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Table 3 Decisions to utilise CWE across groups of participants (CCM alone versus CCM and heroin)

From: Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Participants using CCM

Participants using CCM and heroin

All participants


CWE was used to eliminate non-opioid analgesics (paracetamol and ibuprofen) to reduce the risk of paracetamol overdose.

The many steps involved (including sourcing OTC CCM from multiple pharmacies) made CWE less attractive.


Cravings outweighed concerns about the ineffectiveness of CWE and triggered utilisation.


Online information influenced use of CWE (facilitated tampering of psychoactive medicines but also reduced the risk of harm associated with paracetamol overdose).


Concerns of injecting tablet fillers in solutions containing crushed tablets facilitated use of CWE.


When stronger codeine (prescription-only CCM) were not accessible, participants treated OTC codeine-containing tablets with CWE.


Reduced supply of heroin would lead participants to source other types of opioids including utilisation of CWE.