Codeine Addiction and Abuse
The number of people addicted to prescription drugs, such as codeine, benzodiazepines and other over-the-counter medications is rising. Rehabilitation centers across the UK are currently admitting more people who have problems with legal substances than those dealing with heroin and other illicit drug addictions.
According to addiction experts, opiate painkillers, such as diazepam, tramadol, codeine and benzos are very addictive and cause all sorts of problems. The increasing numbers of addiction and drug related overdoses are partly blamed on the lack of awareness regarding the addictive properties of opiates. The fact that they are legal and mostly cheap makes it harder to spot an addiction until it’s too late, in most cases.
The European Monitoring Centre for Drugs and Drug Addiction states that one in three drug overdose deaths happens in the UK and so increasing numbers of young people are in danger of exposure to these opioids.
What is Codeine?
Codeine is an opioid pain medication, used to treat mild to moderate and severe pain. It is a sedative pain reliever, similar to hydrocodone and morphine. Just like morphine, it latches onto opioid receptors in the brain that communicate pain sensations to the brain and body. It can be used to reduce your discomfort, increase your tolerance to pain and also lead to drowsiness.
Generally, the adult dosage when using codeine as pain relief is 15 to 60mg within a six-hour timeframe. For coughs, it’s within the same timeframe, but the dosage is 10-20mg, with a maximum dose of 120mg every 24hours. You should not drink alcohol or mix codeine with other sedatives, such as Xanax,as this could lead to confusion and brain impairment.
Other names for codeine
As an opiate modification, codeine is prescribed for chronic diarrhoea, severe pain and persistent coughs. It is also one of the most abused prescription drugs in the world, especially amongst younger people. To avoid detection, those who abuse codeine use slang or street names when buying or talking about codeine. Some of the nicknames include:
- Sizzurp/syrup – codeine mixed with soda
- Codeine (alone) – schoolboy or cody
- T-codeine – mixed with Tylenol
- Purple drank- alcohol mixed with promethazine-codeine
- Doors and fours/pancakes and syrup/loads – codeine mixed with glutethimides
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Types of codeine
To signify the method of use when combined with other drugs, codeine is sold under different brand names.
- Codeine with Cotabflu or Colrex: you can use to treat upper respiratory complications, like hay fever, cold symptoms and coughs.
- Fioricet with Codeine: for migraines and headaches. Other types for headaches include Tylenol with Codeine #3 and Tynelol with Codeine #4.
- Codeine with guaifenesin, acetaminophen or pseudoephedrine: for coughs, colds and nasal congestion.
- Codeine with chlorpheniramine: for coughs, colds, as well as coughs with nasal congestion and allergic rhinitis.
- Codeine with pyrilamine: for sinus problems, rhinorrhea, nasal congestion, coughs, colds, allergies and nasal congestion.
There are currently over 50 brand names – most of which are marketed for the treatment of nasal congestion, colds, coughs and hay fever. However, even when prescribed for colds and coughs, one should stay aware of the dangerous potential for addiction.
Codeine is a medication that you should take according to doctors’ orders, due to the potential risk of addiction, misuse or abuse. Using opioid drugs with codeine puts you at risk for life-threatening side effects, like respiratory problems and overdoses. Make sure you speak with your doctor before using codeine with benzos like diazepam, alprazolam and lorazepam.
Before taking codeine, you should tell your doctor if you have any allergies, health problems or if you’ve taken any medication for depression or mental health issues in the past. Pregnant women should not take codeine, except where other medications have failed -nor should people taking medications that might interact with codeine. This can become a serious condition, called serotonin syndrome. If you’re taking herbal medication, vomiting, experiencing nausea, migraine headaches or stimulants, rather do not take codeine.
Causes of codeine addiction
It’s easy to become addicted to codeine, because it’s a habit-forming drug. Physical and mental dependence is likely if you use it without a doctor’s prescription or if you misuse it, for the ‘high’ effect that the drug produces. Addiction to codeine can happen because of several factors,including:
Genetics: scientists have proven that if your parent was an addict, it increases your chances of becoming an addict later in life.
Environmental: if you grew up in an unstable home where you were exposed to drugs at a young age or watched your siblings, parents, neighbours or friends using codeine, you too could be prone to abusing drugs as a way of coping with stressful or emotional events in your life.
Brain chemistry: codeine interacts with the opioid receptors in your brain. It can be used as self-medication to balance a deficiency of naturally-occurring neurotransmitters.
Psychological: there is a risk of you becoming addicted to codeine if you have unaddressed mental health problems. Substance abusers often use codeine to control or bury side-effects of mental disorders.
Addictive properties of codeine
As a natural derivative of opium, codeine shares most of the same addictive properties with heroin and morphine. The medicine binds to opioid receptors in the spinal cord, brain, gastrointestinal tract and the rest of the body, in order to provide you relief and reduce your perceptions of pain.
These feelings – which align with basic functions like eating, breathing and surviving –can potentially influence you into continuing to use codeine, despite the associated health risk. Codeine’s active ingredients have properties that are analgesic, anti-diarrhoeal, antitussive, sedative, antihypertensive, anti-anxiety and hypnotic.
Continuous use of prescription opiates can prevent your body from generating opioid neuropeptides, such as endorphins. Over time, codeine will desensitise your brain’s natural opioid network, making it less responsive and more tolerant, until the user requires a higher dose, in order to feel pleasure. When you become tolerant, you can quickly build up a substance dependence and long-term addiction.
Methods of codeine usage
In the initial stages, most people take codeine in its oral form. Prescription opioids could potentially be abused if you suffered from an opioid use disorder and took the medication above a doctor’s prescription, or altered the delivery in order to make it more potent and faster (via injection). By changing the original formula, it increases maximum concentration of opioids in your brain, in the quickest time possible. This leads to the onset of the rapid ‘high’ and the reinforcing effect that drives abuse. Other ways for you to use codeine include:
- Chewing codeine pills to prevent controlled release
- Taking higher doses
- Crushing and snorting codeine
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What does it mean to be addicted to codeine?
Codeine is an opium-derived synthetic substance created in a lab. According to the Controlled Substance Act, it is a Schedule II drug, because of its addictive nature. When prescribed for pain medication, cold or coughs, you will find that the drug produces a euphoric high. As a mild narcotic, you’ll have to consume copious amounts of codeine to become addicted.
The addiction starts when you disobey your doctor’s orders and take above the recommended dosage. From there, you will build up a tolerance to the drug. This requires higher doses of codeine, in order for you to feel the same effects as your first usage. As codeine affects neurotransmitters in your brain, you’ll need it to perform basic functions, such as sleeping, walking and eating.
Other factors that influence codeine addiction include:
- The ease of codeine synthesis
- Ease of availability
- State laws and local controls
- Lack of public awareness on the addictive nature of codeine
- Illegal diversion history of codeine
- Failure of doctors to emphasisethe importance of sticking to the prescribed dosage
Tolerance to codeine
Addiction is not the same as tolerance. If you are given codeine for severe pains,you could build up a tolerance after extended usage, but this is not the same as addiction. Tolerance simply means the original doses no longer have the same relieving effect on the user. Once you’ve built up a tolerance, you’ll need higher dosesin order to feel the positive effects. A person with a substance abuse disorder will feel withdrawal symptoms within a few hours since last using.
However, it’s important to note that once you do build up a tolerance for drugs, you are at risk of dependence if your drug usage is not monitored or controlled properly by medical professionals.
Codeine Abuse: Signs and Symptoms
Symptoms of codeine abuse vary from individual to individual. However, a few signs to look out for include:
- Lying to cover recreational drug use
- Stealing other prescription drugs from friends and family
- Increase in sleeping time
- Mood swings
- Forging prescriptions to feed drug habit
- Muscle twitches
- Urinary retention
- Sudden lack of empathy for loved ones and responsibilities
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Health Risks from codeine addiction
Codeine might not be as powerful as other narcotic opiates, such as oxycontin andpercocet, but it poses many health risks, should you abuse it in any way. Popular American rapper Lil Wayne reportedly suffered kidney failure from repeated codeine usage.
He was experiencing seizures and was unconscious when admitted to hospital. His stomach had to be pumped three times, in order to remove all traces of codeine. Abusing codeine affects the lungs, heart and kidneys and causes long term brain damage. Other health risks that large doses of codeine may cause you,include paranoia, anxiety, depression and nausea.
Short-term effects of codeine
According to the Institute of Substance Abuse Treatment Evaluation, the immediate arrival of codeine floods your brain’s neurotransmitter with chemicals that alter your natural chemical balance. Other short-term effects include:
Euphoria – dopamine produces feelings of elation and wellbeing when your brain is stimulated.
Sedation – codeine slows down your body and brain processes by releasing endorphins at major brain receptor sites.
Withdrawal effect – short-term effects can culminate in your physical dependency.
Long-term effects of codeine
Side effects of long-term codeine abuse include:
- HIV, Hepatitis B and C (from sharing needles)
- Mood swings
- Brain damage
- Bowel dysfunction
- Sleep disorders
- Low oxygen levels
Withdrawal effects of codeine abuse
When you stop using codeine, the immediate cessation produces withdrawal effects, such as psychosis, racing thoughts, irritability, sweating, drug craving, muscle spasms, stomach cramps, goosebumps, suicidal ideation and hallucination.
When entering detox and drug rehabilitation treatment, medical professionals always access patients for co-occurring disorders that require special treatment plans. Some of the disorders include bipolar disorders, depression, anxiety, schizophrenia, antisocial personalities and conduct disorders.
Use in pregnancy
The major danger if you were to use codeine during your pregnancy, would the risk of the baby having a physical dependence on codeine from birth. Codeine should only be prescribed for pregnant women when the benefits outweigh the risks. There isn’t a‘yes’ or ‘no’ answer to this question, but your doctor knowing your status can best determine if codeine is absolutely necessary.
A research published in 2011 showed no significant differences in the survival rate of women during birth or the congenital malformation rate between unexposed infants and codeine-exposed babies. However, codeine should be administered with caution if you are in your final trimester.
Teen codeine abuse
Sizzurp is the most popular version of codeine amongst teenagers. The Purple Drank mixture combines soda, candy and codeine-loaded cough syrup, in order to form a sweet but dangerous drug. Abuse of this drug has spread due to influence and use by popular celebrities, such as Lil Wayne, Justin Bieber, Pimp C and D.J.Screw.
The sweetness comes from the candy that also gives it colour. However, it’s the sweetness that makes it so dangerous. When mixed with promethazine (which is often the case), the sedating and euphoric high is called ‘swooning euphoria’. Many teenagers are deceived by the sweet taste and soon develop an addiction- or worse, overdose – by taking extremely high amounts of sizzurp.
Positive uses of codeine
Medically, codeine is used to treat mild to moderate pain and relieve cold and cough symptoms. It is also used to treat irritable bowel syndrome, prominent with diarrhoea. Should drugs like ibuprofen and paracetamol fail you, codeine can be especially useful as a painkiller.
It works by binding to opioid receptors in the central nervous system, in order to decrease your pain and your reaction to pain. Don’t drink alcohol or drive when you’re under the influence of codeine, as the sedative compounds will put you and other road users at risk.
Cost of codeine addiction
When considering rehab for codeine addiction, it’s important to know the cost and what services will be provided. You should consider the type of facility: is it an executive, luxury or standard residential rehabilitation center for codeine addiction treatment? Location is another factor, because it influences your travel costs and the price of overall treatment.
Another factor is the size of the programme and the services provided. Intimate rehab will cost you more, because the staff focus intently on each individual. The number of traditional and alternative therapy treatment options also influence the price. Amenities, such as a gym, massages, nutrition counselling, swimming pools,along with the duration of the programme,are all features for you to consider.
The effects of codeine abuse on the brain and body
The effects of codeine on your brain are psychological. As codeine binds to opioid receptors, long-term use will lead to problems like depression, dependence, addiction and impaired mental and cognitive functions, such as disorientation, insomnia and difficulty concentrating.
The effects of codeine on your body are physical; the most dangerous is respiratory depression,which happens as a result of low blood pressure, breathing difficulty and aslowed heart rate. These effects on your body could include convulsions, seizures, nausea, blurred vision, liver and kidney damage, sexual dysfunction and chronic constipation. Some are reversible with addiction treatment, but others are permanent.
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Safety warning for giving codeine tablets to under 18s
According to the European Union’s medicine advisory body, codeine shouldn’t be given to children under 12 years of age. EMA took a risk assessment after reports arose of children dying or developing severe reactions when they took codeine for pain relief. They recommended that children between the ages of 12-18 should be given codeine only when other pain relief medication –such as ibuprofen and paracetamol – had failed.
Yourbody converts codeine into morphine to relieve pain. The physical build of children, however, converts codeine at a faster rate than what is healthy, which floods the bloodstream with morphine and causes respiratory depression.
Relationship between prescription codeine and other substances
Roughly 1-3% of the opium poppy is codeineand these small amounts require codeine to be synthesized from morphine. Codeine is typically combined with other substances, likeFiorinal, Empirinand Tylenol (the most common of them).
The four types of Tylenol combined with codeine depend on the amount of codeine in the pill. Tylenol 1 contains 8 mg of codeine, Tylenol 3 contains 30 mg and is often prescribed for surgical pain or dental pain, while Tylenol 4 has the most codeine, at 60mg.
Codeine overdose explained
The number of recreational users abusing codeine has increased in recent years. The sedative effects and feeling of euphoria produced when you take it is the major factor that causes so many young adults and teenagers to abuse codeine tablets and syrup. An overdose is a major health risk that arises when you take large amount of codeine, with potentially fatal side effects.
Signs that you have overdosed include: breathing problems, lightheadedness, clammy and cold skin, fingernails with a bluish tint, a weak pulse, unresponsiveness, constipation, coma and death. The most common cause of death remains respiratory failure, where a person with an opiate use disorder stops breathing.
What to do if you need help quitting
Codeine addiction is hard to overcome on your own. Talk to your friends and loved ones if they can offer support and call the Addiction Helper 24/7 helpline. Our consultants understand what it means to battle addiction and are on hand to listen to you and help with solutions that can lead to your lasting recovery from codeine addiction.
It’s difficult watching someone you love struggle with an addiction. We can also advise the best ways for you to coerce your friends or family members to get treatment for codeine addiction. Our large network of treatment centres includes specialist care for long-term users, polydrug users, dual diagnoses and people with co-occurring disorders. Call us today to speak with a recovery specialist.
There is a growing misconception that codeine addiction is not as dangerous as other addictions, such as heroin, meth and cocaine. However, statistics on drug overdose from prescription meds show that it’s as dangerous as heroin. Codeine is one of the most abused drugs, because you can buy it without a prescription in the UK (under 100mg). Higher strength codeine – thought to be heavily regulated – is becoming easily available on the street.
Withdrawal happens if you have a substance dependency problem and attempt to quit or stop using codeine abruptly. When you develop tolerance, your body and brain will need more to feel the effects of the drug. As you become more tolerant, your cells need the drug to perform their basic functions – a sign of dependence, which will make you feel you must take codeine constantly to stave off the withdrawal symptoms.
Symptoms of withdrawal
If you are suffering from withdrawal, the symptoms can range from mild to severe, depending on several factors, such as the length of your use, the quantity and your perceived need for the drug. The withdrawal symptoms (when well-managed) are not life threatening, even when they appear to be. However, if you have been a long-time user, your withdrawal will be severe.
Symptoms of withdrawal from codeine include:
- Mood swings
- Runny nose
- Body pain
- Loss of appetite
- Watery eyes
- Weight loss
- Intense sweating
- Suicidal thoughts
- Stomach pain
For your safety and wellbeing, it’s best to go though withdrawal under the supervision of trained medical professionals
Duration of withdrawal
Long-term use of codeine and other opiateswill eventuallytakeits toll on your body, leaving you completely dependent on drugs. When you stop using, your body will need time to re-learn how to perform and function without codeine. The withdrawal timeline depends on how long you’ve been using codeine, but it usually lessens within a week.
If you’ve been using codeine according to doctor’s orders you might also experience withdrawal symptoms after a while. You might become confused or distraught during your withdrawal, thus placingyou at risk of poor judgement, accidents, self-harm or suicide.
Make sure you stay hydrated during the withdrawal process, in order to prevent dangerous complications. Notify your medical team if you’ve been mixing codeine with other drugs, as polydrug use extends the withdrawal process and makes it more painful. Staying at a detox facility ensures that you won’t relapse during withdrawal, as your body might not be able to handle the drug, while you risk dying from respiratory depression.
Codeine withdrawal timeline
First stage: this phase is known as ‘acute withdrawal’. Withdrawal starts within 6-12 hours after your last dose. Notable symptoms include nausea, runny nose, insomnia, irritability, diarrhoea and anxiety.
Second stage: like most addictions, the symptoms peak on the second and third days after your last dose. The most painful symptoms happen on the third day and could extend to the fifth day in some cases. Symptoms include vomiting, lack of appetite, depression and stomach cramps. Try to eat and always stay hydrated, even when you don’t have an appetite.
Third stage: most of the physical symptoms of withdrawal reduce by the fifth day. The body rids itself of the last of the toxins and returns to naturally functioning without drugs. Symptoms include dilated pupils, leg cramps, goosebumps and chills.
Fourth Stage: beyond these three stages, you’ll feel cravings, restlessness, anxiety, depression and insomnia. If you are along-term drug user, this stage starts on the sixth day and sometimes extends for two to three months. Some addiction experts call this ‘extended withdrawal’ and ‘Post-acute withdrawal syndrome (PAWS)’.
Codeine addiction treatment
Unfortunately, detoxification alone isn’t enough to help you through long-term recovery from codeine addiction. You’ll need follow-up care and a proper substance use disorder recovery programme that includes psychotherapy and counseling, to address the underlying reasons why you abused codeine and to show you how to live a drug-free life.
If you are addicted to codeine you are at risk of liver damage, respiratory depression, fluctuating blood pressure, hallucinations, kidney problems, a decreased heart rate and a drastic reduction in libido. Througha combination of detox, pharmacology and psychotherapy, codeine addiction can be treated.
The best codeine addiction centres use alternate pain relievers with low dependency potential, such as buprenorphine and naltrexone during treatment. Options for treatment include:
Inpatient codeine rehab: this treatment is recommended if you are along-term drug user, or if you have polydrug use problems, dual diagnoses and other mental problems that can complicate your withdrawal and treatment. You might also require special care beyond what the average treatment centre can offer. Inpatient rehab combines detox, medication and psychotherapy models, such as CBT, interviewing, counselling, group therapy, individual therapy and family therapy sessions to treat codeine addiction.
Outpatient rehab for codeine addiction: this is recommended if you are a mild to moderate codeine user or if you’ve only used the substance for a short while. In an outpatient facility, you’ll attend to your detox from home and have the counselling sessions scheduled around your work or school commitments. The major difference is that you won’t receive 24/7 specialist care and the risk for relapse is higher.
Therapy for codeine addiction
Cognitive behavioral therapy (CBT) : Many people use codeine and other prescription drugs as a way to cope with negative emotions, stress and trauma. While most prescription drugs provide temporary relief from your emotions, it’s a maladaptive strategy that leads to a substance abuse dependency. CBT is a therapy option that traces the root cause of addiction and your personal triggers that might cause you to relapse.
You’ll learn improved, positive skills for dealing with socio-environmental triggers and how to handle and reduce the instances of relapse. By learning how to modify these negative images of yourself, your self-esteem and confidence will improve and the risk of substance abuse will also reduce.
Motivational interviewing : This is a patient-centered therapy model that is non-confrontational and centered on understanding and empathy. It’s a gentle, positive approach that uses negotiation to motivate positive change. The goal is the same as with CBT; to build confidence, improve the image of self and modify one’s negative emotions towards positive actions, thoughts and behaviour.
Contingency management : Contingency management motivates recovering addicts by rewarding them when they reach new milestones. For example, if you pass a drugs test, practice a healthy lifestyle or reach 30 days of abstinence, you’ll be rewarded with vouchers, cash and prizes that you can spend on items that don’t encourage addiction. According to the Psychology of Addictive Behaviours journal, this therapy option improves sobriety and retention amongst people in recovery.
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Should you head to therapy having noticedyour own tolerance for codeine, the treatment is straightforward and the withdrawal symptoms are manageable. Should you have lived with the addiction for longer periods, you mightface complications throughout the treatment journey. Any recreational drug users who are addicted to codeine find it harder to complete the detox and rehab treatment, because the brain changes that have occurred over the years are very difficult to overcome.
Immediate health risksinclude: accidents, sexual promiscuity, HIV/AIDS and Hepatitis C (from sharing needles), pregnancies and overdose after relapse. The National Institute on Drug Abuse indicates that the long-term usage of opiates leads to brain damage. Each episode of breathing problems damages brain cells and impairs decision making. It’s important that when you enroll for codeine addiction treatment, you create your plan for relapse prevention and surround yourself with support from loved ones.
When to contact a medical professional
The moment you decide to enter treatment, you should contact a medical professional to determine which treatment options are right for you. A medical professional will access your level of addiction and provide adequate information on the course of treatment that’ll be used to help in your recovery journey.
Codeine recovery plan
A recovery plan helps you plan for relapse prevention and form effective methods for maintaining long-term sobriety after rehab. You will not be able to permanently hide from the world, control your environment nor predict what people will say and do. Therefore, it’s important to have a plan of action to deal with triggers and cravings when they arise.
Your recovery plan will include small steps that you’ll follow daily, until it becomes a natural way of life. A few tips include:
- Create an index card with the names and phone numbers of people you can call when you experience cravings. Always carry this card with you.
- Substitute frequenting bars for volunteering at your local soup kitchen or homeless shelter.
- Use a ‘buddy system’ when attending social events that will be filled with triggers.
- Attend recovery meetings religiously.
- Keep medical appointments.
- Create a sleep schedule and stick to it.
- Eat healthy food, avoid carb-loaded meals and junk food.
- Exercise regularly and stay hydrated throughout the day.
Codeine abuse detox
Using codeine changes both yourbody and mind. After prolonged usage, you’ll become physically and psychologically dependent on codeine. Detox treatment is the first step in yourrecovery journey. Your body will rid itself of codeine and other harmful substances. You might experience headaches, vomiting, nausea and body pain during detox. The duration lasts between five days formoderate drug users andup to two weeks forlong-term substance abusers.
Medications that will be used to manage withdrawal include methadone, naltrexone and buprenorphine. You can either detox at a medically supervised facility or as an outpatient from home. Another option is to slowly taper off by reducing the amount of codeine that you consume and your frequency of usage, until your body fully adapts to using less drugs and the withdrawal is mild. This process takes between two weeks to two months and it is better than quitting ‘cold turkey’,if you lackthe help of medical professionals.
Codeine addiction: Statistics
The Substance Abuse and Mental Health Services Administration (SAMSHA) states that almost 17,000 people died from opiate abuse in 2011, while 1.9 million Americans hadan opiate abuse disorder in 2010.
The number of prescription painkiller types has doubled in ten years, with over 190,000 Brits now estimated to be dependent on prescription drugs, because doctors are too quick to recommend them.
An estimated 33 million people use codeine annually.
One-third of people aged 18-24 take over the counter medication daily and most don’t realise the risk of addiction.
What is codeine?
How is codeine used?
The legitimate way for you to use codeine is to consume it orally for the treatment of respiratory problems, colds, coughs, nasal congestion, sinus and rhinorrhea. Those who abuse codeine combine it with alcohol, inject it, snort or inhale it, to increase the potency of the drug.
Is codeine addictive?
Most opium derivates are addictive and to reflect the danger, it’s classified as a Schedule II controlled substance. If you take larger doses to get high, you will soon build up a tolerance and develop a substance dependence on codeine, which increases your risk of addiction.
Who abuses codeine?
People who take codeine in a manner not prescribed by the doctor – or individuals with a substance abuse problem who take codeine for its psychoactive effects or euphoric high. When you take codeine for any purpose beyond its legitimate uses, itis considered abuse.
What does codeine look like?
A codeine-containing pill is usually white in colour with different strengths, a round shape and with different pill imprints.
How can I spot codeine addiction?
It’s hard to tell when a person is addicted to prescription painkillers, but there are a few telltale signs to watch out for. These include: craving codeine and using it compulsively, continued usage (despite knowing the negative effects) and seeking the euphoric high to trigger the reward centre of the brain.
Is codeine harmful?
When taken for legitimate medical purposes, codeine is not harmful, because it’s administered under your doctor’s prescription. However, when you go beyond the recommended dose or mix codeine with illicit substances like designer drugs, stimulants or psychedelics, you risk an overdose, fatal respiratory failure and even death.
Where else can I find help?
If you can’t talk to family or friends about your problems with codeine, you’re not alone. Addiction Helper provides a no-obligation, confidential helpline that you can contact at any time of the day or night. Our empathic counsellors are always on hand to listen to your problems and help you find a solution for your long-term sobriety. You don’t have to hide or feel shame if you’re struggling with addiction to codeine. Let us help you live a drug-free life today.
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