Sproule B A, Busto U E, Somer G, Romach M K, Sellers E M
Psychopharmacology Research Program, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
J Clin Psychopharmacol. 1999 Aug;19(4):367-72. doi: 10.1097/00004714-199908000-00014.
Although codeine is a widely used medication, the problems of codeine abuse and dependence have not been well-studied. This study characterized regular codeine users (using at least 3 days per week for 6 months, excluding those using codeine for the treatment of cancer pain) through a self-completed questionnaire. Recruitment through newspaper advertisements resulted in a total of 339 eligible questionnaires. Thirty-seven percent of subjects met DSM-IV criteria for codeine dependence. Dependent subjects (mean age, 40 +/- 10 years) were using an average of 179 (+/-171) mg of codeine per day. Codeine was predominantly used in the form of combination products with acetaminophen. Dependent subjects identified specific problems causally related to their codeine use such as depression (23%), anxiety (21%), and gastrointestinal disturbances (13%). The dependent subjects reported problems with other drugs more than did nondependent users (alcohol, 57% vs. 26%; cannabis, 23% vs. 5%; sedative/hypnotics, 33% vs. 12%; and heroin, 11% vs. 2%, respectively). Most were taking codeine primarily for a chronic pain problem (81%), although the dependent subjects currently found codeine less effective for treating pain than did the nondependent subjects and were more likely to use codeine for pleasurable effects, to relax, or to prevent withdrawal symptoms. This study showed that dependence is associated with the regular use of codeine. Pain is a key issue with these users; however, they are probably not receiving optimal treatment. There is a need to identify individuals experiencing problems with their codeine use and to develop optimal prevention and treatment strategies.
尽管可待因是一种广泛使用的药物，但可待因滥用和成瘾问题尚未得到充分研究。本研究通过一份自我填写的问卷，对经常使用可待因的人群（每周至少使用3天，持续6个月，不包括因治疗癌症疼痛而使用可待因的人群）进行了特征分析。通过报纸广告招募，共获得339份符合条件的问卷。37%的受试者符合DSM-IV对可待因成瘾的标准。成瘾受试者（平均年龄40±10岁）每天平均使用179（±171）毫克可待因。可待因主要以与对乙酰氨基酚的复方制剂形式使用。成瘾受试者指出了与他们使用可待因有因果关系的特定问题，如抑郁（23%）、焦虑（21%）和胃肠道不适（13%）。成瘾受试者报告的其他药物问题比未成瘾使用者更多（酒精，分别为57%对26%；大麻，23%对5%；镇静催眠药，33%对12%；海洛因，11%对2%）。大多数人主要因慢性疼痛问题服用可待因（81%），尽管成瘾受试者目前发现可待因治疗疼痛的效果不如未成瘾受试者，且更有可能为了获得愉悦效果、放松或预防戒断症状而使用可待因。本研究表明，成瘾与可待因的经常使用有关。疼痛是这些使用者的一个关键问题；然而，他们可能没有得到最佳治疗。有必要识别出可待因使用出现问题的个体，并制定最佳的预防和治疗策略。
