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Journal articles on the topic 'CodePen'

Author: Grafiati

Published: 5 June 2025

Last updated: 16 July 2025

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1

Wijaya, Vannes, Diva Putri Kynta, and Ivan Luthfi Laksono. "Pelatihan Pengembangan Desain Game Dengan HTML dan CSS Pada SMA Negeri 3 Palembang." FORDICATE 4, no. 1 (2024): 30–37. https://doi.org/10.35957/fordicate.v4i1.9686.

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Seiring dengan kemajuan teknologi informasi dan komunikasi, perkembangan di bidang ini terus mengalami peningkatan yang pesat, salah satunya teknologi dalam game. Pelatihan ini bertujuan untuk memberikan pemahaman dasar dan praktik pengembangan desain game menggunakan teknologi web, yaitu HTML, CSS, dan JavaScript. Pada pelatihan ini siswa SMA Negeri 3 Palembang menggunakan platform CodePen sebagai media pembelajaran dengan metode teori dan praktek, CodePen merupakan sebuah website untuk menampilkan game dari coding yang dibuat. Dengan CodePen, struktur dan tampilan dapat memungkinkan peserta untuk membuat, menguji, dan berbagi kode secara interaktif dalam satu lingkungan kerja yang terintegrasi. Pada proyek pengabdian masyarakat ini bertujuan untuk mengenal teknologi pengembangan game berbasis web kepada peserta, meningkatkan pemahaman peserta terhadap dasar-dasar desain dan logika dalam pembuatan game, dan mengasah kreativitas. Pada pelatihan ini rata-rata hasil yang didapatkan dari Pre Test sebesar 11,4 dan rata-rata hasil yang didapatkan Post Test sebesar 45,34.

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Kakkar, Krishna. "Code Pen Clone App: A Real-Time Collaborative Web Development Environment." INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH IN ENGINEERING AND MANAGEMENT 09, no. 05 (2025): 1–9. https://doi.org/10.55041/ijsrem49231.

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ABSTRACT This paper presents the development of a CodePen clone—an interactive, real-time online code editor designed to support HTML, CSS, and JavaScript with live preview capabilities. Online IDEs such as CodePen, JSFiddle, and StackBlitz have revolutionized how developers write, share, and experiment with code snippets. However, most platforms offer limited collaboration features or impose commercial restrictions. This research introduces a custom-built platform using React.js, Node.js, WebSockets, and CodeMirror that facilitates real-time collaboration and automatic preview rendering. Users can sign up, create pens (code snippets), preview results live, and invite others for collaborative editing. The tool addresses accessibility, flexibility, and interactivity in modern coding education and showcases potential as a viable open-source alternative for individual learning, classroom demonstrations, and real-time team projects. Keywords—Code Editor, Online IDE, Real-time Collaboration, HTML/CSS/JS Preview, React.js, WebSockets, CodeMirror

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Tahirov, Behzod Nasriddinovich, and Najmiddin Jahon o'g'li Jo'raqulov. "WEB DASTURCHILAR UCHUN ENG ZARUR VA FOYDALI BO'LGAN PLATFORMALAR." Educational Research in Universal Sciences 2, no. 6 (2023): 97–100. https://doi.org/10.5281/zenodo.8104135.

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Ushbu maqola “web dasturchilar uchun eng muhim va ishonchli platformalar” nomli bo‘lib, unda platformalar, web dasturchilar uchun kodni boshqarish, loyihalarni versiyalash, savollar berish, qo‘llab-quvvatlash va kodni ishga tushirish jarayonlarida ularga yordam berishi uchun muhim vositalar va resurslar yoritilgan. Bu platformalar o‘rtasida GitHub, Stack Overflow, CodePen, Visual Studio Code, Bootstrap, MDN Web Docs, npm, W3Schools va DevDocs kabi eng mashhur va ommabop platformalar kiritilgan.

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Moura, G. L., M. Giublin, L. Albini, R. Pasquini, K. Viana, and F. Chicoski. "Effectiveness,safety and tolerability of codeine in cancer patients." Journal of Clinical Oncology 24, no. 18_suppl (2006): 18577. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.18577.

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18577 Background: In 1984 WHO guidelines for cancer pain was proposed. Codeine was selected among several others drugs when pain ladder step II was required. Since then very few comparative studies have been performed. Codein is a weak opioid and its analgesic action is not completely understood. A possible conversion into morphine is postulated. To determine efficacy, safety and tolerability of codein in advanced cancer patient we designed a prospective cohort study. Methods 150 metastatic cancer patients were studied during six months. A standard zero to then table scale for pain rating was used. The malignacies were: prostate 15 (10%), breast 42 (28%), lung 33 (22%), colon 37 (24.6%), other cancer 23 (15.3%). 62 patients were under treatment (41.3%). Results: There were: 83 M (55.3%) 67 F(44,7%) and the mean age was 62 years. Mean initial and final pain score were 7.1 and 1.3 respectively. Codein dose range from 30 mg/day to 270 mg/day (mean dose 180 mg/day). The average time of use was 13,7 months. Severe toxicity was 0% and the most often side effect was constipation (38.7%). Adjuvant drugs were used in 97 patients (64.7%) of patients. Uncontrolled pain ocurred in 17 patients (11.3%). Conclusions: During the last decade a great increase in the range of opioid agents and formulations available have emerged. Codein still represents an excellent drug for patients with long life expectancy. Side effects are manageable and are mainly constipation. Pain control was achieved in the majority of patients. Codein showed a low toxicity profile with a high compliance rate. Economic reasons must be strongly consider in poor countries and codein represents a good alternative option. Future comparative studies addressing also quality of life should be performed. No significant financial relationships to disclose.

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Ishak, A. S., H. Hussin, Alia Asrani Azmi, and M. H. Othman. "The Knowledge about the Dangerous Effect of Opiates among Adolescent." MATEC Web of Conferences 150 (2018): 05096. http://dx.doi.org/10.1051/matecconf/201815005096.

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Statistics from the National Anti Drug Agency (AADK) showed an increase in adolescent who are in the age range 13 to 18 years involved in drug abuse. Realizing this problem, a study was conducted to examine the knowledge about dangerous effect of drug abuse on opiates among adolescent. There are four type of opiates were tested in this study such as opium, morphine, heroin and codeine. Respondent consisted 759 adolescent aged 16 years old. This quantitative study using the “Soal Selidik Kajian Pengaruh Dadah” as an instrument. The data obtained were analyzed using descriptive statistics to get the frequency and percentage. The result showed that both male and female adolescent know about the dangerous effect of drug abuse. Findings also identify the most popular drugs among adolescent is heroin followed by opium, codein and morphine.

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&NA;. "Codeine/codeine phosphate." Reactions Weekly &NA;, no. 1179 (2007): 12. http://dx.doi.org/10.2165/00128415-200711790-00033.

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Núñez Batalla, Faustino, Carmen Jáudenes Casaubón, Jose Miguel Sequí Canet, Ana Vivanco Allende, and José Zubicaray Ugarteche. "Recomendaciones CODEPEH 2014." REVISTA ESPAÑOLA DE DISCAPACIDAD 3, no. 1 (2015): 163–86. http://dx.doi.org/10.5569/2340-5104.03.01.09.

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Hale, Martin E., Kevin L. Speight, Zoltan Harsanyi, et al. "Efficacy of 12 Hourly Controlled-Release Condeine Compared with as Required Dosing of Acetaminophen Plus Codeine in Patients with Chronic Low Back Pain." Pain Research and Management 2, no. 1 (1997): 33–38. http://dx.doi.org/10.1155/1997/546061.

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OBJECTIVE: To compare pain relief and stability of pain control in patients with chronic low back pain treated with scheduled 12 hourly doses of controlled-release codeine or as required doses of a fixed combination of acetaminophen and codeine.PATIENTS AND METHODS: Patients were assigned to five days of treatment with controlled-release codeine (Codeine Contin; Purdue Frederick) 100 mg q12h or placebo q12h in a randomized, double-blind, parallel group study. Acetaminophen 325 mg q4h prn was available as rescue to the codeine group and acetaminophen 325 mg plus codeine 30 mg q4h prn was available to the placebo group. Pain intensity was assessed pretreatment and four times daily using a four-point categorical scale. Acceptability of therapy was assessed twice daily on a five-point scale.RESULTS: Of 104 patients enrolled, 82 were able to be evaluated for safety and efficacy. Sum of pain intensity differences scores were significantly lower on controlled-release codeine than on as required acetaminophen plus codeine at all assessments. The number of changes in pain intensity throughout the day was higher with acetaminophen plus codeine than with codeine alone (8.6±0.7 versus 6.1±0.6, respectively, P=0.011). Mean total daily codeine dose was 200 mg in the codeine group and 71.1±6.6 mg in the acetaminophen plus codeine group (P=0.0001). Mean total daily prn acetaminophen consumption was 542.2±86.5 mg in the codeine group and 770.8±71.5 mg in the fixed combination group (P=0.0452).CONCLUSION: Twelve hourly dosing of controlled-release codeine provides greater and more stable pain relief in patients with chronic low back pain than as required dosing of an acetaminophen plus codeine combination.

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Radford, Helen, Karen H. Simpson, Suzanne Rogerson, and Mark I. Johnson. "A Single Site Population Study to Investigate CYP2D6 Phenotype of Patients with Persistent Non-Malignant Pain." Medicina 55, no. 6 (2019): 220. http://dx.doi.org/10.3390/medicina55060220.

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Background and Objectives: Codeine requires biotransformation by the CYP2D6 enzyme, encoded by the polymorphic CYP2D6 gene, to morphine for therapeutic efficacy. CYP2D6 phenotypes of poor, intermediate, and ultra-rapid metabolisers are at risk of codeine non-response and adverse drug reactions due to altered CYP2D6 function. The aim of this study was to determine whether genotype, inferred phenotype, and urinary and oral fluid codeine O-demethylation metabolites could predict codeine non-response following a short course of codeine. Materials and Methods: There were 131 Caucasians with persistent pain enrolled. Baseline assessments were recorded, prohibited medications ceased, and DNA sampling completed before commencing codeine 30 mg QDS for 5 days. Day 4 urine samples were collected 1–2 h post morning dose for codeine O-demethylation metabolites analysis. Final pain assessments were conducted on day 5. Results: None of the poor, intermediate, ultra-rapid metabolisers and only 24.5% of normal metabolisers responded to codeine. A simple scoring system to predict analgesic response from day 4 urinary metabolites was devised with overall prediction success of 79% (sensitivity 0.8, specificity 0.78) for morphine and 79% (sensitivity 0.76, specificity 0.83) for morphine:creatinine ratio. Conclusions: In conclusion, this study provides tentative evidence that day 4 urinary codeine O-demethylation metabolites could predict non-response following a short course of codeine and could be utilised in the clinical assessment of codeine response at the point of care to improve analgesic efficacy and safety in codeine therapy. We offer a scoring system to predict codeine response from urinary morphine and urinary morphine:creatinine ratio collected on the morning of day 4 of codeine 30 mg QDS, but this requires validation before it could be considered for use to assess codeine response in clinical practice.

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Kinnaird, Emma, Andreas Kimergård, Stacey Jennings, Colin Drummond, and Paolo Deluca. "From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults." BMJ Open 9, no. 4 (2019): e025331. http://dx.doi.org/10.1136/bmjopen-2018-025331.

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ObjectivesTo investigate the views and experiences of people who use codeine in order to describe the ‘risk environment’ capable of producing and reducing harm.DesignThis was a qualitative interview study. Psychological dependence on codeine was measured using the Severity of Dependence Scale. A cut-off score of 5 or higher indicates probable codeine dependence.SettingParticipants were recruited from an online survey and one residential rehabilitation service.Participants16 adults (13 women and 3 men) from the UK who had used codeine in the last 12 months other than as directed or as indicated. All participants began using codeine to treat physical pain. Mean age was 32.7 years (SD=10.1) and mean period of codeine use was 9.1 years (SD=7.6).ResultsParticipants’ experiences indicated that they became dependent on codeine as a result of various environmental factors present in a risk environment. Supporting environments to reduce risk included: medicine review of repeat prescribing of codeine, well-managed dose tapering to reduce codeine consumption, support from social structures in form of friends and online and access to addiction treatment. Environments capable of producing harm included: unsupervised and long-term codeine prescribing, poor access to non-pharmacological pain treatments, barriers to provision of risk education of codeine related harm and breakdown in structures to reduce the use of over the counter codeine other than as indicated.ConclusionThe study identified microenvironments and macroenvironments capable of producing dependence on codeine, including repeat prescribing and unsupervised use over a longer time period. The economic environment was important in its influence on the available resources for holistic pain therapy in primary care in order to offer alternative treatments to codeine. Overall, the goal is to create an environment that reduces risk of harm by promoting safe use of codeine for treatment of pain, while providing effective care for those developing withdrawal and dependence.

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Dumitru, Croitoru Mircea, Fogarasi Erzsébet, Varga Erzsébet, Chelaru Adelina, Căliman Monica-Simina, and Fülop Ibolya. "Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?" Acta Medica Marisiensis 62, no. 3 (2016): 309–12. http://dx.doi.org/10.1515/amma-2016-0031.

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AbstractObjective: Analgesic medicines containing combinations of nonsteroidal anti-inflammatory drugs and codeine are available without prescription. Codeine, in these combinations can not be used recreationally due to the high toxicity profile of the nonsteroidal anti-inflammatory drugs. However, methods for extracting codeine from these types of medication are available on the internet. The purpose of this work is to evaluate if codeine can be extracted from codeine containing analgesics sold without prescription.Methods: High Performance Liquid Chromatography (HPLC) with UV detection was used to measure the amounts of codeine and nonsteroidal anti-inflammatory drugs recovered after applying an extraction method described on the internet.Results: The results show that codeine can be very easily separated from NSAID as aspirin, acetaminophen, ibuprofen using the cold water extraction method. However, very large differences (20 to 90%) were recorded for the recovery of codeine depending on the OTC product that was used. That large difference increases the risk of potentially lethal overdoses when the user switches between “similar” products.Conclusions: Our work shows that analgesic medication with codeine content can be recreationally used after the extraction of codeine. In order to prevent this, the sell of this type of products should be regulated or products that do not allow the extraction of codeine should be developed.

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Akhigbe, Roland Eghoghosoa, Oladele A. Afolabi, and Ayodeji F. Ajayi. "L-Arginine reverses maternal and pre-pubertal codeine exposure-induced sexual dysfunction via upregulation of androgen receptor gene and NO/cGMP signaling." PLOS ONE 17, no. 9 (2022): e0274411. http://dx.doi.org/10.1371/journal.pone.0274411.

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Background Although codeine has been reported to enhance sexual activity by improving penile reflexes, it has been shown to impair fertility indices. Also, codeine impairs ovarian steroidogenesis and folliculogenesis. Nonetheless, whether or not codeine exerts an epigenetic effect remains unclear. On the other hand, arginine has been speculated to enhance penile reflexes by upregulating NO/cGMP Signaling. Aim The study evaluated the effect of maternal codeine exposure and prepubertal codeine and arginine treatments on F1 male sexual function and fertility indices, as well as the outcome of F2 progenies. In addition, the epigenetic programming mechanism was also explored. Methods Forty three-week-old female rats were randomized into two groups (n = 20 rats/group); the control that received 0.5 ml of distilled water and the codeine-treated that received 5 mg/kg of codeine via gavage for eight weeks. Afterward, the female rats were paired for mating with sexually mature male rats. Rats were maintained on their pre-pregnancy treatments throughout pregnancy and lactation. FI progenies from each cohort (control and codeine-treated cohorts) were weaned at three weeks and randomized into four groups; the control, codeine-treated, L-arginine-treated (300mg/kg), and codeine + L-arginine-treated (n = 10 rats/group). Administration commenced a week post-weaning and lasted for eight weeks via gavage. Key findings Maternal codeine exposure did not alter body weight, but significantly reduced anogenital distance and anogenital index of F1 male offspring. Also, maternal codeine delayed preputial membrane separation, impaired male sexual competence, and penile reflexes of F1 male offsprings. These were associated with reduced dopamine, gonadotropins, and testosterone levels as well as suppressed expression of androgen receptor mRNA. In addition, maternal codeine downregulated NO/cGMP signaling, impaired fertility indices, and reduced the litter size, weight, and survival of F2 progenies. These alterations were observed to be aggravated by prepubertal codeine exposure but improved by prepubertal arginine treatment. Significance In conclusion, codeine programmed sexual dysfunction by suppressing the levels of dopamine and testosterone, as well as repressing the expression of androgen receptor mRNA. In addition, codeine-induced epigenetic reprogramming was expressed in the F2 offsprings as reduced litter size and weight, and survival rate. Notably, these observations were worsened by prepubertal codeine exposure, but dampened by prepubertal arginine treatment.

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Russell, Alan, C. Peter Watson, Alexander J. Clark, et al. "Evaluation of Dosing Guidelines for Use of Controlled-Release Codeine in Chronic Noncancer Plan." Pain Research and Management 8, no. 3 (2003): 143–48. http://dx.doi.org/10.1155/2003/592846.

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OBJECTIVE: The clinical utility of guidelines for conversion of patients from a combination analgesic preparation of acetaminophen 300 mg plus codeine 30 mg every 4 h to 6h as needed to scheduled controlled-release (CR) codeine every 12 h was evaluated.METHODS: Adult patients with chronic noncancer pain underwent a two-week evaluation on acetaminophen plus codeine, followed by eight weeks of treatment with CR codeine. Patients taking four to six tablets of acetaminophen plus codeine per day were transferred to 50 mg CR codeine every 12 h; those on seven to nine tablets were transferred to 100 mg every 12 h; those on 10 to 12 tablets were transferred to 150 mg every 12 h; and those on greater than 12 tablets were transferred to 200 mg every 12 h. Subsequent dose adjustments were permitted. Acetaminophen (325 mg) was available for rescue. Pain intensity (five-point categorical and 100 mm visual analog scale), pain related disability, adverse events and acceptability were assessed.RESULTS: Of the 140 patients enrolled, 95 completed eight weeks of treatment with CR codeine. During month 1 and month 2, the mean CR codeine daily doses were 295.7±119.1 mg and 390.3±163.4 mg, respectively. Pain scores during both CR codeine month 1 and 2 were significantly lower than on acetaminophen plus codeine (53.6±20.9 mm and 49.7±23.7 mm versus 59.6±17.5 mm; P=0.0003, P=0.0001, respectively). CR codeine treatment was rated as moderately or highly acceptable by 82% of patients compared with 50% for acetaminophen plus codeine (P=0.001). Only seven patients (5.9%) discontinued CR codeine treatment because of adverse events.CONCLUSION: The results confirm the safety, efficacy and patient acceptability of the initial conversion and maintenance dosing recommendations for CR codeine from a combination opioid/nonopioid analgesic.

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McCoy, Jacqui, Suzanne Nielsen, and Raimondo Bruno. "Impact of Removing Nonprescription Codeine in Australia: Protocol for a Prospective Cohort Study." JMIR Research Protocols 9, no. 3 (2020): e15540. http://dx.doi.org/10.2196/15540.

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Background On February 1, 2018, Australia rescheduled codeine to a prescription-only medication. Many concerns were associated with this change, including increased financial costs, reduced service accessibility, the potential for poorer pain management, and a decline in physical and mental health if codeine could not be accessed. In the research literature, there is limited knowledge about the long-term consequences of rescheduling pharmaceutical opioids and, as Australia has followed many countries in implementing a restriction on codeine, further study of these consequences is critical. Objective The goal of this study was to examine the impact of rescheduling codeine from an over-the-counter (OTC) product to a prescription-only medicine on the primary measures of codeine use and dependence in a prospective cohort of people who are frequent consumers of OTC codeine. Secondary measures included pain and self-efficacy, health service use, and mental health. Methods The Codeine Cohort study aimed to recruit 300 participants in Australia who regularly (at least a few times per week for the past 6 months) used OTC codeine. Using an online survey, participants were followed up at three time points (February 2018, June 2018, and February 2019) after codeine was rescheduled. Results All four waves of data collection are complete, with the final round of data collection finalized in August 2019. Data analyses are yet to be completed. Information on demographics, codeine use and dependence, physical and mental health, medication use, and health service use will be analyzed using mixed models. Conclusions Results of this study will provide insight into the effectiveness of regulatory restriction in curtailing nonmedical use of and harms associated with codeine. Additionally, results will explore positive and negative outcomes of codeine rescheduling for individual patients, which informs health professionals who support patients who use codeine and further community education. International Registered Report Identifier (IRRID) DERR1-10.2196/15540

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He, Ting, Allison B. Lardieri, and Jill A. Morgan. "Pharmacist and Pediatrician Knowledge of Codeine Use in Children." Journal of Pediatric Pharmacology and Therapeutics 23, no. 4 (2018): 293–97. http://dx.doi.org/10.5863/1551-6776-23.4.293.

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OBJECTIVES In 2011, approximately 1.7 million pediatric patients had a codeine-containing prescription filled at a US retail pharmacy. Numerous cases involving serious adverse effects or fatalities have been reported in children who have been prescribed codeine. In 2013, the US Food and Drug Administration added a boxed warning to avoid codeine in children after a tonsillectomy. The purpose of this study is to determine pharmacists' and pediatricians' knowledge of the boxed warning for codeine in children. METHODS Two separate surveys were administered to community pharmacists in Maryland, pediatricians, and pediatric residents at a single institution in Maryland. Both surveys consisted of questions regarding knowledge of the boxed warning for codeine in children. RESULTS There was no difference in the awareness of the boxed warning between pharmacists (48.9%, n = 43) and pediatricians (51.3%, n = 41, p = 0.88). More pharmacists knew that ultrarapid metabolizers have the risk for increased adverse events from codeine (39.5% pharmacists vs. 20% pediatricians, p = 0.01). In addition, 36% of pharmacists and 33% of pediatricians noted that it was never appropriate to use codeine in a child (p = 0.73). CONCLUSIONS Only half of pharmacists and pediatricians surveyed were aware of the boxed warning for codeine. One third of pharmacists and pediatricians in this study would never use codeine in a child. Therefore, more education is needed for pharmacists and pediatricians regarding the dangers of using codeine in children.

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Lawrence, Amy, Jennifer N. Cooper, Katherine J. Deans, Peter C. Minneci, Sharon K. Wrona, and Deena J. Chisolm. "Effects of the FDA Codeine Safety Investigation on Racial and Geographic Disparities in Opioid Prescribing after Pediatric Tonsillectomy and/or Adenoidectomy." Global Pediatric Health 8 (January 2021): 2333794X2098744. http://dx.doi.org/10.1177/2333794x20987444.

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Objective. Our objective was to examine the impact of the U.S. FDA’s 2013 black box warning against codeine on codeine and other opioid prescription filling after pediatric tonsillectomy and/or adenoidectomy (T/A) overall and by child race and provider urbanity/rurality. Methods. Patients ≤ 18 who underwent T/A in 8/2011 to 8/2016 were identified in Ohio Medicaid claims. Interrupted time series analyses were used to evaluate the impact of the FDA warning on codeine or other opioid prescription filling post-T/A. Results. In August 2011, codeine prescription filling was lower among black than white children ( P < .001) and among children treated at institutions in metropolitan counties than less populous counties ( P < .001). The FDA warning was associated with a 24.0% drop in codeine prescription filling ( P < .001) and 5.5% increase in alternative opioid prescription filling ( P = .046). At conclusion, there remained geographic but no longer racial disparities in codeine prescribing. Conclusion. Codeine prescribing after pediatric T/A decreased after the FDA’s black box warning. However, geographic disparities in codeine prescribing remain.

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Singu, Boni, and Roger K. Verbeeck. "Should Codeine Still be Considered a WHO Essential Medicine?" Journal of Pharmacy & Pharmaceutical Sciences 24 (June 26, 2021): 329–35. http://dx.doi.org/10.18433/jpps31639.

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Codeine continues to be widely used as an analgesic, antidiarrhoeal and antitussive agent. Its analgesic effect depends on its biotransformation to morphine, a strong opioid. The highly variable biotransformation of codeine to morphine, catalysed by CYP2D6, underlies the pronounced interindividual variability of its analgesic response. Randomized controlled trials have demonstrated that codeine administered alone has the poorest analgesic effect among all commonly used analgesics in acute postoperative pain. Moreover, it is highly unlikely that the low dose of codeine contributes to the pain-relieving effect of the non-opioid component in combination analgesic products. In addition, there is a lack of reliable clinical evidence to support the use of codeine as an antitussive in acute or chronic cough. Codeine use, through its active metabolite morphine, has the potential to lead to abuse and dependence. The World Health Organization (WHO) removed codeine from the essential medicines list for children in 2011. Based on the available information in the scientific literature on the efficacy and safety of codeine, the WHO should seriously consider removing it also from the list of essential medicines for adults, which would be a strong signal for all health professionals to prescribe and dispense codeine with the utmost caution.

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Nielsen, BPharm, BPharmSc (Hons), PhD, Suzanne, Jacqui Cameron, BA, BSW, MPhil (Social Science Research), and Nicole Lee, BSc (Hons), GradCertEd (Tertiary), PhD, MAPS. "Characteristics of a nontreatment-seeking sample of over-the-counter codeine users: Implications for intervention and prevention." Journal of Opioid Management 7, no. 5 (2011): 363–70. http://dx.doi.org/10.5055/jom.2011.0077.

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Objectives: Recently, there has been considerable policy and public interest in the availability of over-the-counter (OTC) codeine. Case reports demonstrating severe harm from OTC codeine have been published. However, few studies have examined how people use these products and who develops dependence. The aim of this study was to better understand who develops problematic use of OTC codeine.Design and setting: The authors conducted a web-based survey with people who self-reported OTC codeine use. Eight hundred participants completed the survey that examined codeine use and dependence, pain, and general physical and mental health.Results: Codeine-dependent people differed from nondependent codeine users on a range of characteristics. They were younger, had lower levels of employment and education, and were more likely to report family history of substance dependence. They were more likely to have taken well above recommended doses of OTC codeine and have taken codeine for considerably longer periods of time than recommended. Codeine-dependent people in this study differed markedly from other populations of opioid-dependent people recruited to research in Australia and were more similar to the general population, suggesting that a web-based survey may have reached an under-researched population of opioid-dependent people.Conclusions: How best to use these findings to identify at-risk OTC codeine users requires consideration. Approaches aimed at reducing harm from prescription opioids may be difficult to implement in pharmacy settings. Implications for pharmacists and other health professionals are discussed.

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Paul, Buddha D., Eric T. Shimomura, and Michael L. Smith. "A Practical Approach to Determine Cutoff Concentrations for Opiate Testing with Simultaneous Detection of Codeine, Morphine, and 6-Acetylmorphine in Urine." Clinical Chemistry 45, no. 4 (1999): 510–19. http://dx.doi.org/10.1093/clinchem/45.4.510.

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Abstract Background: Both the Department of Defense (DoD) and the Department of Health and Human Services (DHHS) currently require two confirmation tests to verify use of heroin, one test for total morphine and a separate test for 6-acetylmorphine (6-AM). Our aim was to determine appropriate free-codeine, free-morphine, and 6-AM cutoff concentrations that could be substituted for total-morphine, total-codeine, and 6-AM cutoff concentrations and to develop a less labor-intensive method for measuring codeine, morphine, and 6-AM. Methods: Urine samples containing opiates were extracted, derivatized, and analyzed using gas chromatography–mass spectrometry with selective ion monitoring. Results: The limits of detection for codeine, morphine, and 6-AM were 6, 5, and 0.5 μg/L, respectively. Recoveries were &gt;90%. Quantification was linear over the concentration range of 6–1000 μg/L for codeine, 5–5000 μg/L for morphine, and 0.5–800 μg/L for 6-AM. Cutoff concentrations for confirmation of opiates were 100, 100, and 10 μg/L for free codeine, free morphine, and 6-AM. Conclusion: The proposed cutoff concentrations for free morphine and 6-AM provide better detection windows for morphine and heroin use than the cutoff concentrations for total morphine and 6-AM used at present. Detection of free codeine, instead of total codeine, simplifies interpretation of codeine use. The single-extraction method enables simultaneous, less labor-intensive analysis of morphine, codeine, and 6-AM.

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Claire Van Hout, Marie. "“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine." Drugs and Alcohol Today 14, no. 4 (2014): 219–34. http://dx.doi.org/10.1108/dat-03-2014-0014.

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Purpose – The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues. Design/methodology/approach – A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine. Findings – The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity. Practical implications – Further development of real-time monitoring processes with process evaluation is advised. Originality/value – This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.

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Jaksic, Vladimir, Dijana Miric, Aleksandra Ilic, Suzana Matejic, Snezana Stevic, and Zdravko Vitosevic. "The importance of 6-MAM levels and morphine/codeine ratio in diagnosis of death among drug addicts." Srpski arhiv za celokupno lekarstvo 147, no. 9-10 (2019): 607–11. http://dx.doi.org/10.2298/sarh181005003j.

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Introduction/Objective. Heroin is metabolized to 6-monoacetylmorphine (6-MAM) and morphine. The objective of this study is to examine 6-MAM, morphine, and codeine relationships in order to distinguish deaths related to heroin consumption from deaths related to morphine and/or codeine consumption. Methods. The autopsy blood and urine samples from 45 opioid drug addicts were examined. Gas chromatography/mass spectrometry was applied to evaluate morphine, 6-MAM, and codeine. Two groups were formed: 6-MAM-positive (n = 35) and 6-MAM-negative (n = 10). Results. Compared to the 6-MAM-negative group, blood morphine levels were higher in the 6-MAMpositive group (p = 0.022), while blood codeine levels were similar (p = 0.575). In the 6-MAM-negative group, the blood morphine/codeine ratio was 8.3, and it was 4.3 in the 6-MAM-positive group. There was no difference between the groups regarding urine morphine levels (p = 0.859). The urine morphine/ codeine ratio was 6.2 in the 6-MAM-negative group, whilst it was 32.2 in the 6-MAM-positive group. In the blood samples, morphine and codeine concentrations were significantly correlated (r = 0.607; p = 0.006). In urine samples, correlations between morphine and codeine (r = 0.766; p < 0.001), morphine and 6-MAM (r = 0.650; p < 0.001), as well as codeine and 6-MAM (r = 0.620; p < 0.001), were also significant. Conclusion. Analyses of 6-MAM and morphine/codeine ratio in blood and urine autopsy samples may be used as diagnostic tools to distinguish deaths related to the consumption of different opioid drugs.

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Van Hout, Marie Claire, Ian Norman, Eileen Rich, and Michael Bergin. "Experiences of Codeine Use, Misuse and Dependence: Application of Liese and Franz's Cognitive Developmental Model of Substance Abuse." Behavioural and Cognitive Psychotherapy 45, no. 3 (2017): 238–52. http://dx.doi.org/10.1017/s1352465817000030.

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Background: Misuse of codeine-containing medicines is an emerging public health issue.Aims: We present the application of Liese and Franz's (1996) cognitive developmental model of substance abuse to the trajectory from legitimate codeine use for pain, towards that of therapeutic and other forms of misuse, and physical and psychological dependence. It illustrates a cognitive behavioural analysis of the experiences of codeine misusers – which ‘surfaces’ the specific beliefs, thoughts, emotions and behaviours of this group of hidden codeine dependent individuals, who are distinct and unique from other opioid-dependent cohorts.Method: In-depth one-to-one interviews with codeine misusers and dependent individuals in Ireland (n= 21) and South Africa (n= 25) are analysed and applied to Liese and Franz's (1996) cognitive developmental model of substance abuse.Results: Misuse and dependence pathways are maintained by the interplay between physiological determinants relating to pain, withdrawal and tolerance, and psychological influences such as therapeutic need, pre-empting of anticipated physical pain, pleasure from the dreamy sedative opiate effect of codeine and relief of emotional distress. Progression towards habitual use and misuse for therapeutic and intoxication purposes appears to be mediated by external environmental triggers pertaining to availability, internal meta-cognitions around physical pain and emotional distress, and increasing importance of codeine in the life of the user.Conclusion: The concept mapping of codeine misuse and dependence presented here could provide psychological therapists working with individuals experiencing problems with codeine, misusing codeine and those with iatrogenic dependence, with an enhanced understanding of the key concepts involved in misuse and recovery pathways.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1378 (2011): 13–14. http://dx.doi.org/10.2165/00128415-201113780-00042.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1388 (2012): 11. http://dx.doi.org/10.2165/00128415-201213880-00039.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1167 (2007): 12. http://dx.doi.org/10.2165/00128415-200711670-00036.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1194-1195 (2008): 14. http://dx.doi.org/10.2165/00128415-200811940-00044.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 551 (1995): 5. http://dx.doi.org/10.2165/00128415-199505510-00016.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 429 (1992): 7. http://dx.doi.org/10.2165/00128415-199204290-00031.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 621 (1996): 5. http://dx.doi.org/10.2165/00128415-199606210-00017.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 650 (1997): 7. http://dx.doi.org/10.2165/00128415-199706500-00020.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 682 (1997): 7. http://dx.doi.org/10.2165/00128415-199706820-00022.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 684 (1998): 7. http://dx.doi.org/10.2165/00128415-199806840-00019.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 824 (2000): 8. http://dx.doi.org/10.2165/00128415-200008240-00019.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 836 (2001): 7. http://dx.doi.org/10.2165/00128415-200108360-00017.

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&NA;. "Codeine." Reactions Weekly 844, no. 844 (2001): 8. http://dx.doi.org/10.2165/00128415-200108440-00021.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1416 (2012): 18. http://dx.doi.org/10.2165/00128415-201214160-00056.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1417 (2012): 18. http://dx.doi.org/10.2165/00128415-201214170-00061.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1085 (2006): 12. http://dx.doi.org/10.2165/00128415-200610850-00036.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1116 (2006): 12. http://dx.doi.org/10.2165/00128415-200611160-00032.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 894 (2002): 6–7. http://dx.doi.org/10.2165/00128415-200208940-00017.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 914 (2002): 7. http://dx.doi.org/10.2165/00128415-200209140-00021.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1280 (2009): 16. http://dx.doi.org/10.2165/00128415-200912800-00051.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1243 (2009): 16–17. http://dx.doi.org/10.2165/00128415-200912430-00051.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1301 (2010): 16. http://dx.doi.org/10.2165/00128415-201013010-00055.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1035 (2005): 7–8. http://dx.doi.org/10.2165/00128415-200510350-00018.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1057 (2005): 8. http://dx.doi.org/10.2165/00128415-200510570-00021.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1058 (2005): 8. http://dx.doi.org/10.2165/00128415-200510580-00021.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1353 (2011): 11. http://dx.doi.org/10.2165/00128415-201113530-00036.

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Rees, Sharon. "CODEINE." Journal of Prescribing Practice 1, no. 3 (2019): 113. http://dx.doi.org/10.12968/jprp.2019.1.3.113.

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&NA;. "Codeine." Reactions Weekly &NA;, no. 1422 (2012): 19. http://dx.doi.org/10.2165/00128415-201214220-00060.

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