Codeine is an opioid painkiller typically found in combination with other prescription medications in cough syrup, migraine medications, and post-surgical painkillers. This medication, in prescription doses, treats mild-to-moderate pain, and until very recently, it has been considered safe for children as well as adults.
Codeine works as the liver processes this compound into morphine, which is then filtered into the bloodstream to relieve pain. The morphine will bind to the opioid receptors in the brain, like oxycodone or hydrocodone, and reduce pain signals coming from the body.
Codeine is very effective, but it is also addictive, and its wide availability means it is commonly abused. The World Health Organization has codeine listed on its Essential Medicines list, in spite of its addictive properties, and the Drug Enforcement Agency lists codeine as a Schedule III substance when it is alone in doses less than 90 mg. Schedule III substances are considered less addictive than Schedule I and II substances; other narcotic painkillers like oxycodone and hydrocodone are listed as Schedule II. Listing codeine as Schedule III might make this drug seem less addictive than it actually is for some people.
How Does Codeine Abuse Begin?
The leading method for people in the United States to become addicted to codeine is through a prescription. Cough syrups, pills, and tablets are all available via prescription. Prescription opioid abuse and addiction are epidemic in the US. According to the American Society of Addiction Medicine, in 2014, 21.5 million Americans ages 12 and older struggled with a substance use disorder, and 1.9 million of those individuals specifically struggled with prescription painkillers, including codeine.
However, there are some pop culture instigators for codeine abuse too. In 2006, the DEA warned about a mix of cough syrup, often with codeine, and soda. This mix is sometimes called sizzurp, lean, purple drank, or syrup. There are many cases of mixing cough syrup and alcohol as well. Pop culture figures like Lil Wayne and other rap artists are commonly associated with popularizing these concoctions in their music, encouraging teenagers to use these mixtures as well. Many of these teens subsequently become addicted. Although codeine is often found in prescription cough syrup, these mixes also rely on over-the-counter cough medications that contain dextromethorphan, or DXM, which can cause a hallucinatory high in large doses or when mixed with alcohol. Both codeine and DXM cough syrups are dangerous and addictive.
Regardless of how a person is introduced to a prescription opioid like codeine, addiction is a disease that needs treatment.
Some people are more susceptible to becoming addicted to substances than others, although the exact genetic or environmental reasons behind this are not completely understood.
However, effective treatment does exist, and it is important to get help as soon as possible.
Codeine Abuse and Addiction Statistics
Codeine abuse statistics tend to be mixed in with abuse statistics related to other opioid medications, like oxycodone and morphine. However, some sources of data branch these numbers out into separate categories for each opioid drug. For example, a report from the Substance Abuse and Mental Health Services Administration compared nonmedical use of specific opioid painkillers between 2012 and 2013, and found that rates of abuse for many of these, including codeine, were on the rise. In a survey in 2012, 264 people reported nonmedical use of codeine; this number increased to 293 in 2013.
Signs, Symptoms, and Dangers of Abuse
- Nausea or vomiting
- Itching or a mild rash
Because codeine is a narcotic, or opioid, painkiller like oxycodone or hydrocodone, this medication can slow or stop breathing. This is a common and dangerous symptom of overdose.
The FDA recently advised against prescribing codeine to children after tonsil or adenoid removal surgery. In rare cases in individuals with high metabolisms, codeine can break down quickly into morphine in the liver, which can lead to overdose symptoms even when a regular prescription dose has been consumed. Metabolism and body mass have considerable impact on how the body processes codeine, making this medication
potentially unsafe for young or elderly individuals.
- Blue-tinged lips or fingernails
- Shallow or slow breathing
- Slowed or erratic heart rate
- Loss of balance or coordination
- Passing out, especially when the person is unable to wake up
- Mood swings, extreme euphoria, sadness, or aggression
- Extreme constipation
- Difficulty urinating
Mixing codeine with other medications, alcohol, or recreational drugs can also be very dangerous. Side effects like depressed breathing can be enhanced, especially when mixed with sedatives, alcohol, or other drugs that are central nervous system (CNS) depressants. Mixing codeine medications with other opiates like oxycodone or heroin also increases the likelihood of adverse reactions and overdose.,
If a person has become addicted to codeine, whether through a legal prescription or recreational abuse, it is important to seek help. Rehabilitation can ease withdrawal symptoms, make relapse less likely, and help the person work through psychological cravings and address the roots of the addiction.
- Runny nose and watery eyes
- Muscle aches
- Stomach cramps and loss of appetite
- Nausea and vomiting
With medical oversight, these symptoms are manageable, sometimes with help of small amounts of over-the-counter or prescription medications. For example, ibuprofen or acetaminophen can ease mild physical pain. Imodium can be used to treat diarrhea.
Clonidine, typically used to treat high blood pressure, has often been used off-label to treat opiate withdrawal symptoms. It works to ease muscle aches, anxiety, agitation, and cramps, among other symptoms.
For people who have developed a dependence on codeine, or who have taken codeine for a very long time, tapering medications like buprenorphine, found in both Subutex and Suboxone, could be prescribed with medical oversight to help wean people off the need for opiates.
Outpatient treatment can work for people who believe they will be able to stay away from drugs of abuse, but in many cases, inpatient rehabilitation is a better choice. Clients work with therapists and support groups to develop a solid foundation in recovery, and they receive medical oversight while they undergo the withdrawal process. With inpatient rehabilitation, people are removed from triggers in their daily lives that may lead to cravings or relapse as well.