[Codeine-based combinations : an expanding public health crisis]

Often regarded as a "mild" opioid, codeine and dihydrocodeine (slightly more potent) enjoys a reassuring image among the general public. Its availability in pharmacies, common use as a mild analgesic or cough suppressant, and pharmaceutical manufacturing all contribute to this perception of safety. Yet, this accessibility masks a very real addictive potential, now well documented. Diversions from medical use, particularly in the form of recreational mixtures such as Purple Drank, illustrate the dangers of dihydrocodeine and the diphenhydramine when combined with other central nervous system depressants. Behind its medical legitimacy, codeine can produce effects comparable to those of more potent opioids, a risk still too often underestimated.