Codeine and Tramadol Use in Athletes: A Potential for Abuse.
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ABSTRACT:
SUBMITTER: Zandonai T
PROVIDER: S-EPMC8222773 | biostudies-literature | 2021
REPOSITORIES: biostudies-literature
Publications
Codeine and Tramadol Use in Athletes: A Potential for Abuse.
Zandonai Thomas T Escorial Mónica M Peiró Ana M AM
Frontiers in pharmacology 20210610
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Project description:IntroductionHip fractures among older people are a major public health issue, which can impact quality of life and increase mortality within the year after they occur. A recent observational study found an increased risk of hip fracture in subjects who were new users of tramadol compared with codeine. These drugs have somewhat different indications. Tramadol is indicated for moderate to severe pain and can be used for an extended period; codeine is indicated for mild to moderate pain and cough suppression.ObjectiveIn this observational study, we compared the risk of hip fracture in new users of tramadol or codeine, using multiple databases and analytical methods.MethodsUsing data from the Clinical Practice Research Datalink and three US claims databases, we compared the risk of hip fracture after exposure to tramadol or codeine in subjects aged 50-89 years. To ensure comparability, large-scale propensity scores were used to adjust for confounding.ResultsWe observed a calibrated hazard ratio of 1.10 (95% calibrated confidence interval 0.99-1.21) in the Clinical Practice Research Datalink database, and a pooled estimate across the US databases yielded a calibrated hazard ratio of 1.06 (95% calibrated confidence interval 0.97-1.16).ConclusionsOur results did not demonstrate a statistically significant difference between subjects treated for pain with tramadol compared with codeine for the outcome of hip fracture risk.
| S-EPMC9296392 | biostudies-literature
Project description:ImportanceAlthough tramadol is increasingly used to manage chronic noncancer pain, few safety studies have compared it with other opioids.ObjectiveTo assess the associations of tramadol, compared with codeine, with mortality and other adverse clinical outcomes as used in outpatient settings.Design, setting, and participantsRetrospective, population-based, propensity score-matched cohort study using a primary care database with routinely collected medical records and pharmacy dispensations covering more than 80% of the population of Catalonia, Spain (≈6 million people). Patients 18 years or older with 1 or more year of available data and dispensation of tramadol or codeine (2007-2017) were included and followed up to December 31, 2017.ExposuresNew prescription dispensation of tramadol or codeine (no dispensation in the previous year).Main outcomes and measuresOutcomes studied were all-cause mortality, cardiovascular events, fractures, constipation, delirium, falls, opioid abuse/dependence, and sleep disorders within 1 year after the first dispensation. Absolute rate differences (ARDs) and hazard ratios (HRs) with 95% confidence intervals were calculated using cause-specific Cox models.ResultsOf the 1 093 064 patients with a tramadol or codeine dispensation during the study period (326 921 for tramadol, 762 492 for codeine, 3651 for both drugs concomitantly), a total of 368 960 patients (184 480 propensity score-matched pairs) were included after study exclusions and propensity score matching (mean age, 53.1 [SD, 16.1] years; 57.3% women). Compared with codeine, tramadol dispensation was significantly associated with a higher risk of all-cause mortality (incidence, 13.00 vs 5.61 per 1000 person-years; HR, 2.31 [95% CI, 2.08-2.56]; ARD, 7.37 [95% CI, 6.09-8.78] per 1000 person-years), cardiovascular events (incidence, 10.03 vs 8.67 per 1000 person-years; HR, 1.15 [95% CI, 1.05-1.27]; ARD, 1.36 [95% CI, 0.45-2.36] per 1000 person-years), and fractures (incidence, 12.26 vs 8.13 per 1000 person-years; HR, 1.50 [95% CI, 1.37-1.65]; ARD, 4.10 [95% CI, 3.02-5.29] per 1000 person-years). No significant difference was observed for the risk of falls, delirium, constipation, opioid abuse/dependence, or sleep disorders.Conclusions and relevanceIn this population-based cohort study, a new prescription dispensation of tramadol, compared with codeine, was significantly associated with a higher risk of subsequent all-cause mortality, cardiovascular events, and fractures, but there was no significant difference in the risk of constipation, delirium, falls, opioid abuse/dependence, or sleep disorders. The findings should be interpreted cautiously, given the potential for residual confounding.
| S-EPMC8527363 | biostudies-literature
Project description: Not available
| S-EPMC9647590 | biostudies-literature
Project description:Background: Tramadol and codeine are metabolized by CYP2D6 and are subject to drug-gene and drug-drug interactions. Methods: This interim analysis examined prescribing behavior and efficacy in 102 individuals prescribed tramadol or codeine while receiving pharmaco-genotyping as part of the INGENIOUS trial (NCT02297126). Results: Within 60 days of receiving tramadol or codeine, clinicians more frequently prescribed an alternative opioid in ultrarapid and poor metabolizers (odds ratio: 19.0; 95% CI: 2.8-160.4) as compared with normal or indeterminate metabolizers (p = 0.01). After adjusting the CYP2D6 activity score for drug-drug interactions, uncontrolled pain was reported more frequently in individuals with reduced CYP2D6 activity (odds ratio: 0.50; 95% CI: 0.25-0.94). Conclusion: Phenoconversion for drug-drug and drug-gene interactions is an important consideration in pharmacogenomic implementation; drug-drug interactions may obscure the potential benefits of genotyping.
| S-EPMC6562829 | biostudies-literature
Project description:BackgroundCytochrome P450 2D6 is involved in the metabolism of several important medicines including opioids. Variations in CYP2D6 have been implicated in drug response and according to the Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6, dosing for CYP2D6 substrates should be based on variants carried by individuals. Although CYP2D6 variations in Ghana had been previously recorded, not all variants have been reported in the Ghanaian population. In this exploratory study we set to investigate certain unreported variations in the Ghanaian population in addition to the previously reported ones and use that to understand the tramadol 'abuse' crisis that is currently being experienced in Ghana.MethodsThis study employed a convenience sampling approach to include 106 unrelated participants who were recruited as part of the PHARMABIOME project. We successfully genotyped 106 samples using Iplex GOLD SNP genotyping protocol after extracting DNA from these individuals. Allele and diplotype frequencies were undertaken by counting from observed genotypes. Comparison of alleles reported from various studies were done.ResultsUnreported alleles such as *3, *9 and *41 which are classified as no function and decreased function were observed in our study cohort. In addition, variants such as (*1, *2, *4, *5, *10, *17 and *29 were observed with different frequencies. Our study showed 26% representation of intermediate metabolizers (IM) and 2% poor metabolizers (PM) in the study population.ConclusionThe implications for informal sector workers who use tramadol for recreational purposes, is that IMs and PMs will overdose as they may have reduced analgesic effects which will translate into increased risks of unforeseen adverse events. We therefore propose that CYP2D6 should be considered in opioid dosage while making use of these observed variations to implement new approaches to tackle the tramadol 'abuse crisis' in Ghana.
| S-EPMC10804791 | biostudies-literature
Project description:The current Dutch Pharmacogenetics Working Group (DPWG) guideline, describes the gene-drug interaction between CYP2D6 and the opioids codeine, tramadol and oxycodone. CYP2D6 genotype is translated into normal metaboliser (NM), intermediate metaboliser (IM), poor metaboliser (PM) or ultra-rapid metaboliser (UM). Codeine is contraindicated in UM adults if doses >20 mg every 6 h (q6h), in children ≥12 years if doses >10 mg q6h, or with additional risk factors. In PMs, an alternative analgesic should be given which is not or to a lesser extent metabolised by CYP2D6 (not tramadol). In IMs with insufficient analgesia, a higher dose or alternative analgesic should be given. For tramadol, the recommendations for IMs and PMs are the same as the recommendation for codeine and IMs. UMs should receive an alternative drug not or to a lesser extent metabolised by CYP2D6 or the dose should be decreased to 40% of the commonly prescribed dose. Due to the absence of effect on clinical outcomes of oxycodone in PMs, IMs and UMs no action is required. DPWG classifies CYP2D6 genotyping for codeine "beneficial" and recommends testing prior to, or shortly after initiation of treatment in case of higher doses or additional risk factors. CYP2D6 genotyping is classified as "potentially beneficial" for tramadol and can be considered on an individual patient basis.
| S-EPMC9553935 | biostudies-literature
Project description:IntroductionTramadol abuse is a current public health concern in Ethiopia. Drug abuse including that of tramadol is a significant public health issue that causes health, economic, and social problems to individual drug users, their families, the community, and the entire nation. Therefore this study delivers information regarding current tramadol abuse among students of an Ethiopian University.ObjectiveThe aim of this study is to assess the prevalence of tramadol abuse and associated factors among Hawassa university students, February to June 2023.Methods and materialsA cross-sectional study was performed among 402 randomly selected Hawassa university students. Data was collected from participant through self-administered researcher made questionnaire using kobo toolbox software applications. Data from kobo toolbox were directly exported to and analyzed by using SPSS version 26 software. Binary logistic regression was applied to identify the factors associated with tramadol abuse. In the final model, Adjusted Odds Ratio, and 95% CI was used to measure the strength of association and P-value less than 0.05 considered statistically significant.ResultA total of 402 students were enrolled in this study of which 46 students (11.4%) [95% CI 8.5-14.7] had history of tramadol abuse once in their lifetime with 23.9% of them were active tramadol abuser with some dependence behaviors. The result of multivariate analysis shows that having a friend who use drugs [AOR = 1.691, 95% CI (0.718-3.980), p = 0.041], knowing about tramadol [AOR = 13.766, 95%CI (3.003-63.113), p = 0.001] and having the history of taking tramadol with physicians prescription in their life time [AOR = 7.960, 95%CI (3.603-17.587), P < 0.001] were the significant predictors of tramadol abuse.ConclusionThe life time prevalence of tramadol abuse among university students is high and it demands attention of government and the general public.
| S-EPMC11892866 | biostudies-literature
Project description:ObjectiveTo assess the potential impact of Pharmacogenomic (PGx) variation in cytochrome P450 2D6 (CYP2D6) enzyme function, using loss in quality-adjusted life years (QALYs) associated with treatment problems, and the willingness to pay to avoid treatment problems from patients' and payers' perspectives.Patients and methodsThe study included patients prescribed tramadol or codeine, or both, between January 1, 2005, and December 31, 2017. Demographic information and adverse drug events, including adverse drug events and poor pain control, were collected from the electronic health records using natural language processing techniques and review by trained abstractors. Patients' willingness to pay and QALY estimates were based on comprehensive literature review. The CYP2D6 phenotypes were divided into 4 groups: ultra-rapid metabolizers, normal metabolizers, intermediate metabolizers, and poor metabolizers.ResultsAmong the 2860 identified patients, 63 (2%) were ultrarapid metabolizers, 1449 (50%) were normal metabolizers, 1155 (40%) were intermediate metabolizers, and 193 (7%) were poor metabolizers. The patients' average estimated willingness-to-pay value to avoid treatment problems was $23 per month; poor metabolizers developed problems with the highest estimated willingness-to-pay value ($32 per month). The mean QALY loss among all patients was 0.024 QALYs (8.8 healthy days); poor metabolizers had the highest loss (0.027 QALYs, 9.9 healthy days).ConclusionPatients with various phenotypes developed different treatment problem profiles. Poor CYP2D6 metabolizers developed problems with highest willingness to pay, and they might potentially benefit most from PGx-guided treatment and problem prevention.
| S-EPMC7930862 | biostudies-literature
Project description:PurposeThis study aimed to examine the 12-month prevalence and 12-month prospective change in reported sexual harassment and abuse (SHA) victimization among young elite athletes, recreational athletes, and reference students in three different social settings and to identify the perpetrators.MethodsIn total, 919 adolescents responded to an online questionnaire in 12th grade (T1) and 13th grade (T2). The sample consisted of elite athletes ( n = 482) and recreational athletes ( n = 233) attending Norwegian elite sport high schools ( n = 26), and reference students ( n = 200) attending ordinary high schools with no sport specialization ( n = 6). Data were analyzed using independent-sample t -test, Pearson χ 2 for independence/Fisher's exact test, McNemar test, and logistic regression analysis.ResultsThe total 12-month prevalence of SHA was 38.6% at T1 and 35.1% at T2. Most of the participants (74.6%-85.0%) reported no change in SHA from T1 to T2. The prevalence of SHA was higher for girls compared with boys, and elite athletes reported less SHA than recreational athletes and reference students, respectively. SHA occurred most often in a free time setting. Verbal sexual harassment, nonverbal sexual harassment, and physical SHA were reported by 24.6%, 27.0%, and 14.0%, respectively. Peers were reported as perpetrators by 83.1%, trainer/teacher/health personnel by 20.1%, and "other" perpetrators by 56.4%.ConclusionsBecause one in three elite athletes and nearly one in two recreational athletes and reference students, respectively, reported SHA victimization within a 12-month period, well-targeted preventive measures are needed for both young athletes and nonathletes.
| S-EPMC9584052 | biostudies-literature
Project description:Compound-analgesics containing codeine (CACC) have been a common source of codeine for people seeking opioid replacement therapy (ORT) for codeine use disorder (CUD). Our previous work demonstrated no relationship between pre-treatment CACC and ORT buprenorphine doses; we hypothesised that CYP2D6 activity would partially account for this disconnection. One hundred six participants with CUD were compared to a published population sample of 5408 Australian patients. Mean age of participants with CUD at treatment entry was 35 years, with mean 6.1 years duration of CUD. Mean codeine dose was 660 mg/day (range 40-2700 mg). Mean calculated CYP2D6 activity scores were significantly higher in the codeine group (CUD 1.65 + 0.63 vs. Gen pop 1.39 + 0.65, Wilcoxon W = 347,001, p < 0.001). Pre-treatment CACC dose weakly predicted sublingual buprenorphine doses overall; there was a stronger relationship within ultrarapid metabolisers. While normal and ultrarapid metabolisers of codeine were more likely to have a diagnosis of CUD, poor or intermediate CYP2D6 metaboliser status may protect against CUD.
| S-EPMC10661737 | biostudies-literature