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Codeine and CWE Megathread - The long awaited!

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are u sure ya just talking about just the small amounts of Ibuprofen & apap that are soluble & get into ya cwe or are and not talking about when u take over the recommended doses occasionally over time? yes, I am 100% on that and I think I might have posted links that cover it previously in this thread.
oh ok ya talking about the recommended dose. the cwe gives alot less than the recommended dose though No, I think it is safe to assume that damage will be done to the gastro intestinal tract with varying degrees of severity from drinking a CWE made from N+. I am not going to try to comment on the dose of ibuprofen in your specific CWE, I CWE'd generic N+ for several months every day and I am quite convinced I was taking a significant dose of ibu with each CWE. There was a discussion about the actual effectiveness of CWE a little while back in this thread.

I know someone who is prescribed 800mg Ibuprofen tablets to take daily for a bad back.
fucking drs. they think a codeine addiction is worse than gastric and duodenal ulcers

what do u think should be precribed for on going mild pain issues?
I think a low dose of tramadol is appropriate
I actually dont think panadeine forte is a good idea. they wanted to put me on that for 6 months while waiting to get my wisdom teeth out. i cant remember correctly but I think they wanted me to take 4 a day & were more concerned about the codeine addiction than the apap. ofcourse I chose to take tramadol instead because ive been educated about how harmful apap is in the long-term unlike most the drs ive met

I was getting minor stomach aches for a while. I get a script for a drug called pariot. ive also had nexium before. they are proton pump inhibitors. they are given to ppl with stomach ulcers. i havnt been diagnosed with stomach ulcers. they just give it out for stomach aches too. it stops the production of acid & helps ya stomach heal itself. works alot better than an antacid.
there's no harm in taking PPIs so if anyone out there gets stomach aches, even sometimes it would probably be a good idea to get a script even just to take for a few weeks. (I only had to take it for a couple of weeks before it went away)

u dont have to be using ibuprofen regularly to get stomach ulcers. drinking and other drugs can cause them to. even a bacteria disease can cause it

I also take milk thistle now. i was talking about that earlier on. a strong antioxidant for ya liver.

the hydralyte electrolyte drinks u get from the pharmacy a really good too for dehydration.

fiber supplements like metamucil are also good. they help constipation & diarrhea. nearly everyone doesnt have enough fiber in there diet

Another good supplement i take is valium :)

The severity of damage will depend on the dose, dose frequency and the resilience of the individual CWE drinker's gut. There will be an innate level of resilience the corrosive effects of ibuprofen/NSAIDs on the gut lining which varies from person to person probably has to do with the strength and integrity of the gut. Any existing disease of the gut lining will obviously reduce resilience as well. For example my ex always had sensitive guts and could never take even half an ibuprofen dose with trouble but I could take it with no issues expcept maybe a slight funny feeling in my stomach for several hours. At fist at least but when I started with CWE N+ my guts slowly started to change for the worse.

There are some things that we can do to enhance the resilience and reduce the damage done **reduce not eliminate. such as not taking it on an empty stomach.

Antacid
Ibuprofen/NSAIDs inhibit the ability of the stomach lining to secrete a protective layer of mucous which is the only barrier between it and the corrosive digestive juices of the stomach. This means that for the duration of ibuprofen's effect the highly acidic digestive juices of the stomach have an increased/increasing level of access to the stomach lining and in the weakest points of the mucous barrier digestive juices will start to eat away at the lining, producing an ulcer initially and a perforated ulcer with time. Using ant acids at regular intervals for about 12 hours (length of ibuprofen's effect) you might be able to decrease the acidity of your stomach and decrease the damage done to the stomach lining on exposure.
Things that coat and soothe the gut wall are good to like chamomile tea and slippery elm bark powder. Ask at the health food store.
 
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Does anyone have any links to studies that were done on long term users of either Paracetamol or Ibuprofen? Would be curious to see the long term studies as it is quite worrying. Been doing CWE's for few years now min 2-3 times a week now days.
 
AFAIK blood tests do can indication of kidney health. Similar to testing for liver function.

As part of my detox thing I did I had to do a 24hr urine sample (every time I had to urinate I had to piss in a big bottle) that gets analysed for certain things. Pretty sure that would show up any kidney deficiencies (I hope anyway). My liver was really good and I think I remember him saying my kidneys were too, but Im not 100% certain on that. Touch wood.

I might look into it.
 
i recently had a bad experience. dosage was;

T 0:00 - 400mg codeine - feel good
T 3:00 - 3 shots, and 3 beers over 2 hours - feel good
T 8:00 - 20mg valium
T 9:00 - FOOD (small amount of roast chicken with gravy, and some salad)
T 9:30 - nausea
T 13:00 - puked after prolonged nausea

was nauseous the entire following day

seeing as they occurred at the same time, im not sure if it was the valium or contaminated food that made me sick. i hadnt had a drink in about 3 hours, had been for a walk, generally felt good, and had levelled out before i took it. is valium known to reacted badly after take either or both of these drugs? i have taken small amounts of valium before drinking in the past and have had better experiences than just straight alcohol.
 
^ Did you perhaps smoke a cigarette or two? For me even now tobacco despite being pleasurable on opiates generally causes nausea. I remember as a novice opiate user often butting cigarettes out a third of the way through and having to lie on the couch for ten minutes while my head span.

Alcohol and opiates can also be extremely nauseating, when I first started using CWE regularly I drank most days but would find any more than a couple of drinks on codeine would lead to significant nausea. It is only years of foolish practise that allow me to currently drink large amounts on codeine and seldom feel ill. Taking benzodiaepines (such as valium/diazepam) greatly potentiates alcohol and increases the chances of getting the 'spins', especially mixed with another CNS depressants, in your case codeine.

When you consider that diazepam is a long acting benzo that you took only an hour before eating, it is quite understandable that it may of taken a while to come up. Add to that, atleast for me personally, when I have food in my gut it makes opiate and alcohol, and/or fluid induced nausea worse. The fact it took you several hours to puke may have prolonged your nausea in my experience. It probably isn't healthy to throw up often, but when I feel nauseus I tend to find throwing up makes me feel considerably better.

Given you have had good experiences with just diazepam and codeine I would be willing to bet alcohol is the culprit here. Either that or you neglected to mention tobacco use. My money is on the fact that you don't drink a lot and it was unwise of you to mix all three drugs in this situation. I highly doubt your food was contaminated.
 
^ agreed. the alcohol + opiate combination has caused me a very similar sort of sickness in the past, and combining valium only adds to the equation. codeine makes some people nauseous, as can alcohol - and valium intensifies the effects of both of them.
i'm sure it wasn't the food.
it sort of sounds like opiates to me, as they usually make you spew as the high is wearing off, at least when you take them orally. but i'm sure the alcohol and the food in the belly didn't help either ;)
 
^ I wouldn't ordninarily blame a small amount of food in a healthy individual in this type of case, but when you consider codeine is relatively short acting and they ate 9 hours past the codeine, 6 hours past the alcohol and an hour past the diazepam I personally feel that eating can potentially intensify and/or prolong the resulting nausea. I am not a doctor,I am only talking about personal experience, but ime food could definately be a factor, not more than the drugs and alcohol but still a contributor.
 
SEPERATE QUESTION FOR YOU SONNY JIM, if you don't mind that is.. Do you know if Nexium is okay to take with Methadone.8(
The severity of damage will depend on the dose, dose frequency and the resilience of the individual CWE drinker's gut. There will be an innate level of resilience the corrosive effects of ibuprofen/NSAIDs on the gut lining which varies from person to person probably has to do with the strength and integrity of the gut. Any existing disease of the gut lining will obviously reduce resilience as well. For example my ex always had sensitive guts and could never take even half an ibuprofen dose with trouble but I could take it with no issues expcept maybe a slight funny feeling in my stomach for several hours. At fist at least but when I started with CWE N+ my guts slowly started to change for the worse.

There are some things that we can do to enhance the resilience and reduce the damage done **reduce not eliminate. such as not taking it on an empty stomach.

Antacid
Ibuprofen/NSAIDs inhibit the ability of the stomach lining to secrete a protective layer of mucous which is the only barrier between it and the corrosive digestive juices of the stomach. This means that for the duration of ibuprofen's effect the highly acidic digestive juices of the stomach have an increased/increasing level of access to the stomach lining and in the weakest points of the mucous barrier digestive juices will start to eat away at the lining, producing an ulcer initially and a perforated ulcer with time. Using ant acids at regular intervals for about 12 hours (length of ibuprofen's effect) you might be able to decrease the acidity of your stomach and decrease the damage done to the stomach lining on exposure.
Things that coat and soothe the gut wall are good to like chamomile tea and slippery elm bark powder. Ask at the health food store.
 
^^there is no interactions between methadone & nexium:
http://www.drugs.com/drug-interactions/methadone-with-nexium-1578-0-1015-567.html


I had some generic version of nurofen + tablets laying around so I did cwe on them & what was dripping through the filter was cloudy white water. must have been the pill binder put i through it away
does anyone know if the water is cloudy when u use Nurofen +?
when i use chemist's own pain tablets they dissolve easy in the water & the water come out almost clear
 
If anything, the raised stomach pH from the Nexium may increase absorption somewhat of the methadone. Looking at the pKa, probably nothing drastic but there you go.
 
Does anyone have any links to studies that were done on long term users of either Paracetamol or Ibuprofen? Would be curious to see the long term studies as it is quite worrying. Been doing CWE's for few years now min 2-3 times a week now days.
if u look further up the page i have a post about this cuz im also worried about long-term use of apap. (even if it's just the soluble apap used in 100mL of water at 10 degrees celcius)
http://www.naturalnews.com/001523.html
 
Repeated Use of Acetaminophen Can Be Fatal

Taken from Medscape, you have to be registered with them to view articles so I just pasted it below.

NSFW:
Clinical Context

In the November 3, 1979, issue of the BMJ, Prescott and colleagues reported the use of intravenous N-acetylcystine (NAC) for the treatment of early, nonstaggered acetaminophen (paracetamol) overdose. However, the clinical course and outcomes for acetaminophen overdose resulting from repeated supratherapeutic doses (staggered overdoses) and delayed presentation beyond 15 hours are not clear.

This retrospective review of prospectively collected data by Simpson and colleagues assesses the incidence, clinical course, and outcome of staggered and delayed acetaminophen overdoses vs a single-time overdose.

Study Synopsis and Perspective

Repeated doses of slightly too much acetaminophen (known as paracetamol in the United Kingdom and elsewhere in Europe) can be fatal, according to the results of a large, single-center cohort study published online November 22 in the British Journal of Clinical Pharmacology.

"On admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at a greater risk of dying than people who had taken single overdoses," senior author Kenneth J. Simpson, MBChB (Hons), MD, FRCP (Edin), from the University of Edinburgh and Scottish Liver Transplant Unit in the United Kingdom, said in a news release.

"They haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal," he adds.

In the United Kingdom, acetaminophen hepatotoxicity is the leading cause of acute liver failure (ALF). However, the effect of a staggered overdose pattern or delayed hospital presentation on mortality or need for emergency liver transplantation was previously unknown.

Of 663 patients admitted with acetaminophen-induced severe liver injury between 1992 and 2008, 161 (24.3%) had taken a staggered overdose. Compared with patients who took an overdose at a single time, patients with staggered overdose were significantly older and more likely to abuse alcohol.

When asked why they repeatedly ingested more than the recommended dose of acetaminophen, patients with staggered overdose most often cited pain relief as their rationale (58.2%).

Compared with patients who took an overdose at a single time, those who took staggered overdoses had lower total ingested doses and lower serum alanine aminotransferase (ALT) levels on admission. Nonetheless, they were more likely to be encephalopathic and to require renal replacement therapy or mechanical ventilation.

Although mortality was higher in staggered overdoses than in single-time overdoses (37.3% vs 27.8%; P = .025), the staggered overdose pattern was not an independent predictor of mortality. For staggered overdoses, sensitivity of the King's College poor prognostic criteria was reduced (77.6%; 95% confidence interval [CI], 70.8% - 81.5%).

Delayed presentation to medical services more than 24 hours after single-time overdose occurred in 44.9% of those in whom accurate timings could be determined, and was independently associated with death or liver transplantation (odds ratio [OR], 2.25; 95% CI, 1.23 - 4.12; P = .009).

In their logistic regression analysis, the investigators controlled for signs and symptoms, such as hepatic encephalopathy and prothrombin time, as well as various demographic factors.

"Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the paracetamol antidote, N-acetylcysteine [NAC], irrespective of the concentration of paracetamol in their blood," Dr. Simpson said.

Because both these groups are at increased risk of developing multiorgan failure, they should be considered for early transfer to specialist liver centers.

Limitations of this study include reliance on patient recall regarding the time of last ingestion, total paracetamol dose, and suicidal intent; limited data regarding the use of concomitant P450 enzyme inducers or recent fasting; and selection bias for the more severe cases of acetaminophen toxicity in Scotland.

"[T]his large cohort study demonstrates the deleterious effects of delayed presentation and staggered overdose pattern upon outcome following paracetamol-induced acute liver injury," the study authors conclude. "Both delayed presentation > 24 hours and staggered overdoses are strongly associated with multiorgan injury and the need for [liver transplantation]. Patients presenting with these overdose patterns should be treated as high risk for progression to ALF, and should receive NAC in their presenting hospital whilst awaiting serial ALT and PT levels."

This study received no external funding. The authors have disclosed no relevant financial relationships.

Br J Clin Pharmacol. Published online November 22, 2011.

Study Highlights

During a 16-year period, 938 patients were admitted to the Scottish Liver Transplantation Unit for severe acute liver injury.
663 patients (70.7%) had acetaminophen-induced severe acute liver injury.
Severe acute liver injury was defined as a sudden deterioration in liver function with coagulopathy in the absence of chronic liver disease.
Acetaminophen overdose was defined as more than 4 g/day of acetaminophen ingestion within 7 days of presentation, a serum acetaminophen level of more than 10 mg/L, a serum ALT level of more than 1000 IU/L within 7 days of a history of acetaminophen ingestion, and exclusion of other causes of acute severe liver injury.
All patients were treated with continuous NAC at 6.25 mg/kg/hour until the international normalized ratio was less than 2.
King's College Hospital poor prognostic criteria were used to identify patients most likely to die without liver transplantation.
Mean age of the patients was 34 years, and 52.5% were women.
450 patients (73.6%) took a single-time overdose of more than 4 g of acetaminophen.
161 (24.3%) took a staggered overdose of acetaminophen, defined as 2 or more supratherapeutic doses at more than an 8-hour interval resulting in a cumulative dose of more than 4 g/day.
Patients taking a staggered overdose vs those with a single-time overdose were more likely to be older, more likely to abuse alcohol, more likely to have taken alcohol concomitantly with the overdose, less likely to receive NAC in the referring hospital, had lower serum acetaminophen levels at admission (37.8 vs 75.6 mg/L), and had lower total acetaminophen ingestion (24 vs 27 g).
Compared with patients taking a single-time overdose, those taking a staggered overdose had the following findings:
Lower admission ALT (4622 vs 8415 IU/L)
Lower sodium level (134 vs 136 mmol/L)
Higher creatinine level (172 vs 114 µmol/L)
Lower albumin (33 vs 37 g/L)
Lower platelet count (113 vs 130 x 109/L)
Increased likelihood of encephalopathy on admission (43.5% vs 34.5%) or at any stage (55.9% vs 46.9%)
Increased need for renal replacement therapy
Increased need for mechanical ventilation (47.8% vs 38.2%)
Decreased spontaneous survival duration (62.7% vs 72.4%)
Similar prothrombin time, King's College Hospital poor prognostic criteria, transplantation, and development of encephalopathy during admission
In patients with staggered acetaminophen overdose, independent predictors of death were hepatic encephalopathy on admission, increased prothrombin time, leukocytosis, renal impairment, and hypoalbuminemia.
396 (88.0%) of 450 patients with single-time overdose had data on the accurate timing of dose: 19.7% presented to emergency services within 12 hours of the last acetaminophen dose, 35.4% presented after 12 to 24 hours, and 44.9% presented after 24 hours (delayed presentation).
Patients who presented to the hospital after 24 hours, at 12 to 24 hours, and within 12 hours had the following respective findings:
Lower serum acetaminophen levels (37 vs 89 vs 139 mg/L)
Higher creatinine levels (162 vs 94 vs 94 µmol/L)
Increased likelihood for development of hepatic encephalopathy during illness (57.3% vs 41.4% vs 28.2%)
Increased need for mechanical ventilation (47.2% vs 32.9% vs 20.5%)
Increased need for renal replacement therapy (39.9% vs 22.9% vs 12.8%)
Increased King's College Hospital poor prognostic criteria (33.7% vs 19.3% vs 10.3%)
Decreased spontaneous survival duration (64.0% vs 76.4% vs 88.5%)
Similar ALT, bilirubin, albumin, sodium, prothrombin time, and platelet count
In patients with single-time overdose, independent predictors of death were delayed presentation (> 24 hours; OR, 2.25; P = .009), older age, hepatic encephalopathy on admission, leukocytosis, and prothrombin time.
King's College Hospital poor prognostic criteria had a decreased sensitivity for staggered overdose vs single-time overdose (77.6% vs 89.9%), but the specificity was similar.
Study limitations were reliance on patient recall for the time and dose of acetaminophen use and lack of data on other medications or recent fasting.


Clinical Implications

Patients with staggered overdose vs those with a single-time overdose of acetaminophen are more likely to have encephalopathy on admission, need renal replacement therapy or mechanical ventilation, and have higher mortality rates.
In patients with a single-time overdose of acetaminophen, delayed presentation (> 24 hours) to the hospital vs presentation at 12 to 24 hours or within 12 hours is linked with a higher risk for death or the need for liver transplantation.


< Also, 13,000.
 
Cheers for that detailed post but was wondering what would be the long term negative effects of using CWE's only and not the pills itself. CWE's have way less ibu/para in it but still quite concerned and curious if there has been studies done on CWE long term usage.
 
I doubt there are any studies on CWE specifically.

just use common sense and apply what is already known about the ibu/para toxicity.

your never going to know exactly how much ibu/para your taking in you CWE.

whether there is less or more ibu/para in your CWE is kind of irrelevant because it is impossible to know. Caution states you'd have to assume you were taking some ibu/para with each CWE dose.

The only thing we really know about a kitchen CWE is that it most commonly produces a drink that is not lethal in the short term. I say most commonly because people stuff it up and die or end up in hospital from time to time.

keep in mind that one only has to read this thread to realise that the definition of CWE varies greatly. CWE is kind of a meaningless term in that sense because peoples techniques vary greatly. Some people may get results that are very similar to the solubility information posted, whereas some people are getting dangerous doses that in one case caused temporary deafness. I posted a story that almost ended in tragedy from the erowid experience vaults.
 
^^yes exactly. Id estimate u get 0.5g-1g of apap every time ya do a cwe. regualar codeine users would probably dose 3-4 a week i guess. so im just wondering what taking 4g a week a apap would do over the long-term.
i cant be that bad. i mean drs put ppl on panadeine forte long term to ake 2g a day. the dr wanted to put me on this dose for 8 months or something waiting for wisdom teeth removal. luckily im a BLer & realized that would be a bad idea i suggested tramadol
 
So yesterday, in preparation for today, I did a double chemist hit to get a couple packs of 30x pan plus. The I get back into the car and realise the stupid bitch gave me a 15 pack and didnt realise. No biggy I thought, so went and bought another packet.

So last night I left my car in town overnight as I had a few drinks. This morning I can find my P+ packs ANYWHERE..... after picking my car up in town and I notice that I forgot to lock it. No biggy I thought, nothing of value in there.

But I think some fuck stole my goddam pan + packs from my glove box. Can you believe that shit? I cant find them anywhere. Its truly bizarre. So I had to go back out this morning and buy another pack plus borrow 15 tablets off a mate. Lucky being a pub holiday the pharmacists are all different.

Weird.

/vent
/rant

=D
 
^^there is no interactions between methadone & nexium:
http://www.drugs.com/drug-interactions/methadone-with-nexium-1578-0-1015-567.html


I had some generic version of nurofen + tablets laying around so I did cwe on them & what was dripping through the filter was cloudy white water. must have been the pill binder put i through it away
does anyone know if the water is cloudy when u use Nurofen +?
when i use chemist's own pain tablets they dissolve easy in the water & the water come out almost clear

Yes it always does that, even through thorough double-filtering with coffee filters etc. I believe you're right, that it is the fillers, because if one were to run their finger through the water it's quite clear that there's no fine, undissolved, material in the drink - and ibuprofen is as insoluble as paracetamol (1mg/ml @ 21 degrees Celsius).
 
Nurofen Plus tablets have a white, rubbery, paper thin film which coats the outside of each tablet. This rubbery outer layer dissolves in water to give a cloudy solution.

To get crystal clear solution with nurofen plus you have to peel the thin white outer layer from the pills. It a paper thin kind of rubber film which peels off cleanly though it is very fiddly. There is no real benefit to peeling this thin outer layer off anyway, except it might make it easier to see any ibupren particles that made it through the filter.

Oh and ibuprofen is less soluble than paracetamol in cold water, its been mentioned a few times just check back in the thread for the exact figures quoted.
 
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