Codeine is an analgesic opioid commonly prescribed to treat pain and cough symptoms. A direct derivative of the opium poppy plant, codeine is most often used to treat mild to moderate pain. Although it is an addictive opioid, codeine is not as strong nor as frequently prescribed as most synthetic opioids like oxycodone or hydrocodone. Codeine is often formulated with acetaminophen or antihistamines to treat pain, and various codeine-containing drugs range in DEA Scheduling from II to V, under the Controlled Substances Act. Scheduling depends on the amount and potency of codeine in the drug. Codeine is prescribed for short periods to treat symptoms because long-term or reckless use of any opioid can lead to dependence and dangerous drug abuse risks.
Effects of Codeine
Codeine may be less potent than many synthetic opioids, but it is still an opioid and carries a high risk of abuse and dependence because of its effects. Some common effects of codeine include the following:
- respiratory depression
- nausea and vomiting
- shortness of breath
- abdominal cramps
Effects of codeine use may vary depending on the individual and personal circumstances, but misuse of this drug increases tolerance to its effects, which means higher quantities become necessary for the same effect. There is an additional risk associated with growing tolerance to codeine. Since codeine is common in combination with other drugs like acetaminophen, excessive use of these combination drugs increase the risk of liver damage caused by acetaminophen.
Codeine abuse often begins with a legitimate prescription for pain, and frequently evolves to users seeking more powerful opioids to reach their desired state of euphoria with fewer pills. People who abuse codeine don’t necessarily have to be taking it for a long time to become dependent, especially if someone is taking large amounts of the drug regularly. Dependence can occur in less than two weeks. Codeine pills or tablets are not the only forms of the drug that people abuse. The most popular and well-known method of abusing codeine is drinking it. Unlike most other opioids, codeine abusers can consume their drug by sipping on a drink called lean. Lean is a combination of prescription-strength codeine cough syrup, soda, and hard fruit-flavored candy. Lean can also be made using alcohol instead of soda, and it goes by many other names on the street, including Purple Drank, Sizzurp, Purple Jelly, and Dirty Sprite. Originally made popular in the southern hip-hop scene during the 1990s, lean is a candy-flavored drink that users will sip on throughout the day, becoming more intoxicated with every passing hour. As users continue to sip, they need to lean on things to stand upright, giving the intoxicating drink its name. Abusing codeine in a liquid or pill form is extremely dangerous and presents serious risks to users.
Risks of Codeine Abuse
Codeine is an opioid, which means it presents serious health risks in excessive amounts. The expected effects of codeine use can be dangerous, but the consequences of overdose can be deadly. There is no way to know which pill or sip of lean will cross the line to a potentially fatal overdose. Some signs and consequences of codeine overdose include the following:
- constricted (pinpoint) pupils
- loss of consciousness
- labored or no breathing
- cold or clammy skin
- coma or death
Codeine overdose is more likely to occur when the drug is taken non-medically and in a compulsive manner. In addition to the above-listed effects of codeine overdose, a serious risk of codeine abuse is an addiction, which is virtually inevitable with continued abuse of the drug.
Codeine dependence occurs as tolerance increases and a user continues to abuse larger quantities of the drug. Once dependence develops, a user is no longer able to control when or how much codeine he or she uses, and detoxification becomes a necessary step in recovery. One of the most devastating consequences of codeine dependence is an addiction and the lengths to which an addict will go to avoid opioid withdrawals and continue abusing drugs. These lengths fall under the umbrella of addictive behaviors, and they include things like:
- taking more codeine than prescribed or for non-medical reasons
- asking the prescribing physician for stronger or higher quantities of codeine
- doctor shopping, or seeking multiple prescriptions for codeine or other opioids from multiple providers
- taking codeine from others who have legitimate prescriptions
- purchasing codeine or other opioids from black market sources like dealers and illegal online pharmacies
- using codeine recreationally at any time, for any non-medical reason
- using other substances to enhance the euphoria or intoxicating effects of codeine
- becoming more preoccupied with taking codeine, like obsessing over when the next dose will be, or constantly worrying about how many pills are left
Addiction to codeine is a step beyond addictive behaviors because it means the body and brain need codeine for normal functions. Like all opioids, codeine dependence is physical and psychological. As the brain continually adjusts to functioning normally under the influence of codeine, tolerance grows, making more codeine necessary to achieve the same results of intoxication or therapeutic relief. As tolerance to codeine becomes the new normal, a user experiences withdrawal symptoms without the drug. Tolerance is not the same as dependence, but it is part of developing dependence. Dependence is a natural response to taking any substance over a prolonged period and can occur even if someone uses codeine as prescribed. Someone who drinks soda or coffee every day, then suddenly stops, will likely experience mild forms of withdrawal. The same is true for codeine and other drugs of abuse, and only withdrawal symptoms are much more severe with most drugs of abuse.
Codeine Withdrawal Symptoms
Codeine withdrawal is not life-threatening, but it is excruciating and unpleasant. Many addicts who have experienced codeine withdrawal become desperate to avoid it again because of the discomfort and pain associated with it. The severity of symptoms can vary, depending on the nature of an individual’s codeine use, but the most common symptoms include the following:
- runny nose
- high fever
- excessive yawning
- muscle and body aches
- nausea and vomiting
- abdominal pain
- high blood pressure
- increased heart rate
- cold sweats
- intense cravings
Some symptoms can linger for several days or weeks after codeine has been removed from the body. These symptoms include insomnia, intense cravings, and anhedonia (inability to feel pleasure). It is often these lingering symptoms that are the main factors in relapse.
Codeine Addiction Treatment
Codeine addiction is dangerous, and those caught in its vicious cycle may feel hopeless at times, but there is help in quality and comprehensive addiction treatment program. Since codeine is an opioid, the first step in addiction treatment is detox, which can be very difficult to complete. The most common codeine detox process is one which provides medical assistance and supervision to reduce some severe withdrawal symptoms like high blood pressure, insomnia, severe anxiety, and abdominal pain. Even with the increasing popularity of medication-assisted treatment (MAT) using methadone or buprenorphine, medical detox remains the most common form of detoxing from codeine and other opioids.
Codeine Detox: Medically Supervised vs. Medication-Assisted Treatment
With the overwhelming devastation of America’s opioid epidemic, low-cost, effective and accessible opioid addiction treatment has been on the front lines of recovery. There are a few ways to detox from codeine and other opioids, but the two most common are a medication-assisted treatment (MAT) and medically supervised detox in a facility. Although both are effective, they are very different in process and results. While medication-assisted treatment is a more cost-effective option, it does not detox a person from opioids. Rather, MAT uses methadone or buprenorphine to maintain a steady level of opioids for the dependent brain. An addict transitions from codeine or another opioid of abuse, to a comparable dosage of methadone or buprenorphine. The transition allows addicts to avoid the discomfort of opioid withdrawal and maintain a steady level of opioids. Contrarily, a medically supervised detox does fully remove all opioids and other drugs of abuse during the multiple-day process. The length of time varies, depending on the severity of substance abuse. Controlled medications and trained medical staff ensure as comfortable a detox experience as possible by easing the severity of painful withdrawal symptoms. Despite these significant differences in process, there is still much work and support required as addicts move forward in recovery.
Recovery From Codeine Addiction
Codeine addiction is not only harmful to the human body, but it also changes the way the brain functions. When in recovery from codeine addiction, there is a period of readjustment to the absence of codeine. The readjustment period is often the most difficult time for an addict. It is this time when cravings can be the strongest and most frequent, and recovering addicts are most vulnerable because they have not yet established a strong foundation for recovery through addiction treatment. An individualized addiction treatment program provides the tools, information, support, and skills to build a strong foundation for recovery. In codeine addiction treatment, addicts receive a wide range of tools, support, skills, and education to promote healthy habits, addiction education, self-awareness, and relapse prevention. Many of the tools provided by addiction treatment allow addicts in recovery to do the following:
- identify and effectively avoid relapse triggers
- find activities and eating habits that promote a sober and healthy lifestyle
- stress management and coping skills
- address underlying issues that may have contributed to drug abuse
- engage support in sobriety through groups and individuals in recovery
- break destructive habits that may prompt relapse
The time someone needs to stay in addiction treatment depends on individual circumstances, but the National Institute on Drug Abuse (NIDA) recommends at least ninety days of treatment. The most highly recommended course of addiction treatment gradually steps down the intensity of treatment as such:
- detox is highly structured and supervised with minimal freedom of movement barring an AMA (against medical advice) discharge
- inpatient or residential is a high-intensity treatment program in which the addict resides at a drug-free treatment facility with supervision and planned daily activities
- sober living is a drug-free living environment housing recovering addicts who have already completed residential or inpatient treatment. This environment allows free movement to work or school during daytime hours with regular drug testing and structured curfews and recovery meetings.
- outpatient is continuing aftercare for addicts in recovery who have completed inpatient or residential treatment. Outpatient provides important supports for individuals in every stage of recovery from addiction
As NIDA recommends, the longer someone remains in treatment at any level of care, the greater his or her chances of sustained recovery. For more information on codeine addiction treatment, and how we can help you, or a loved one break the cycle of addiction, please contact us right away. Our certified and experienced counselors can verify your insurance and answer any questions you may have about our individualized addiction treatment program. Make the call today to end the suffering. We are here to help.