders, trauma, or whatever else — there are people out there who need these meds just to function. The system acting like anyone who takes them daily is automatically an addict is part of the problem.


Bottom line: It’s not the drugs. It’s how they’re used, why they’re used, and the environment people are in. The U.S. has a cultural, economic, and medical mess that goes way deeper than pills. That’s what’s killing people — not just the meds themselves.

Bro I think you nailed it prohibition creates hustle too which makes sense, if the economy wrecked it, then ppl will use these criminalized substances because it's a gold mine available.

 

[4DQSAR]

More and more nations are now applying the UNODC list although the de jure law and de facto law MAY differ significantly. If someone is poor and lives in an isolated village, likely their is no doctor or at least no FREE doctor, pharmacists are the place where people go for medical advice.

Certainly culture is a part of it but so is poverty. The price of medicines puts a severe strain on the majority of people on the planet.

 

[chippermonk]

More and more nations are now applying the UNODC list although the de jure law and de facto law MAY differ significantly. If someone is poor and lives in an isolated village, likely their is no doctor or at least no FREE doctor, pharmacists are the place where people go for medical advice.

Certainly culture is a part of it but so is poverty. The price of medicines puts a severe strain on the majority of people on the planet.

There is also a widespread problem of counterfeit drugs or poor quality substandard "official" generics made in countries like India which are sold all over the world for cheap. It's all that a lot of people can afford but they aren't necessarily effective or what they are advertised as.
I got some 30 mg codeine cold formulation capsules in a pharmacy once in a small Peruvian town and I'd be willing to bet they had zero codeine because I'm sensitive to codeine normally and I felt nothing. But I imagine if I had to gone to a more upscale pharmacy, say in Lima, that I could have gotten better quality. ( I never tried getting any other formulations other than the codipront, though)

 

[4DQSAR]

There is also a widespread problem of counterfeit drugs or poor quality substandard "official" generics made in countries like India which are sold all over the world for cheap. It's all that a lot of people can afford but they aren't necessarily effective or what they are advertised as.
I got some 30 mg codeine cold formulation capsules in a pharmacy once in a small Peruvian town and I'd be willing to bet they had zero codeine because I'm sensitive to codeine normally and I felt nothing. But I imagine if I had to gone to a more upscale pharmacy, say in Lima, that I could have gotten better quality. ( I never tried getting any other formulations other than the codipront, though)

I could never work out why Indian generics are so dubious. In bulk diazepam is only $100-$600/Kg. I SUSPECT that the generic manufcturers tender for the cheapest price for the pilling process to others so they make a million that are just slightly under the stated dose (but within the accepted range) and then make another million to sell on the black marker.

Peru I don't know. Brazil used to be interesting if only because there were and still are some medicines unique to that nation. Viminol used to be a [P] medication but is now [POM] although how would they even recognize a UK prescription? So who knows?

But the only medication I consume is that which I am prescribed and even then, I open each box in the pharmacy and count them. Mistakes can happen, I know the staff so know it would never be intentional.

IF someone ever offered me anything else, unless it comes with instrumental an instrumental analysis, I won't touch it. No chemical is so good that it's worth dying for.