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Codeine Addiction and Abuse

Codeine is a narcotic analgesic that is recognized on the World Health Organization list as an Essential Medicine. In order to support public health needs, codeine must therefore be effective, safe and comparatively affordable. Within this context, the codeine that is dispensed to the population is required to meet quality standards with supporting information and be available in appropriate doses at all times in health care systems. Despite this Essential Medicine designation and these stringent qualification standards, the opium content in codeine contributes to the frequency with which codeine medications are abused that result in codeine addiction and abuse.

History of Codeine Addiction and Abuse

Codeine, morphine and heroin are all derived through various extraction procedures from the seed of the opium poppy plant (Papaver somniferum). In 1832, French scientist Pierre Jean Robiquet discovered codeine during a morphine extraction process. Once discovered, codeine quickly achieved widespread popularity for its analgesic and antidiarrheal properties. Because of codeine’s ability to relieve pain, it replaced the use of raw opium in the 19th century for this purpose and has since retained its popularity as a powerful and effective pharmaceutical for use in modern health care systems. However, most of the codeine used today is synthetized from morphine through the O-methylation process.

Codeine Addiction and Abuse Trends

Take Our Treatment AssessmentIn recent years, codeine abuse has significantly increased due to misuse of many codeine products that are available to consumers today. Although codeine is relatively safe when used as directed, the psychoactive ingredients in codeine has the potential to cause dependence and codeine addiction through frequent or continuous use.

Codeine is marketed as both a single-ingredient drug and in combination with other substances such as acetaminophen and synthetic compounds such as aspirin and ibuprofen which are nonsteroidal anti-inflammatory drugs (NSAID). When codeine is used in combination with other ingredients, these can sometimes heighten codeine abuse risks. And, although it is primarily used to treat mild to severe pain and cold symptoms, some people develop codeine dependence if they use the drug beyond recommended use periods or increase the dose. Recreational use of codeine primarily for its euphoric effects presents a much greater opportunity for consumers to develop codeine addiction. Codeine withdrawal symptoms that occurs if use of the drug is abruptly halted is a strong indicator of a developing tolerance, dependence or codeine addiction.

Common street names for Codeine

The most common street names for codeine usually differentiate which type of codeine product is being abused such as:

  • Cody or Schoolboy describes codeine-only products
  • Sizzurp describes cough syrup with codeine that is combined with soda.
  • T 1, T2, T3 and T4 describes Tylenol with different strengths of Codeine.
  • Codeine and Doriden (Glutethimides) may be called loads, pancakes and syrup or doors and fours.

The preceding list is by no means a complete compilation of street names for codeine. Because codeine is a component of many medications including over the counter tablets and syrups, it can be referred to by many different names that relate to the codeine alone or in combination with other medications that are being abused.

Codeine Methods of Administration

Codeine may be administered via…

  • A time-release tablet
  • Cough Syrup
  • Subcutaneous or intramuscular injections
  • Suppository

Codeine Drug classification

1 DEA classification for codeine is defined by sole-content or combination products such as:
Codeine-only drugs have a Schedule II Drug designation.
2 Codeine methylbromide (Eucodin) or salt of codeine and active metabolite of codeine (Codeine-N-oxide) have a Schedule I designation.
3 Cough medicines with codeine are examples of Schedule V drugs.

Codeine Side effects

Although most people do tolerate codeine well with little or no negative reactions, the following codeine side effects have been experienced and reported:

  • constipation
  • dry eyes
  • drowsiness
  • lightheadedness
  • impaired coordination
  • shortness of breath
  • nausea
  • vomiting
  • stomach pain
  • sweating
  • Itchiness and rash

Signs of Codeine Addiction and Abuse

The calming effects of codeine can be seductive. It is one reason many people continue to take codeine or products containing codeine even after the purpose for taking it such as to relieve pain or to alleviate symptoms of a cold has been resolved. And, although codeine is not as habit forming as other substances of abuse, continued use can lead to dependence and codeine addiction. For this reason, it is important to understand the signs of abuse or codeine addiction which may include some or all of the following:

1 Codeine abusers may frequently have dilated pupils and experience slurred speech, drowsiness, impaired judgment and lack of coordination.
2 Dependency on codeine may be indicated by extended and consistent use and the need to increase the amount consumed to get the same effects.
3 Codeine addiction may be defined by behavior that meet the Diagnostic and Statistical Manual of Mental Disorders addiction criteria such as…

  • Having a high tolerance for codeine.
  • Experiencing withdrawal symptoms when the drug is withheld.
  • Cravings that drive obsessive and compulsive use of codeine.
  • Inability to stop drug use despite negative consequences such as deterioration of physical and mental health and problems with relationships as a direct result of the effects caused by codeine abuse.
  • Trouble controlling how much or how often codeine is consumed.
  • Significant changes in normal patterns of behavior.

Even so, only a qualified addiction specialist or physician through a process of evaluation can definitively diagnose codeine addiction.

Codeine Withdrawal symptoms

Codeine produces morphine-like withdrawal symptoms that may range from mild joint pain to debilitating feelings of depression. The duration and severity of these symptoms are usually dependent on the extent of the physical and psychological impact of the addiction on the individual.

The first codeine withdrawal symptoms can begin to manifest within 12 hours after the last dose and continue for about a week. These first symptoms may cause runny nose, muscle aches and pains, anxiety and drowsiness or trouble falling and staying asleep. The second phase of codeine withdrawal symptoms could include nausea and vomiting, loss of appetite, cramping in the stomach, diarrhea, sweating and chills. These can last from two weeks to a month or more.

Although Codeine withdrawal symptoms are typically not life-threatening, the discomfort often cause people to resume drug use which can exacerbates the codeine addiction condition.

Codeine Addiction and Abuse Treatment

Codeine addiction can simultaneously impair the physical and psychological health of the addict. As such, treatment must help the individual to stop habituated drug use; preferably in a safe and comfortable environment with around the clock medical oversight. It should also provide the appropriate treatment interventions and tools to restore both mental and physical homeostasis. For rehabilitation from codeine addiction to be successful, it is therefore important to participate in and complete a comprehensive recovery program that considers the unique mental and physical condition of the patient relative to the addiction.

We believe that the primary objective of any codeine addiction treatment is to alleviate the symptoms of addiction and provide a level of care and tools that support and enable long term sobriety. Call White Sands Tampa at 1-877-640-7820 if you or a loved one is suffering from Codeine addiction.

1. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009704/?report=details
2. http://www.who.int/topics/essential_medicines/en/
3. http://www.fda.gov/Drugs/default.htm
4. https://www.deadiversion.usdoj.gov/schedules/orangebook/d_cs_drugcode.pdf#search=codeine

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