Domestic Abuse of Codeine: A Case Study of Non-Medical Use Leading to Fatal Outcome

Codeine, an opioid analgesic present in many over-the-counter (OTC) formulations, is frequently misused through non-medical extraction techniques such as cold water extraction (CWE). These practices carry substantial risks, including incomplete removal of hepatotoxic co-formulants, contamination, and highly unpredictable dosing. We report a fatal case of a 29-year-old man who ingested codeine extracted from Antidol® tablets in combination with energy drinks and psychotropic medications. Post-mortem LC–MS/MS analysis revealed the presence of codeine (0.66 µg/mL), morphine (0.02 µg/mL), hydroxyzine (2.52 µg/mL), alprazolam (0.15 µg/mL), paracetamol (30.64 µg/mL), and additional substances in blood samples. Concentrations of codeine and hydroxyzine exceeded therapeutic ranges and were consistent with values reported in fatal intoxications, confirming a poly-drug poisoning. This case highlights the danger associated with non-medical codeine use, particularly when combined with central nervous system (CNS) depressants, and underscores the need for stricter regulation of OTC codeine-containing products as well as improved public awareness of the risks associated with domestic extraction methods.