{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:11:52Z","timestamp":1790521912401,"version":"4.1.0"},"reference-count":58,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2011,7,11]],"date-time":"2011-07-11T00:00:00Z","timestamp":1310342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2011,8]]},"abstract":"<jats:p><jats:bold>WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT<\/jats:bold><\/jats:p><jats:p>\u2022\u2003Dihydrocodeine (DHC) is an opioid analgesic sometimes prescribed as an alternative to other medications (e.g. methadone and buprenorphine) for opioid misuse. Its effectiveness is, however, still controversial.<\/jats:p><jats:p>\u2022\u2003DHC prescription rates seem to be related to levels of DHC fatalities, possibly in relation to levels of disregard of the availability of supervised or interval dispensing of opioids, but no large\u2010scale analysis of DHC fatalities has been carried out.<\/jats:p><jats:p>\u2022\u2003We analysed here involvement of DHC in fatalities that occurred between 1997 and 2007 among individuals with a history of opiate\/opioid misuse reported to the National Programme on Substance Abuse Deaths (np\u2010SAD).<\/jats:p><jats:p><jats:bold>WHAT THIS STUDY ADDS<\/jats:bold><\/jats:p><jats:p>\u2022\u2003DHC, either alone or in combination, was identified in 584 fatalities. Typical cases identified were males in their early thirties. In accidental overdoses, DHC, which had been prescribed to 45% of the victims, was typically identified in combination with other drugs, such as heroin\/morphine, methadone and hypnotics\/sedatives. Both paracetamol and antidepressants were more typically identified in combination with DHC in suicides.<\/jats:p><jats:p>\u2022\u2003Opiate\/opioid misusers should be educated about risks associated with polydrug intake and prescribers should carefully consider a pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction.<\/jats:p><jats:p><jats:bold>AIMS<\/jats:bold> Although its effectiveness is somewhat controversial, it appears that dihydrocodeine (DHC) is still prescribed in the UK as an alternative to both methadone and buprenorphine for the treatment of opiate addiction.<\/jats:p><jats:p><jats:bold>METHODS<\/jats:bold> Data covering the period 1997\u20132007 voluntarily supplied by coroners were analysed. All cases pertaining to victims with a clear history of opiate\/opioid misuse and in which DHC, either on its own or in combination, was identified at post\u2010mortem toxicology and\/or implicated in death, were extracted from the database.<\/jats:p><jats:p><jats:bold>RESULTS<\/jats:bold> Dihydrocodeine, either alone or in combination, was identified in 584 fatalities meeting the selection criteria. In 44% of cases it was directly implicated in the cause of death. These cases represented about 6.8% of all opiate\/opioid\u2010related deaths during this period. Typical DHC cases identified were White males in their early thirties. Accidental deaths (96%) were likely to involve DHC in combination with other psychoactives, mainly heroin\/morphine, hypnotics\/sedatives and methadone. Both paracetamol and antidepressants were found in proportionately more suicide cases than in accidental overdoses. DHC had been prescribed to the decedent in at least 45% of cases.<\/jats:p><jats:p><jats:bold>CONCLUSIONS<\/jats:bold> Opiate\/opioid misusers should be educated about risks associated with polydrug intake. More in particular, co\u2010administration of DHC with heroin, methadone and benzodiazepines may increase the risk of accidental fatal overdose. Prescribers should carefully consider pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. More resources are required to do prospective research in this area.<\/jats:p>","DOI":"10.1111\/j.1365-2125.2011.03908.x","type":"journal-article","created":{"date-parts":[[2011,1,14]],"date-time":"2011-01-14T15:59:18Z","timestamp":1295020758000},"page":"330-337","source":"Crossref","is-referenced-by-count":30,"title":["Deaths of opiate\/opioid misusers involving dihydrocodeine, UK, 1997\u20132007"],"prefix":"10.1111","volume":"72","author":[{"given":"Giuliano","family":"Zamparutti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Schifano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Corkery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adenekan","family":"Oyefeso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Hamid","family":"Ghodse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,7,11]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1191\/0269216305pm1054oa"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2006.01603.x"},{"key":"e_1_2_7_4_2","unstructured":"StrangJ BridgeJ DayE FarrellM GeradaC GilvarryE HarrisL HowardJ KeenJ KiddB MylesJ OrettiR RaistrickD RobertsonR SteventonN WalkerH WardleI WrightN ZadorD.Drug Misuse and Dependence \u2013 UK Guidelines on Clinical Management.London: Department of Health (England) the Scottish Government Welsh Assembly Government and Northern Ireland Executive 2007Available athttp:\/\/www.nta.nhs.uk\/uploads\/clinical_guidelines_2007.pdf(last accessed 22 May 2010)."},{"key":"e_1_2_7_5_2","first-page":"179","article-title":"Drug substitution treatment of heroin dependent patients with codeine preparations \u2013 treatment effects from the viewpoint of the physicians and patients","volume":"22","author":"Krausz M","year":"1995","journal-title":"Psychiatr Prax"},{"key":"e_1_2_7_6_2","first-page":"256","article-title":"Substitute drug\u2010assisted treatment of drug dependent patients in general practice","volume":"108","author":"Elias H","year":"1990","journal-title":"Fortschr Med"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0740-5472(00)00093-3"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-4-1"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-8-3"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(01)00122-3"},{"key":"e_1_2_7_11_2","first-page":"444","article-title":"The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales","volume":"55","author":"Strang J","year":"2005","journal-title":"Br J Gen Pract"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/16.4.375"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/002580240004000405"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/003693300104600506"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0379-0738(93)90058-I"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1000690"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.300.6735.1313"},{"key":"e_1_2_7_18_2","first-page":"261","article-title":"Dihydrocodeine in substance dependence","volume":"108","author":"Ulmer A","year":"1990","journal-title":"Fortschr Med"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2005.05.004"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2006.00259.x"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2006.01688.x"},{"key":"e_1_2_7_22_2","first-page":"1293","article-title":"Opioid poisoning deaths in New Zealand (2001\u20132002)","volume":"118","author":"Reith D","year":"2005","journal-title":"NZ Med J"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-949149"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2007.01762.x"},{"key":"e_1_2_7_25_2","unstructured":"GhodseH CorkeryJ OyefesoA SchifanoF AhmedK NaidooV.Drug\u2010related deaths in the UK: Annual Report 2009. Drug\u2010related deaths reported by Coroners in England Wales Northern Ireland Guernsey Jersey and the Isle of Man; Police forces in Scotland; & the Northern Ireland Statistics and Research Agency \u2013 Annual Report January \u2013 December 2008. London: International Centre for Drug Policy St George's University of London. September 2009. Available athttp:\/\/www.sgul.ac.uk\/research\/projects\/icdp\/pdf\/np\u2010SAD%2011th%20annual%20report%20Final.pdf(last accessed on 22 May 2010)."},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.3109\/15563657808988229"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2001.961014438.x"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.paf.0000220913.19508.99"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1159\/000088581"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.084145"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/1745-0179-3-20"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/10550490802020160"},{"key":"e_1_2_7_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2003.08.008"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1521\/suli.2010.40.1.14"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1080\/10550490490482973"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1080\/13811110903263191"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2009.0004"},{"key":"e_1_2_7_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31815ca2a3"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2008.09.003"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1997.tb09633.x"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0755-4982(05)84060-6"},{"key":"e_1_2_7_42_2","first-page":"123","article-title":"The epidemiology of attempted suicide in the Oxford area, England (1989\u20131992)","volume":"15","author":"Hawton K","year":"1994","journal-title":"Crisis"},{"key":"e_1_2_7_43_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2270"},{"key":"e_1_2_7_44_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2003.00376.x"},{"key":"e_1_2_7_45_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.301.6743.119-a"},{"key":"e_1_2_7_46_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595230600868504"},{"issue":"3","key":"e_1_2_7_47_2","first-page":"CD002208","article-title":"Methadone maintenance at different dosages for opioid dependence","author":"Faggiano F","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/070674370605101003"},{"key":"e_1_2_7_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2008.01.015"},{"key":"e_1_2_7_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61273-2"},{"key":"e_1_2_7_51_2","doi-asserted-by":"publisher","DOI":"10.1002\/hup.698"},{"key":"e_1_2_7_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000244483.17443.0e"},{"issue":"3","key":"e_1_2_7_53_2","first-page":"CD002025","article-title":"Buprenorphine for the management of opioid withdrawal","author":"Gowing L","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_54_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595230500286039"},{"key":"e_1_2_7_55_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.149.2.235"},{"key":"e_1_2_7_56_2","doi-asserted-by":"publisher","DOI":"10.1159\/000130417"},{"key":"e_1_2_7_57_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2007.01759.x"},{"key":"e_1_2_7_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2005.09.007"},{"key":"e_1_2_7_59_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-009-1472-0"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-2125.2011.03908.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-2125.2011.03908.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T13:21:46Z","timestamp":1694611306000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2125.2011.03908.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,7,11]]},"references-count":58,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2011,8]]}},"alternative-id":["10.1111\/j.1365-2125.2011.03908.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-2125.2011.03908.x","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7,11]]}}}