Codeine Symptoms and Warning Signs

Codeine is an opioid painkiller used for treating mild to moderate pain. It is available over the counter (OTC) in the UK and is prescription-only in the US. Codeine is prescribed for coughs, rhinitis, colds and sinus problems, headaches, nasal congestion, allergies, diarrhoea, body pain, muscle spasms, and osteoarthritis, among other medical conditions. Popular brands include Robitussin AC, Ambophen, Chlorpheniramine, Pyrilamine, Bromotuss, Solpadeine, Nurofen Plus, Migraleve, Codis, Syndol, and Tylenol 3.

Many people become addicted to codeine because of the pleasurable effect of euphoria and sedation it provides. You might assume that the risk of abuse is low because it’s an OTC, or it was prescribed by your doctor. Codeine is addictive, and taking high doses or mixing it with other substances accelerates the addiction timeline, and can lead to dangerous side effects such as respiratory depression, loss of consciousness, and coma.

How Addictive Is Codeine?

Codeine is a schedule II controlled substance in the US with a high potential for abuse. Codeine is converted to morphine in the liver, hence it is a habit-forming medicine that can lead to physical dependence and addiction if used for longer than prescribed.

When metabolised, it produces 6-glucuronides, which are responsible for the large percentage of analgesia (inability to feel pain) that codeine causes. Morphine is the active metabolite of codeine and it works by binding to the u-opioid receptor in the brain and other organs in the body.

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Who Abuses Codeine?

There are so many health benefits of codeine that it’s hard to narrow down to one group that is the most likely to abuse codeine. A study published in Addictive Behaviourfound that men, Hispanics, and Native-Americans had a higher propensity to abuse codeine. Members of the LGBT community and students from urban areas are also more likely to abuse codeine. However, these results are region and habit-linked as well as age-dependent.

A variation of codeine, known as purple drank, is common in the club scene and hip-hop culture. It has been referenced by some professional athletes and in the southern rap music scene. Young people are likely to ‘doctor shop’ for a prescription for non-medical purposes. They see codeine as a harmless gateway drug. When they build up a tolerance for codeine, they then move on to stronger opioids, like heroin, because of the powerful euphoric “high”.

The problem is most disturbing among teenagers, with over 460,000 American teenagers abusing codeine in 2014, and 168,000 battling an addiction to codeine. The British government recently unveiled plans to fight the problem of substance abuse among British teenagers. This includes addiction treatment for teenagers dealing with substance abuse, and prison sentences for those who sell drugs to adolescents.

How Do I Know If Someone Is Abusing Codeine?

Making frequent visits to the pharmacy for OTC : There are many codeine-like products anyone can buy over-the-counter. Addiction could occur after only a few weeks of abuse.

‘Doctor shopping’ to get another prescription : Have you noticed that your loved one is spending more time visiting doctors to get a codeine prescription? Doctor shopping is a typical behavioural sign of codeine dependence.

Lying and faking symptoms to get a prescription : Someone who is addicted to codeine will do just about anything to get a prescription. They will lie that they’ve lost their pill bottle or fake symptoms to convince the doctor that they need codeine for their pain.

Preoccupation with codeine : An addict’s only desire is to use drugs as much as they can. When they are not taking drugs, they are thinking of how to get more drugs. If your loved one finished their prescription faster than they were supposed to, that’s a sign of abuse.

Disruption in sleep patterns : Opiates disrupt your normal sleeping patterns. Users have difficulty sleeping at night and are always tired during the day.

Isolation : If your loved one has been making excuses not to hang out with friends, or attend social functions or family events, they might be abusing codeine. It consumes every moment of their life and anything that might interrupt their codeine use is not interesting to them.

Poor personal hygiene : When your loved one is high on codeine, they don’t feel or think about anything else. Grooming habits they cared about in the past such as shaving, bathing, and brushing their teeth all start to seem inconsequential.

Personality changes : An even-tempered individual becomes imbalanced when they abuse opioids. One moment they are happy, calm and relaxed, and the next moment they are angry, confrontational, irrational, and angry because they can’t access codeine.

Denial : It’s always a difficult task trying to get an addict to admit that they have a substance abuse problem. They will often insist they have it under control and can quit whenever they want. It’s worse if your loved one is a ‘high-functioning addict’. They don’t see the effect of codeine abuse on their home or work life and so feel there is no need to stop.

The Signs of Codeine Abuse

When someone takes codeine, they appear inebriated, similarly to alcohol intoxication. If a recreational user abuses codeine over a long period of time they suffer physical pain when they can’t access it, alongside insomnia, vivid nightmares and seizures. You’ll also notice that when the pain or symptom for which they started taking codeine has faded, they still continue to take the drug. After a while, they build up a tolerance and become dependent on codeine just to feel like themselves or perform basic functions.

The work performance of an addict suffers. They have legal problems, marital issues, and strained relationships with their children and loved ones. Look for empty prescription pill bottles around the house, or street names for codeine on their phones or during conversations, names such as Robo, Candy, schoolboy, captain Cody, doors & fours, pancakes & syrup, DXM, lean, and purple drank.

The Symptoms of Codeine Abuse

If you abuse codeine, you might experience one or more of the following:

  • Nausea and vomiting
  • Clammy hands and feet
  • Anxiety
  • Mood swings
  • Constipation
  • Gastrointestinal pain
  • Drowsiness
  • Itching
  • Weight loss
  • Decreased appetite
  • Blurry vision
  • Nodding off in the middle of a sentence or activity
  • Shallow breathing
  • Sleeping more than usual

How Do Doctors Diagnose Codeine Addiction?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists the following criteria for determining addiction:

  • Inability to quit codeine or reduce large doses
  • Preoccupation with obtaining and using codeine
  • Taking codeine longer than it was prescribed for
  • Experiencing withdrawal symptoms when you suddenly quit codeine abuse
  • Inability to meet family and work responsibilities because of codeine abuse
  • Building tolerance
  • Exhibiting risky behaviour
  • Continued codeine abuse even when you know the negative consequences
  • Using codeine to the extent that it affects your personal obligations, work, and social life
  • Cravings for codeine
  • Continued use even when it affects your ability to function properly

The scale of clinical determination ranges from mild to severe. Mild means you meet at least 2-3 points in the criteria, and severe means you meet six or more.

Why Do People Abuse Codeine?

Addiction might develop from a combination of the following factors:

Environmental: One hypothesis on how addiction develops states that a child who was raised in an unstable home environment, where drug use was common, could end up abusing addictive substances in the future. They learn through the influence of their home environment that substance abuse is an acceptable way to cope with stress and emotional problems.

Brain chemistry: Codeine interacts with neurotransmitters in the brain. Individuals whose brains don’t create sufficient levels of serotonin could make up for the deficiency by self-medicating with codeine.

Mental health issues: Untreated mental health issues such as past trauma, depression, and anxiety could cause you to seek temporary relief from codeine.

Genetics: Having a parent who struggled with substance use disorder increases your chances of abusing substances and developing an addiction later in life.

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What Are the Short-Term Effects of Codeine Abuse?

If you take codeine exactly how it was prescribed, it’s highly unlikely you will develop a tolerance to it. When you take codeine, the immediate effect you feel is the euphoric “high”, along with feelings of relaxation, calmness, drowsiness, and sedation. These are the positive effects that most recreational users seek when they take codeine. When you crash from the “high” short-term effects include:

  • Nausea and vomiting
  • Allergic skin reaction
  • Dry mouth
  • Drowsiness
  • Confusion
  • Dysphoria
  • Low blood pressure
  • Shallow breathing
  • Constipation
  • Indigestion
  • Stomach pain
  • Loss of appetite

The Long-Term Effects of Abusing Codeine

Liver and kidney damage: On its own, codeine isn’t bad for your liver, but, if you combine it with acetaminophens, such as Tylenol, abuse could lead to a serious long-term problem. Your liver becomes overworked, which leads to liver toxicity. If you were prescribed codeine alongside an anti-inflammatory medicine, take it exactly how it was prescribed to avoid kidney damage.

Respiratory depression: Codeine is a Central Nervous System (CNS) depressant that slows functions in the spinal cord and neural pathway of the brain. Complications with respiratory suppression include respiratory diseases and lung problems.

Physical dependence: A well-known long-term effect of abusing codeine is developing a dependence on it. Recreational users abuse codeine to feel its psychoactive effect and, after a relatively short time, tolerance sets in. At this stage, you’ll need larger doses to feel the original effects, which increases your risk of overdose.

Other long-term effects include:

  • Potential brain damage due to lack of oxygen
  • Seizures
  • Nightmares
  • Insomnia
  • Depression

The Dangers of Mixing Codeine with Alcohol

Codeine is an antitussive and narcotic painkiller used for treating mild to moderate pain. As an opioid drug, there is a high potential for diversion and abuse. Alcohol abuse is a serious problem in the UK and United States, affecting tens of millions of people. Mixing codeine with alcohol could be fatal, as alcohol increases the opioid “high”.

Both substances are CNS depressants that enhance the side effects and pleasurable effects from each other. Alcohol binds to GABA receptors and codeine to opioid receptors. Both trigger the release of serotonin and dopamine neurotransmitters in the reward centre of the brain.

The short-term effects of combining both substances include breathing difficulty, dizziness, mental fog, impaired judgment, and delayed motor skills. An accident could also occur while under the influence. This results in internal organ damage, broken bones, and head injuries. A fatal overdose is a serious risk that causes the brain to shut down, and can lead to coma and death.

The Signs of Codeine Overdose

Over a long period of abuse, your brain adjusts to the presence of codeine and depends on it to perform basic functions. Taking high doses, or combining, codeine with other substances that depress the CNS, such as alcohol and benzodiazepines increase the risk of overdose. A few signs to look out for when a loved one has overdosed on codeine include:

  • Frequent vomiting
  • Lack of a pulse
  • Loss of consciousness
  • Extreme fatigue
  • Pinpoint pupils
  • Shallow breathing
  • Bluish tint to fingernails and lips
  • Coma

You must dial your local emergency number if you recognise any of these symptoms. An overdose could lead to death or permanent damage to the brain. Emergency treatment could help prevent fatalities from an overdose.

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Where Can I Find Support for Codeine Addiction?

There are several options to consider when looking for support. Call a drug counsellor and they’ll discuss your options, or recommend the best places to find help for codeine addiction. Options include:

  • 12-step programmes, such as Narcotic Anonymous
  • Sober living facilities
  • SMART Recovery
  • Medically-supervised detox
  • Therapy and counselling
  • Residential rehab
  • Outpatient rehab
  • Aftercare
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