Codeine Abuse: Addiction Potential, Symptoms and Effects

Medically Reviewed

A derivative of morphine that comes from the opium poppy plant, codeine is a prescription narcotic drug. It is designed to treat pain, and it also has some cough-relieving effects. According to the U.S. Food and Drug Administration (FDA), codeine is marketed on its own and as a combination medication, often in cold and cough medications and with nonsteroidal over-the-counter (OTC) pain medications, such as aspirin or acetaminophen. Codeine can be administered via tablet, capsule, or liquid to be swallowed or through injection usually in a hospital setting.

Codeine has been widely used medically as an analgesic drug since it was first synthesized in the 1800s. It is a drug with a high potential for abuse and addiction, and as such, codeine is classified as a Schedule II controlled substance by the Drug Enforcement Administration (DEA). This is the highest drug scheduling for substances with approved medical uses in the United States. Combination codeine products containing less than 90 milligrams per dosage are classified as Schedule III controlled substances.

Codeine is an opiate drug. Prescription opioid drugs are some of the most commonly misused medications in America, the National Institute on Drug Abuse (NIDA) warns. NIDA further reports that approximately 54 million Americans have used a prescription medication for nonmedical purposes at least once in their lives. Codeine is a prescription medication that should be used only as directed by a medical professional, as it does carry a significant risk for abuse, dependence, and addiction.

Side Effects of Codeine Use

As an opioid, codeine interacts with brain chemistry and the central nervous system. Opiates bind to receptors in the brain and act as central nervous system depressants. These drugs block pain sensations and lower the body’s stress response. A sense of relaxation is often induced by an opiate drug.

Codeine also causes a backlog of dopamine in the brain. Dopamine is one of the brain’s chemical messengers, called neurotransmitters, which send signals through the central nervous system telling the brain and body how to feel and act. Dopamine is involved in helping to regulate emotions, body movement, and sleep functions. When a person takes an opiate drug like codeine, dopamine is not reabsorbed back into the brain at the same rate, causing levels of the neurotransmitter to rise. Elevated levels of dopamine increase the sensation of pleasure, decrease anxiety, and can make a person feel mellow, uncoordinated, and drowsy.

There are added side effects of codeine use, as published by the U.S. National Library of Medicine (NLM):

  • Stomach pain
  • Headache
  • Trouble urinating
  • Irregular menstruation
  • Erectile dysfunction
  • Decreased sex drive
  • Hives
  • Tremors
  • Nausea and vomiting
  • Fever
  • Itching
  • Rash
  • Vision changes
  • Constipation
  • Heartbeat irregularities
  • Breathing difficulties
  • Hallucinations
  • Changes in muscle tone
  • Impaired thinking and concentration abilities

Codeine is considered a habit-forming drug, which means that if a person takes it regularly for a period of time, they may become physically dependent on the drug. Over time and with chronic use, a tolerance to codeine can build up. A person will then need to take more of the drug in order for it to continue to be effective. 

Drug dependence forms with repeated codeine use as well. This is when the brain needs codeine to keep its chemical balance, as it has become reliant on the drug’s interaction with the production, transmission, and reabsorption of some of its neurotransmitters. The brain will struggle to keep levels of dopamine normalized without the interference of codeine after a dependence has formed.

When the drug wears off and processes out of the body, dopamine levels dip, leaving a person feeling lethargic, irritable, restless, agitated, depressed, and anxious. Physical withdrawal symptoms for codeine can be uncomfortable and often resemble a really bad case of the flu. They include excessive sweating and chills, runny nose, watery eyes, yawning, stomach cramps, vomiting, diarrhea, accelerated heart rate, dizziness, body and muscle aches, tremors, and a loss of appetite.

Drug dependence can form even if a person takes codeine for medical reasons with a valid and necessary prescription. As such, it is not recommended to suddenly stop taking codeine after a period of extended use without professional guidance.

Spotting Problematic Use

At the time of the 2016 National Survey on Drug Use and Health (NSUDH), nearly 3.5 million Americans (aged 12 and older) were considered to be currently misusing prescription pain relievers. Misuse of a drug like codeine may begin with a legitimate prescription and medical use of the drug. Codeine use can cause a rush of euphoria, however, resulting in a high that the user may seek to repeat. This can lead the person to begin to abuse the drug.

Once physical dependence sets in, the withdrawal symptoms and drug cravings that occur when codeine wears off encourage the person to keep taking the drug beyond its medical scope and necessity. Some warning signs that can indicate a problem with codeine use include:

  • Taking a higher than prescribed dosage
  • Taking codeine products in between scheduled doses
  • Exaggerating symptoms to get more prescriptions
  • Going to more than one doctor, called “doctor shopping,” to obtain more painkiller prescriptions
  • Altering the medication and using it in a way other than directed, such as crushing the tablets to snort, smoke or inject the drug, or chewing the tablets or capsules
  • Continuing to take codeine after the medical need for it has passed

Codeine and prescription painkillers are most commonly abused by young adults and individuals between the ages of 18 and 25. According to NIDA, more than seven percent of this demographic abused a pain reliever in 2016.

On the streets, codeine often goes by the names “Cody” and “schoolboy.” Cough and cold medications containing small amounts of codeine have become popular drugs of abuse for adolescents, NIDA for Teens explains. In addition, teens may abuse over-the-counter cough and cold medications that contain DXM. More than 3.5 percent of 10th graders misused one of these products in 2017.

Any use of a codeine product that is not medically necessary and directed by a health care professional is considered drug abuse and is cause for concern.

Overdose Potential and Short-Term Health Hazards

America is in the midst of an opioid overdose crisis, and according to the National Institutes of Health (NIH), over 20,000 people in the United States died as the result of a prescription opioid overdose in 2016. Drug overdose is now the number one cause of death for people under the age of 50, with more than half of the fatal overdoses involving an opioid drug.

Codeine impacts the respiratory system. In the case of an overdose, a person will struggle to breathe or potentially even stop breathing completely. Muscle weakness, irregular heart rate, slow pulse, lowered blood pressure, delirium, seizures, cold and clammy skin, muscle tension, nausea and vomiting, mental confusion, sedation and possible loss of consciousness, and coordination issues are possible signs of a codeine overdose.

A codeine overdose can be reversed with naloxone, also known by the brand name Narcan, which is an opioid antagonist drug that is frequently carried by first responders. In the event of a suspected codeine overdose, call 911 immediately.

When codeine is mixed with other drugs and/or alcohol, the odds of a negative reaction and a potentially life-threatening overdose increase. Alcohol, other opioids like heroin, and benzodiazepine drugs are all central nervous system depressants as well, so when these substances are combined with codeine, the odds for overdose rise exponentially.

Codeine intoxication may look similar to intoxication from alcohol. Slurred speech, impaired reflexes, difficulty with balance, diminished motor skills and coordination, dizziness, lowered inhibitions, lack of regard for consequences, trouble thinking clearly and making rational decisions, drowsiness, and out-of-character behavior can all be side effects of a codeine high. A person under the influence of codeine is at an increased risk for accidents or injuries since they may engage in behaviors that could be hazardous. The risk of contracting a sexually transmitted or infectious disease goes up with codeine abuse, as a person is more likely to get into a potentially dangerous situation and not practice safe sex. 

Long-Term Risks

As even taking codeine with a prescription for a medical condition can lead to drug dependence, so can repeated codeine abuse. The American Society of Addiction Medicine (ASAM) reported that around 2 million people in the United States battled addiction involving a prescription painkiller in 2016.

Addiction is a chronic, relapsing, and treatable brain disease. When someone struggles with addiction, they are unable to control their substance use, and it likely impacts many different facets of their life. Most of a person’s time will be spent focusing on, using, or recovering from opioid use, so they won’t have much ability to fulfill regular obligations or a desire to keep up with social or recreational activities that were a priority before. Codeine use will become the most important thing in life and the person will keep taking the drug despite any personal risk that may occur as a result.

Work and/or school production suffers, which can impact employment and finances as well as home life. Persistent mood swings and a potential shift in personality can disrupt family and interpersonal relationships. Someone struggling with codeine addiction may also suffer from declining physical health. Codeine can impact appetite, and the person may become malnourished and suffer from unhealthy weight fluctuations. Normal sleep patterns are disrupted as well.

Per the journal Trends in Anesthesia and Critical Care, there are additional potential side effects of long-term opioid use.

  • Immune system suppression: This heightens the odds for a person to suffer from an infection, illness, or disease.
  • Increased risk for osteoporosis and fractures: Chronic opioid use may impact bone mineral density, which can lead to osteoporosis and an elevated risk for broken bones
  • Cognitive impairment. Opioids impact normal brain function, which may then disrupt regular learning, thinking, and memory functions. This may worsen with continued use.
  • Decreased pain threshold: Long-term use of an opioid drug may actually make a person more sensitive to pain over time.
  • Disrupted sex drive: Opioid drugs may interfere with levels of sex hormones, which can then negatively impact sexual function and desire.

Codeine abuse also impacts the reward system in the brain. Opioid drugs create a kind of shortcut to happiness, bypassing some of the normal brain functions. This can actually rewire parts of the brain related to pleasure. When a person stops taking codeine, it can become difficult for them to feel pleasure, and depression and anxiety are common side effects. The brain may need to be retrained in how to function without the interference of a drug like codeine.

Long-term abuse of codeine can bring many negative health ramifications. With proper care and abstinence from the drug, these effects will be mostly reversible. The damage to the brain done by opioid abuse can heal with specialized care. 

Medical Detox and Comprehensive Treatment

Opioid drugs can create a high level of physical and emotional dependence. Due to the significance of the withdrawal symptoms, it is not recommended to stop taking them suddenly (going cold turkey). Instead, codeine is often weaned off slowly through a tapering schedule. This controlled taper can be accomplished in a medical detox program wherein an individual’s vital signs can be continuously monitored in a safe and secure environment. A medical detox program is optimal when opioid dependence is significant. A person will generally stay in a medical detox program for about a week on average while the brain stabilizes and a safe physical balance is reached.

A longer-acting opioid, such as methadone or buprenorphine, may be substituted for codeine during detox. These replacement medications stay in the body for longer, requiring less frequent dosing. Buprenorphine is also only a partial opioid agonist, meaning that it doesn’t activate the receptors in the brain quite as fully as codeine does, so it does not create the same high. Buprenorphine is often combined with the opioid antagonist naloxone. The naloxone component remains dormant unless the drug is altered and abuse is attempted; it then precipitates withdrawal.

Other medications are used during medical detox to address side effects and cravings. For example, the FDA recently approved the drug lofexidine (Lucemyra) for opioid withdrawal, per NIDA. The blood pressure medication clonidine (Catapres) can help with opioid cravings and some of the associated withdrawal symptoms. Sleep aids, mood stabilizers, nonsteroidal pain medications, and gastrointestinal medications can all treat specific side effects of withdrawal. 

What Are Your Treatment Options?

Codeine abuse can be treated in a variety of settings and with many different methods. Outpatient services can help those with lower levels of physical drug dependence who need to attend to daily life obligations, such as work, school, or family needs. Inpatient addiction treatment programs offer the opportunity to completely immerse oneself in healing and recovery, and they provide highly structured and inclusive programs.

Addiction treatment should be different for each person and address each person’s variable needs and circumstances. There are specialized treatment programs for different genders, races, sexual orientation, and ages. Complete assessments and evaluations prior to admission help trained professionals to determine the level of care that will be optimal for the individual.

Various different types of therapy and supportive measures may be included in a treatment plan.

  • Behavioral therapy: Cognitive behavioral therapy (CBT) and other behavioral therapies help to develop new coping strategies and stress management tactics, improve life skills, and teach relapse prevention techniques.
  • Group and individual counseling: Sessions are designed to help people work through issues related to drug abuse and improve the overall quality of life.
  • Family programs: Therapy and educational opportunities involve family members in the treatment and healing process, which is instrumental for a complete recovery.
  • Co-occurring disorders treatment: Integrated and simultaneous care can manage any and all medical and mental health disorders that may be present. Teams of treatment professionals all work together to ensure comprehensive care.
  • Medication management: Medications are often an important part of a drug addiction treatment program. 
  • Support groups: Peer support and 12-step programs aid in providing encouragement, relapse prevention skills, and a healthy outlet for the duration of recovery.
  • Adjunctive treatment methods: Chiropractic care, yoga, massage therapy, spa treatments, mindfulness meditation, acupuncture, nutrition planning, and fitness programs can all supplement traditional treatment methods.
  • Transitional programs: After completing a treatment program, transitional services help individuals to reintegrate back into society through sober living arrangements.
  • Aftercare support: Continued support for ongoing recovery through sober events, peer contact, alumni programs, and ongoing counseling services can decrease the likelihood of relapse.

NIDA recommends that treatment last at least 90 days. The longer a person remains in a drug addiction treatment program, the more opportunity the brain has to heal and the more ingrained the new coping strategies and healthy habits will be. 

Again, each person in recovery is unique. A trained professional can design and implement the right addiction treatment program for the specific individual and their family that can help them to enter long-term recovery. If you or your loved one has questions surrounding the many treatment options available, don’t hesitate to call The Palm Beach Institute at 855-534-3574 now or contact us online today. Our addiction specialists are ready 24/7 to help you escape the harsh realities of addiction and get you back on your feet.

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