Codeine Addiction – Signs, Symptoms, and Transformative Treatment Strategies

Introduction

In recent years, the widespread use of codeine, both in cough syrup and as a prescription painkiller, has heightened concerns about codeine addiction and its role in the opioid crisis. Despite its common inclusion in cough syrups for supposed cough suppression, there's a lack of technical evidence supporting this claim.

As a prescription opioid, codeine, along with medications like oxycodone and hydrocodone, has significantly contributed to the increase in opioid abuse and overdose deaths over the last decade.

Between 2004 and 2016, over 40,000 codeine-related adverse events were reported to the U.S. FDA, resulting in 7,200 deaths. Though not as lethal as some opioids, the substantial number of deaths emphasizes the urgency of addressing codeine's potency.

What is Codeine?

Codeine, an opioid derived from morphine, serves a dual purpose as a pain reliever and cough suppressant. While lower doses are available over the counter in pharmacies, prescription-based codeine is often mixed with other painkillers such as ibuprofen or aspirin.

Available in tablet, capsule, and liquid forms, it is used for various therapeutic uses, including short-term relief of mild to moderate pain. A recent study reveals that, despite its therapeutic benefits, those with limited drug experience are prone to using codeine recreationally, perceiving it as a harmless narcotic substance. Young men, especially those with limited drug experience, are more likely to misuse codeine.

How does Codeine Work?

Codeine, classified as a narcotic medication, operates through a mechanism of action similar to other opioids like morphine. The primary function of codeine is to modify pain signals by attaching to and activating specialized opioid receptors in the brain designed for endogenous opioid-like neurotransmitters.

The neurotransmitters influenced by codeine play a crucial role in pain control and reducing sensations of fatigue. This interaction initiates an increase in dopamine activity, creating a reinforcement loop that associates taking the opioid with heightened pleasure. This, in turn, may prompt individuals to engage in repeated use and induce feelings of euphoria, relaxation, and an overall sense of well-being, contributing to the potential for addiction.

Classification of Codeine

Codeine, recognized for its potential for abuse and addiction, is subject to classification by the United States Drug Enforcement Agency (DEA). Understanding its placement in various drug schedules is crucial for legal and medical considerations.

• Codeine, when used alone, falls under Schedule II, indicating a high potential for abuse and severe dependence. Legal acquisition requires a prescription from a physician due to the associated risks.
• Formulations containing less than 90 mg of codeine, such as Tylenol with Codeine, are classified as Schedule III drugs. While still necessitating a prescription, they are considered to have a lesser potential for addiction and abuse compared to Schedule II substances.
• Codeine is categorized as a Schedule V drug when used in combination with other substances, with the condition that the codeine content is fewer than 200 milligrams. Schedule V drugs have a relatively lower potential for abuse and dependence.

Side Effects of Codeine

When codeine is used as prescribed for a troubling cough or minor pain, it is generally safe. However, misuse, especially for recreational purposes, can lead to serious repercussions, potentially requiring treatment at a codeine addiction center.

Common Side Effects

The effects of codeine can vary slightly depending on the drug formulations. Common side effects include:

• Nausea
• Stomach cramps
• Increased sedation
• Constipation
• Euphoria (a feeling of calmness and well-being
• Difficulty urinating

Severe Effects

• Fever
• Sweating
• Confusion
• Agitation
• Dizziness
• Fast, slow, or irregular heartbeat
• Impaired coordination
• Hallucinations
• Shallow breathing
• Vomiting or diarrhoea
• Loss of appetite
• Irregular menstruation
• Erectile dysfunction
• Decreased sexual desire
• Impaired cognitive ability and judgment
• Rash and Hives
• Intense itching
• Seizures

What is Codeine Addiction?

Codeine, a commonly prescribed painkiller readily accessible due to its widespread use, can lead to addiction—a complex disorder of the brain's reward system. This compulsion to engage in rewarding behaviors, like taking codeine, persists despite awareness of negative consequences.

The 2022 National Survey on Drug Use and Health revealed that of the 19.8 million people aged 12 and older who used codeine products in the past year, 9.3% misused the drug. Alarmingly, nearly 1 in 4 individuals misusing prescription pain relievers engaged in codeine misuse during the same timeframe.

How Codeine Occurs?

The mechanism of codeine addiction involves repeated exposure to altering brain chemicals, particularly dopamine levels. This alteration propels individuals into a persistent pursuit of positive feelings, deepening their addiction over time. The pleasurable stimulus induced by codeine, including a relaxing 'high,' contributes to physical addiction, with long-term users taking codeine to stave off withdrawal symptoms.

Historically, codeine misuse has been associated with a concoction known as lean or sizzurp. This mixture typically involves prescription cough syrup containing codeine and promethazine, combined with sweet flavorings like candy or soda. The popularity of this cocktail underscores the need for awareness regarding the potential misuse of codeine-containing medications.

What Makes Codeine Addictive?

Codeine's addictive nature is rooted in its classification as an opioid medication, often prescribed for pain relief. One of the key factors contributing to its potential for addiction lies in its ability to induce feelings of euphoria, providing users with a temporary escape from discomfort and pain. Additionally, the transformation of codeine into morphine within the body intensifies its impact as it directly acts on the brain's pleasure and reward centers.

This interaction with the pleasure and reward centers sets off a cycle of dependency. Individuals may find themselves repeatedly using codeine in an attempt to recapture the pleasurable sensations it induces. 

Over time, prolonged use of codeine can lead to an increased tolerance, meaning higher doses are required to achieve the same effects. This escalation further fuels the cycle of addiction.

Signs and Symptoms of Codeine Addiction

It can be challenging to identify codeine addiction, as individuals often conceal their condition due to the associated stigma of drug abuse. However, certain signs and symptoms may indicate a potential codeine addiction:

Behavioral Signs of Codeine Addiction

• Using codeine for minor ailments like headaches.
• Regularly visiting a doctor to obtain more codeine.
• Faking or exaggerating illness or injury to get more codeine.
• Cravings for codeine.
• Isolating themselves socially.
• Being secretive about their codeine use.
• Sudden mood changes.
• Drop in performance at work or increase in days taken off sick.
• Running into financial difficulties due to money spent on codeine.
• Sourcing the drug illegally if they can no longer get it via legal routes.
• Signs of increased tolerance – needing to take more codeine to get the same effect.
• Taking more doses of codeine than prescribed or taking the codeine more frequently than prescribed.
• Unsuccessful attempts to quit the use of the drug.
• Having relationship problems as a result of codeine use.
• Getting angry when confronted about the use of the drug.

Codeine Overdose

Codeine overdose can have severe consequences, particularly in terms of respiratory depression, which is a life-threatening condition. Recognizing the signs of a codeine overdose is crucial for prompt medical intervention.

Signs of Codeine Overdose

• Diminished levels of consciousness
• Low blood pressure
• Confusion
• Weak pulse
• Cold, clammy skin
• Bluish fingernails and lips
• Limp skeletal muscles
• Constricted pupils
• Respiratory depression
• Being hard to wake or unresponsive
• Very slurred speech, not making sense
• Pronounced drowsiness progressing to stupor or coma

Additional Overdose Symptoms with Mixed Substances:

• CNS depression
• Coagulation defects
• Damage to the kidneys
• Hypoglycemic coma

Codeine Withdrawal

Opiate addiction development is relatively easy, but quitting poses a significant challenge. The brain stops producing dopamine that stimulates the reward center, leading to increased drug tolerance and the need for more to achieve the desired effect.

When a person is physiologically dependent on codeine, they experience mild to severe withdrawal symptoms as the brain and body adapt to the absence of the drug. Codeine is commonly associated with withdrawal symptoms, alongside substances like heroin, oxycodone, morphine, and hydrocodone. The severity of withdrawal can vary based on factors like duration of use, typical dose, and dosing interval.

Codeine Withdrawal Timeline

Symptoms of Codeine Withdrawal

Common withdrawal symptoms include:

• Fever and sweating
• Runny nose and watery eyes
• Anxiety
• Chills and goosebumps
• Nausea, vomiting
• High blood pressure
• Fast pulse
• Insomnia
• Diarrhea
• Bone and muscle pain
• Heightened reflexes
• Jerky muscle spasms

Codeine Addiction Treatment

Effectively addressing codeine addiction involves a comprehensive approach, combining medication and behavioral therapy for optimal outcomes. Medications like methadone, buprenorphine, and naltrexone play a crucial role in dealing with withdrawal symptoms and cravings, significantly reducing the risk of relapse. 

The treatment strategy may vary based on the severity of withdrawal symptoms and the level of support required for recovery.

Tailored Treatment Plans

Recognizing that each individual's journey is unique, treatment plans are personalized to address specific needs and challenges. An assessment identifies the most impactful interventions, guaranteeing an all-encompassing and personalized approach to the recovery process.

Behavioral Therapy

Behavioral therapy forms a cornerstone of codeine addiction treatment, addressing the psychological aspects of addiction. Individual counseling adopts a tailored approach by delving into the underlying causes of addiction and formulating coping strategies for adequate recovery. Group therapy fosters community and shared experiences, promoting emotional healing and peer support.

Medication-Assisted Treatment (MAT)

MAT integrates medication with counseling and behavioral therapies, offering a comprehensive approach to addiction treatment. This integrated approach addresses both the physical and psychological aspects of codeine addiction, optimizing the chances of successful recovery.

Outpatient Programs

Outpatient programs offer flexibility for individuals with milder addiction or a strong support system. These programs enable individuals to undergo treatment while upholding their daily life commitments, facilitating the seamless integration of recovery strategies into their routines.

Relapse Prevention

Education and strategies for preventing relapse are integral components of codeine addiction treatment. Individuals learn to identify triggers, develop coping mechanisms, and navigate challenges that may arise post-treatment, enhancing their ability to sustain recovery.

Holistic Approaches

Holistic practices, including yoga, meditation, and mindfulness, are integrated to complement traditional treatment methods. These practices contribute to overall well-being and provide additional tools for managing stress and maintaining a balanced lifestyle.

Aftercare Planning

Aftercare planning is a critical aspect of codeine addiction treatment. Continued therapy, participation in support groups, and lifestyle adjustments contribute to sustained recovery. Ongoing support helps individuals navigate the complexities of post-treatment life and reinforces their commitment to maintaining a drug-free lifestyle.

Frequently Asked Questions

Is over-the-counter codeine addictive?

Yes, over-the-counter codeine is an opiate and has the potential for high addiction. It is crucial to adhere strictly to the recommended dosage and seek medical advice if there is any uncertainty about the appropriate amount.

How does codeine addiction affect mental health?

Codeine addiction can lead to various mental health issues, including acute anxiety and depression. Prolonged use followed by cessation may intensify these feelings, potentially resulting in chronic depression, self-harm, and even suicidal thoughts.

What are the signs of a codeine overdose?

Signs of a codeine overdose include severe respiratory depression, diminished consciousness, constricted pupils, and cold, clammy skin. Additional symptoms may arise if other substances are mixed with codeine, such as liver cell death or damage to the kidneys.

How does codeine make a person feel?

Beyond its pain-relieving properties, codeine induces a general sense of calm and alleviates anxiety or stress. However, the rapid development of tolerance means individuals may need escalating doses to sustain these effects.

Can you overcome codeine addiction without professional help?

While some individuals may attempt to overcome codeine addiction independently, professional help significantly enhances the chances of successful recovery. Under medical supervision, counseling, and personalized treatment plans, both the physical and psychological dimensions of addiction are effectively addressed.

Sources:

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3. Veronin, M. A., Schumaker, R. P., Dixit, R. R., & Elath, H. (2019). Opioids and frequency counts in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database: A quantitative view of the epidemic. Drug, Healthcare and Patient Safety, 11, 65–70.

Drug Enforcement Agency. (2019). Controlled Substance Schedules