Codeine is a drug that is available in low doses “over the counter” or on prescription in higher doses. It is an opiate drug that is used in the treatment of mild to moderate pain. Like other opioid drugs, codeine should only be taken for a short period as prolonged use, even at therapeutic doses, can cause increased tolerance and raises the risk for addiction. Abuse of codeine also increases the risk of addiction and makes an overdose more likely.
Codeine is part of the opioid family of drugs. It is used in the treatment of mild to moderate pain. By itself, codeine is typically available on prescription only, but when combined with the other substances mentioned above in low doses, it can be obtained from pharmacies and other outlets.
Codeine is usually prescribed by a doctor to treat pain that is not responding to typical over-the-counter painkillers such as paracetamol or ibuprofen. It is characteristically available in tablet form, but it can also be sold as a syrup to treat chronic coughs in adults (although there is little evidence that it is effective in treating acute cough in children or adults).
Although considered less addictive than some other opiates, codeine remains an addictive substance and one that should be taken with caution. Unlike most other opiate drugs, codeine is available “over the counter” in most pharmacies but only in low doses, often as a combination drug with other substances such as paracetamol, aspirin, or ibuprofen.
The fact that codeine is available in pharmacies often gives people the illusion that it is completely safe to take, but it can carry significant risks to health, particularly when abused. Moreover, when taken in a way it is not intended, there is an increased risk of addiction.
How Can Codeine be Addictive?
As an opioid drug, codeine does induce similar effects as other drugs in its class, so those who take it may experience feelings of contentment, relaxation, and wellbeing. It can also make some individuals feel calm and sleepy.
As with other opiates, codeine is an addictive drug and so prolonged regular use can result in cravings and a fervent desire to keep using it. Recommended for short-term use only, it is very possible to build up a tolerance to codeine when it is used for longer periods of time. Increased tolerance means that you may find codeine to be less effective than it was when you first started taking it.
Regular users of codeine often develop both a physical and psychological dependence on the drug, which causes various symptoms whenever they try to quit. To avoid these withdrawal symptoms, many people will continue to use codeine, even if doing so causes negative consequences for themselves and others. It is this cycle of abuse that more often than not leads to a crippling addiction.
Codeine: Key Facts
Codeine is an opiate drug.
It is used to treat mild to moderate pain and is available both over-the-counter and on prescription.
Codeine is available in tablet form, as a liquid to swallow, or in injectable form.
Codeine stops pain signals from travelling to the brain.
Codeine addiction is possible if the drug is abused.
It is not recommended for use in children under the age of 12.
Codeine is a Class B drug and it is, therefore, illegal to have without a prescription.
Supplying codeine to another person, even if that person is a friend or family member, could result in a prison sentence of up to 14 years and an unlimited fine.
The effects of codeine are typically noticed after about fifteen to thirty minutes and peak around two-and-a-half-to-three hours. They tend to last for up to six hours.
The most common side effects associated with codeine use are constipation and drowsiness.
Why are Opiates Prescribed?
Opiates are typically prescribed for the treatment of mild to severe pain. While codeine is the opioid of choice for mild pain, most other forms of the drug are reserved for conditions that cause moderate to severe pain. In most cases, opiates are used for acute pain caused by trauma or surgery. They are fast acting and effective and, when used for a short period of time, are considered quite safe to take.
Opiates are not usually recommended for the treatment of chronic pain though unless that pain is caused by a terminal condition such as cancer. For patients with terminal conditions, opiates can form an important part of their palliative care.
Although medications such as codeine were once considered highly effective in treating cough, studies are now throwing some doubt on the efficacy of such treatments.
One side effect of opiate drugs is constipation, so they are sometimes prescribed in the treatment of diarrhoea or irritable bowel syndrome. Long-term use of opiates for the suppression of diarrhoea is not recommended though as it can lead to constipation.
Understanding Codeine Abuse
Most people do not understand what codeine abuse is, which is usually because they don’t know that this is a drug that can be harmful when taken in a way that was not prescribed.
Taking more than prescribed
Taking codeine in doses larger than those prescribed by a doctor or as recommended on the pack is considered abuse.
Mixing with alcohol
Abuse of codeine also occurs when the drug is mixed with alcohol, which is a common occurrence in those trying to enhance its effects.
Any other use of the medication intentionally used to increase its effects is considered abuse.
Understanding Codeine Dependency and Tolerance
Codeine is not recommended for long-term use because the body and brain can quickly build up a tolerance to it. A tolerance occurs when the body adjusts and becomes less responsive to it. The result is that you might feel as though the codeine is not working as effectively as it once did to relieve your pain.
When a tolerance to codeine occurs, abuse of the drug frequently follows. Many individuals believe that the best way to achieve the desired effects is to increase their dosage of the drug. Unfortunately, this is a cycle that will continue, and your body will simply adjust to the higher dosage too.
After a while, your body and brain will learn to rely on codeine for the relief of pain or to feel ‘normal’ so that when you do try to quit or cut down on your use, you will probably suffer a range of withdrawal symptoms. These symptoms occur as your body tries to adjust to the removal of the drug that it has come to rely on.
When treating codeine addiction, it could be beneficial for you to be prescribed a substitute drug to lessen the impact of withdrawal. Two of the most common drugs used as substitutes during the treatment of opioid dependence are methadone and buprenorphine. When it comes to the treatment of codeine addiction, buprenorphine is the substitute typically used.
The aim of a substitute for codeine is that it can be administered during the detox process when you are trying to break free from your medication. Withdrawal from any type of opiate drug can lead to a range of rather unpleasant withdrawal symptoms, but the use of a drug such as buprenorphine can lessen the severity of the process.
Before buprenorphine can be used as a substitute for codeine, an assessment will be carried out by whoever is treating you. He or she will, for example, determine the dose to be taken, which will usually be between 12mg and 16mg. Your doctor might introduce buprenorphine slowly while at the same time decreasing your dose of codeine. This helps to limit the type and severity of withdrawal symptoms that you might experience.
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The Dangers of Codeine Addiction
Codeine addiction is like any other addiction in that it can be dangerous and lead to many harmful consequences in terms of health and other aspects of your life. The longer you are abusing a drug such as codeine, the greater the risk that you will develop long-term mental and physical health problems.
These health problems can include liver damage, kidney damage, and acute pancreatitis. There is also the risk of long-term damage to certain parts of the brain resulting in an increased risk of things such as anxiety disorder and chronic depression.
Addiction to codeine can have a negative impact on many other areas of your life too. Let’s face it, addiction to any drug will worsen with time without being treated, and it can take over every aspect of your being. If you become consumed by your need for codeine, you are likely to have little time for anything else and you might very well lose interest in doing anything other than taking the drug that you crave.
Many people believe that addiction affects only the person abusing the drug, but this is never the case. In fact, for every person with an addiction, it is estimated that a further five are negatively impacted. In most cases, it is the people closest to the addict who will suffer, but others can also be affected.
Relationships with family members and friends are placed under massive strain because of addiction, but you may also find that your relationships with those you work with are also affected. Your performance levels in your job are likely to drop dramatically if you are constantly under the influence of a drug such as codeine or if you are so consumed by it that it is all you can think about. If the people you work with are having to pick up the slack due to your poor performance, it is highly likely that they will come to resent you.
You might even begin missing days at work due to your addiction. Depending on your job, this could then affect your income levels. If so, you might find that your financial situation also starts to suffer.
You need to also be aware that abuse of codeine can put you at significant risk of overdose, which can sometimes end up being fatal in some individuals. Your ability to think clearly can be severely hampered by the drug you are taking, and you might begin to take unnecessary risks, such as increasing your dose of codeine or mixing it with other substances such as alcohol.
What many people do not realise when they are taking low-dose codeine is that taking it in large quantities can have fatal consequences. This is because codeine bought over-the-counter is combined with other substances such as paracetamol or ibuprofen. Taking these medications in large doses can result in liver failure, kidney failure, and internal bleeding.
The signs of a codeine overdose can include:
cold clammy skin
low blood pressure
bluish fingernails and lips
Codeine Overdose Risks
As we said above, the risk of overdose occurs when the drug is taken in doses higher than those recommended by a doctor or stated on the packet if bought over-the-counter. The overdose risk also increases when the drug is combined with other substances such as alcohol, other opiate drugs, or benzodiazepines. As these are all depressant drugs, they tend to enhance the effects of each other, potentially leading to extreme sedation and a shut-down of various functions such as breathing.
Taking codeine differently to that which it was intended can also raise the risk of overdose. For example, some individuals have been known to crush codeine tablets and snort them, or else mix the resulting powder with a liquid and inject it. Although, thankfully, what we have just described is very rare indeed, doing so will dramatically increase the risk for overdose.
When to Seek Medical Care
If you believe that you may have taken more codeine than the recommended dose or have mixed it with another substance and are showing signs of overdose, it is vital to seek out emergency medical care.
There is a risk of serious complications and even death with codeine overdose, so it is absolutely critical to get help as soon as possible.
Medical care should also be sought by those who believe they may have developed an addiction to codeine. To overcome addiction, professional help is almost always required and getting help sooner rather than later will improve your chances of a full and successful recovery.
Codeine Brand and Street Names
As you know by now, codeine is available with other substances over-the-counter and is sold under a few different brand names:
Codral Cold & Flu Original
Codeine is also known under the following street names:
Causes and Risk Factors for Codeine Abuse
Most people who abuse codeine do not do so intentionally. Some people develop a physical dependency on codeine that results in withdrawal symptoms when they try to quit or cut down on their use. They soon realise though that taking more codeine makes these symptoms subside and so they can quickly get caught in a cycle of abuse and withdrawal.
There are some individuals who abuse codeine deliberately though. They do so because of the feelings of euphoria and relaxation that can be induced by the medication, particularly in higher doses. While there are some who abuse the drug for recreational purposes, others do so to escape the realities of life for a while.
Being under the influence of codeine means they forget about their problems and avoid feeling the pain associated with memories of traumatic events.
The cause of codeine addiction is not the same for each person and not everyone who uses the drug will develop an addiction. There are certain risk factors that do increase the likelihood of it occurring. These can include:
a family history of addiction
an unresolved trauma
a history of mental health disorders
environmental influences such as peer pressure, relationship problems or stress
early exposure to codeine
Codeine Abuse Statistics
In 2016, the number of paracetamol deaths was 219. Twenty-eight per cent of those involved a paracetamol compound that included codeine.
The number of people attending hospital in England with opiate poisoning in 2015/2016 was 11,660. This related to drugs such as codeine, oxycodone, fentanyl, and morphine.
The Royal Pharmaceutical Society and the Faculty of Pain Medication at the Royal College of Anaesthetists have stated that they have concerns about the growing number of people using opioids such as codeine and tramadol.
Codeine is available on prescription only in 25 countries, although it remains legal to purchase it in pharmacies and other outlets in the UK.
In 2015, the UK consumed almost 16% of the world’s share of codeine, second only to India with 19.3% and ahead of the United States with 12.8%.
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Co-Occurring Disorders of Opiate/Codeine Abuse
Substance abuse commonly occurs in those with mental health disorders, but it can also be the catalyst for these problems to develop. Many people with conditions such as major depressive disorder or anxiety disorders will use drugs such as codeine to help relieve their symptoms.
The fact that codeine can help them to relax and feel more content can reduce feelings of anxiety and stress. Abuse of codeine commonly occurs in people suffering from mental health disorders, but it is important to remember that long-term abuse of any mood-altering chemical can contribute to symptoms such as anxiety and depression.
Having a co-occurring disorder along with codeine abuse can make treatment more complicated. It is often the case that treatment providers are unsure which disorder occurred first or which one is causing the symptoms. It is important that you access a treatment provider that specialises in dual diagnosis if you have a codeine problem coupled with a mental health issue.
Some of the more common co-occurring disorders of opiate/codeine abuse include:
generalised anxiety disorder
post-traumatic stress disorder
obsessive compulsive disorder
major depressive disorder
Codeine and Other Substances
Codeine is often combined with other substances such as alcohol and other sedative drugs. When codeine becomes less effective, there is a temptation to mix it with other drugs or alcohol to enhance the effects.
Alcohol is particularly dangerous when used with codeine as it can cause the active ingredients in the medication to be released much more quickly, which could lead to overdose. Aside from the risk of overdose though, mixing alcohol with codeine can lead to problems with judgement and decision making, potentially leading to an increased risk of harm through accidental injury.
Codeine can be equally dangerous when taken with other depressant substances as the effects on the respiratory system can be devastating. When combining more than one substance that depresses the central nervous system, there is a very real risk of respiratory distress, coma, and even death.
Codeine Addiction and Possible Treatments
Treatment for codeine addiction usually begins with detox and then followed by rehabilitation. Detox addresses the physical element of the illness while the rehab deals with the underlying cause of the addiction.
When it comes to treating a codeine addiction, there are several methods regularly used. The type of treatments used to help you overcome your addiction will depend on the severity of the addiction and the preferences of the treatment provider.
The treatment is usually tailored to the needs of the individual patient, meaning that your programme of care will be one that meets your needs and preferences. It might include, for example, a combination of medication, behavioural therapy, and holistic treatments.
Medication can help to lessen the impact of withdrawal, while traditional talking and behavioural therapies are used to help you identify the cause of your behaviour and show you how to avoid a return to it going forward. Holistic therapies are often used in conjunction with medication and traditional therapies for a more rounded approach to recovery. They can help to heal the mind, body, and spirit as a whole, rather than just the addiction itself.
Codeine detox will obviously be necessary if you have a physical addiction; it is the process that will break the cycle of abuse. It is highly recommended that you detox in a special facility though where staff can help to make the process much easier and more comfortable.
During detox, you might experience a range of withdrawal symptoms, depending on the severity of your addiction and how long you have been addicted for. Your physical and mental health will also play a role in the type and intensity of any symptoms you might experience.
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What about Withdrawal?
Withdrawal from codeine can be unpleasant and many individuals see a similarity between the symptoms they experience and having a bout of severe flu. The symptoms that occur are usually the result of the brain and body’s reaction to the withdrawal of the drug they have come to rely on.
Symptoms tend to appear after a few hours of taking the last dose and usually last for about a week. However, psychological symptoms can persist for many months. Although a sudden cessation of codeine is the quickest way to break free from the drug, it can be more severe, so a gradual reduction of medication is usually recommended.
Do You Need to go onto Rehab?
When you are no longer using codeine after a detox, you might mistakenly believe that treatment is over and that you can get back to normal everyday life without any worries. Nevertheless, to overcome an addiction, you will need to more than just quit the drug. It is important that you also deal with any issues that potentially caused the addiction in the first place. Furthermore, as these may be buried deep in the subconscious mind, you are likely to need a programme of rehabilitation to help you achieve this.
Rehabilitation involves a series of treatments that take place on a one-to-one basis with a counsellor or in a group setting with other recovering addicts. So just to reiterate, to fully overcome your addiction, you will need to engage in a comprehensive programme of recovery that includes both detox and rehabilitation.
Frequently Asked Questions
Can misuse of these OTC medicines lead to addiction?
Over-the-counter medications are commonly considered completely safe; many people do not even realise that their use constitutes abuse. Codeine is not recommended for long-term use, but many individuals continue to take it regularly, unaware of the potential for addiction.
Abuse of codeine, or even prolonged use at recommended doses, can lead to an increased tolerance, the development of a physical dependence, and addiction.
How can these OTC medicine overdoses be treated?
Emergency medical treatment is required for a codeine overdose. Because there is a serious risk of harm or even death, it is vital to seek medical care as soon as possible if you believe you or someone you love has taken too much codeine.
Treatment will depend on the symptoms being displayed.
For example, if the person is suffering from breathing difficulties, artificial ventilation may be used. An opioid antidote known as Naloxone might also be administered to reverse the effects of the overdose.
Activated charcoal, which can prevent any more the drug from being absorbed by the stomach, could also be offered.
How can I spot codeine addiction?
If you are worried that you might have an addiction to codeine, it is important to think about how much control you have over your use of the medication. If you have tried to quit or cut back on your use but found yourself unable to do so because of withdrawal symptoms, you may have developed a physical dependence to your medication. This tends to be the precursor for addiction.
If you are addicted, you are likely to continue abusing codeine even if it is having a negative impact on daily life. You may be preoccupied with the medication to the point where you are unable to think of anything else.
What is the goal of codeine addiction treatment?
Codeine addiction treatment is designed to help you break the physical cycle of abuse and tackle the underlying emotional and psychological issues associated with the illness.
How bad is codeine addiction?
As with any other addiction, codeine addiction has the potential to cause a lot of harm to your life and the lives of those around you. Continued regular abuse of an opiate drug such as codeine can result in a plethora of health problems, some of which could become life-threatening.
You might also suffer relationship problems because of your addiction, and unless you get treatment, these relationships could end up being pushed to breaking point.
How to cure codeine addiction?
Codeine addiction can never be completely cured, but it is possible to overcome your addiction and go on to live a full and healthy sober life without ever suffering a relapse. Committing to a comprehensive programme of recovery that includes a detox and rehabilitation followed by aftercare support is the best way to achieve permanent recovery.
How to help someone who is addicted to codeine?
If you are worried about a loved one who you believe might be addicted to codeine, it is important that you address the issue head-on. You might be hoping that by doing nothing the problem will go away, but this is unlikely to happen. It is far more likely that the situation will only get worse, so it is vital that you broach the subject with the affected person.