Codeine Abuse, Addiction, And Treatment Options
Codeine abuse and addiction are widespread problems that affect people of all age groups and socioeconomic backgrounds. Formal treatment is often required to break codeine addiction.
What Is Codeine?
Codeine belongs to two classes of drugs: the opioid and antitussives classes. When codeine is used to treat pain (opioid), it works by changing the way the body perceives pain. When codeine is used to reduce coughing (antitussive), it works by decreasing the activity in the part of the brain that causes the coughing response.
Also available in combination with acetaminophen, aspirin, carisoprodol, and promethazine-codeine is commonly used in cough and cold medications. While codeine can be helpful in managing cold and flu symptoms, it is not a treatment for the original cause of these symptoms.
Some brand names for codeine include:
- Brontex (codeine, guaifenesin)
- Guiatuss AC (codeine, guaifenesin)
- Nalex AC (brompheniramine, codeine)
- Phenergan VC with Codeine (codeine, phenylephrine, promethazine)
- Robitussin AC (codeine, guaifenesin)
- Vanacof (codeine, dexchlorpheniramine, phenylephrine)
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Codeine Abuse And Addiction
Codeine is an addictive drug that can produce dangerous side-effects at higher doses. Like other opioids, codeine works as a central nervous system (CNS) depressant, and may cause feelings of relaxation, euphoria, drowsiness, and slowed heart rate.
The abuse of codeine is a widespread issue. In 2014, a study found that more than 145 gallons of codeine cough syrup had been used for illegal purposes over a five-year period in Texas. Addiction to codeine starts with occasional abuse of the drug, which slowly develops into a physical dependence, and then into addiction.
Even though codeine’s chemical structure is similar to morphine, its potency is only a fraction of morphine, making codeine a weaker pain killer in comparison. In 2013, the Substance Abuse and Mental Health Administration (SAMHSA) also estimated that 1.9 million American had experienced an opiate use disorder in 2012.
Addiction potential to codeine is increased due to the effects it produces when taken in large amounts. Once a physical dependence is formed, the individual will not be able to function normally without codeine in their system.
Tolerance to opioids, like codeine, develops quickly which results in an increased demand for the drug by those using it. In some cases, addicted individuals who no longer have access to a prescription opioid drug will turn to abuse street drug like heroin, as it is more widely available and less costly.
Signs And Symptoms Of Codeine Abuse
Like other opioids, codeine can cause someone to feel drowsy, mentally foggy, nauseous, and constipated. Some signs and symptoms of codeine abuse can include:
- contracted pupils
- slow breathing
- blue in the fingernails and/or lips
- nausea and vomiting
- delirium and hallucinations
Often, codeine addiction begins with a legitimate medical reason that develops into an addiction. Additional signs of codeine addiction can also include, loss of appetite resulting in weight loss, nausea and vomiting, decreased interest in activities that were once enjoyable, and cold sweats and clammy skin.
Addiction to codeine can also produce psychological side effects like confusion, extreme mood swings, and changes in sleeping patterns. These symptoms may be followed by a slow breathing rate, which has the potential to cause accidental death.
Effects Of Codeine Abuse
There can be several unpleasant side effects with codeine abuse, which can potentially be fatal. These include:
- gastrointestinal distress
- clouded thinking and impaired judgment
- a dangerous decrease in blood pressure
- decreased heart rate
- liver and kidney malfunction
The above symptoms will vary from person to person and depend on:
- how long they abuse codeine
- level of tolerance to codeine
- if other substances are abused in combination with codeine
- if a co-occurring disorder is present
Long-term abuse of opioids, like codeine, can result in irreversible damage to the liver and kidneys. Individuals who have abused codeine for a period of three weeks or more may develop sleep disorders such as sleep apnea, constipation, and other bowel dysfunction, and depression.
If codeine is abused by injection, it can also increase the risk for contracting HIV and hepatitis B and C. Prolonged exposure to codeine in high doses can also result in irregularities in heart rhythm, which can potentially lead to stroke or infection.
An additional risk of codeine addiction is the potential to overdose on the drug. The likelihood of overdosing on codeine is increased when the drug is used with other central nervous system depressants like alcohol or other opioids. This combination can be lethal because it suppresses the brain stem, making breathing extremely difficult.
Symptoms of a codeine overdose may include:
- difficulty breathing
- excessive drowsiness
- loss of consciousness
- cold clammy skin
- fainting and dizziness
- extremely slowed heartbeat
Who Is Abusing Codeine?
Millions of Americans take cough syrup each year to help cope with cold and flu symptoms. When taken as directed, codeine is a safe and effective way to manage uncomfortable cough symptoms. But, there are several cough medications the contain codeine, which can be a mind-altering drug when taken in higher doses than recommended.
In 2014, the Drug Enforcement Administration (DEA) estimated that one in ten teens abused codeine cough syrup. Some of these cough syrups were once available over-the-counter and did not require a prescription to obtain, making them easily accessible to anyone. Since then, codeine has been classified as a controlled substance and now requires a prescription.
Often codeine cough syrups are mixed with other substances like alcohol to make a lethal concoction sometimes referred to as “purple drank.” The name purple drank comes from the purple color often found in codeine-containing cough syrups.
The purple drank mixture often consists of cough syrup, soda, alcohol and sometimes hard candies like jolly ranchers, and is popular among teenagers and nightclub goers.
Once physical dependence to codeine has developed, withdrawal symptoms will occur if the amount of codeine in someone body does not remain constant or suddenly decreases.
The severity of the withdrawal will depend on the severity of the addiction. This can cause codeine withdrawal symptoms to range from mild to severe. Although codeine withdrawal can be a very uncomfortable process, it is typically not life-threatening.
Individuals with other existing health issues and long-term codeine abuse often experience more severe and painful withdrawal symptoms, while recovering from codeine addiction, compared to those who do not have an existing condition and have not been addicted to codeine long.
Codeine withdrawal symptoms can include:
- extreme mood swings
- restlessness or insomnia
- runny nose, watery eyes, and other flu-like symptoms
- nausea, stomach cramps, vomiting
- loss of appetite
- aches and pains in muscles and joints
Treatment Options For Codeine Abuse And Addiction
Treatment for codeine abuse and addiction starts with detoxing from the drug. During detox, the amount of codeine taken is slowly reduced until the body is able to function without it. Although codeine detox is typically not fatal, it is still a good idea to go through detox in an inpatient setting because this stage of recovery is when individuals are likely to relapse.
Relapse tends to occur more often during the detox phase because individuals may want to self-medicate, in order to stop the uncomfortable withdrawal symptoms they are experiencing. Once the initial detox is done, individuals may choose to continue their inpatient care or enroll in an outpatient program.
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