In recent years, cough drops, compound licorice tablets and other non-narcotic drugs have been reported in the media as potentially addictive. For example, “addicts” mix cough syrup, which is the same color as Coke, with Coke to make “shaken head water” and consume more than 360ml of cough syrup per day, and this form of abuse is especially popular among high school students. Since then, compound licorice tablets and nux vomica tablets have also been reported to have addiction risks. As a result, people began to focus their attention on these drugs commonly used by the general public to suppress cough and expectorant, clear heat and detoxify the body. This article focuses on the types of these potentially addictive non-toxic anesthetic drugs, the identification of addiction symptoms, and how to properly use these drugs.
A. Several common non-toxic anesthetic drugs that cause dependence
1. Compound codeine phosphate solution
This product is a cough suppressant, is a commonly used cough drops, mainly containing codeine, ephedrine, ammonium chloride, paracetamol and other ingredients. Although this product is not a narcotic drug, it contains codeine, an opioid ingredient, and ephedrine, both of which are under national control of narcotic drugs and psychotropic substances and have the potential for dependence. Codeine, as a central cough suppressant, directly inhibits the medullary cough center to produce cough suppression, while ephedrine hydrochloride has a calming effect and is often used in the treatment of bronchial asthma. The combination of the two can exert cough suppressant, asthma calming and expectorant effects. The codeine and ephedrine levels in cough medicine are very low, so normal use is not addictive. The dose is usually 10-15 ml per dose, 3 times a day for adults, and should not exceed 30 ml in 24 hours.
The drug has some adverse reactions, including gastrointestinal discomfort, abdominal pain, constipation, nausea, vomiting, dry mouth, drowsiness and dizziness, and some patients may experience euphoria and irritability when taking more than 60ml in one oral dose. Large amounts can produce euphoria and hallucinations, giving people a feeling of drifting. Long-term use of cough drops containing these ingredients can lead to pathological addiction, and mental depression, memory loss, and abnormal behavior may occur after discontinuing use. This is the pharmacological basis that leads to abuse. Addiction not only causes physical and psychological damage to the patient, but also may lead to personality alienation and even to the path of drug abuse and other illegal crimes. Therefore, the national authorities have classified it as a prescription drug, and pharmacies are required to sell it with a prescription to avoid the harm caused by abuse to patients.
2.Compound licorice combination and compound licorice tablets
Compound licorice combination and compound licorice tablets are commonly used as cough suppressants and expectorants, containing licorice infusion, opium powder, antimony potassium tartrate, camphor and anise oil, etc. They are generally used for coughs caused by colds and upper respiratory tract infections. Normal therapeutic doses are: compound licorice combination, 10 ml per dose orally for adults, 3 times a day; compound licorice tablets, 3-4 tablets per dose for adults, 3 times a day.
Because the opioid powder component of the drug is a narcotic drug, addictive adverse reactions from its application have been reported in recent years, especially in the elderly. One study reported that a 62-year-old male patient, who took 4 tablets of this drug orally three times a day for chronic bronchitis, became addicted for three months, manifesting as mental depression, general discomfort, lacrimation, sighing, and violent coughing. If not taken in time it is extremely painful and even a sense of despair. If the product is taken in time, the above symptoms can disappear completely within 5 to 10 minutes. It is recommended that the clinician should prescribe the dosage of this product in the usual amount of no more than 3 d and no more than 7 d continuously, or use other expectorants and cough suppressants instead of this product.
3.Tincture of compound camphor
Compound camphor tincture is a common antidiarrheal drug, containing a small amount of opium (about 5 parts per million), can enhance intestinal smooth muscle tone, reduce gastrointestinal propulsive peristalsis, dry stool and stop diarrhea, mainly for diarrhea, abdominal pain, etc., mostly for non-bacterial severe diarrhea. The normal dose for use is, taken orally, 2~5ml once, 3 times a day.
As early as in 70s and 80s, there was an epidemic trend of compound camphor tincture abuse and addiction in some areas of China. Due to the serious adverse consequences, the production, supply and use of compound camphor tincture were once forced to stop. At present, compound camphor tincture has been included in the national narcotic drug control catalog, and patients buy such drugs under the prescription of narcotic prescription by doctors.
4.Niuhuang detoxification tablets
Niuhuang detoxification tablets are commonly used for throat diseases, and are the representative of the Chinese patent medicine for clearing heat and detoxifying drugs. It is mainly made of artificial niu huang, xiong huang, gypsum, rhubarb, scutellaria, orris, ice chips and licorice, which has the effect of clearing heat and detoxifying. It is used for the treatment of common diseases such as tonsillitis, pharyngitis, gingivitis, mouth ulcers and constipation. There are reports in the literature that long-term use of Niuhuang detoxification tablets can lead to addiction. Severe withdrawal symptoms can occur after stopping the drug, with increased sore throat, perioral and nasal herpes, general malaise, euphoria and insomnia, decreased appetite, constipation, and rapid relief of the above symptoms after taking the drug again. The mechanism of addiction is not clear, and long-term use should be avoided.
Identification of addiction symptoms
If the patient meets 2 of the following conditions in the use of the above drug, then addiction to the drug has occurred.
1.Increased tolerance: the dose of the drug used must be increased to obtain the previous effect.
2.Decreased control: knowing that it is wrong to take the drug for a long period of time and in excess, but not being able to control their behavior.
3. the emergence of craving: an increasing desire to obtain the drug
4.Withdrawal symptoms: when the drug is discontinued, withdrawal symptoms that are the opposite of the therapeutic effect occur.
5. “Drug”-centered life pattern: the patient is increasingly disinterested in other social and recreational activities and spends more time seeking and using the drug or takes longer to recover from the effects of the drug.
6. continued use of the drug despite having demonstrated toxic effects of drug overdose, such as psychotic depression or functional impairment, and the patient does know the nature and extent of these harmful outcomes.
III. Proper use of drugs
The fear of “addiction” is very strong due to the overemphasis on the dependence-causing properties of these non-narcotic medications in the information provided to the medical community and the public. It is important to be objective and recognize that all drugs have positive and side effects. Acknowledging the side effects of a drug does not mean that its normal medical application should be denied, but the correct way to use a drug is to “manage it and use it” – to manage it properly and to use it wisely. If the addictive effects are exaggerated and the normal use of the drug is affected, the patient will be the ultimate victim. So how should we use these drugs correctly?
1, strictly follow the medical advice to take
Although some cough medicines and fever relievers contain the above-mentioned dependence-causing ingredients, they will not lead to addiction if taken for therapeutic purposes and in strict accordance with the prescribed dosage and regimen; moreover, most of the drugs containing codeine are prescription drugs and have clear specifications for use. In addition, because the combination of different addictive drugs can easily produce a superimposed effect, greatly increasing the dependence and danger, so remember not to combine the use of alcohol, morphine and other addictive substances in taking the above drugs.
2.The principle of short-term and moderate use of drugs
Since most of these non-narcotic drugs are used for symptomatic treatment and have potential addictive properties, they are not suitable for long-term and large amounts. These drugs should be taken in strict accordance with the dose recommended by the medication rules and should be taken for a short period of time, generally not more than 1 week. In the unlikely event of addiction symptoms, you should go to the hospital promptly and seek medical help.
3, special populations should be used with caution
For children, the elderly and other special populations, should try to avoid using cough medicine containing codeine, ephedrine ingredients. Pregnant women should not take them. At the same time, people who need to drive or engage in other concentration work had better not take it.