Currently, in the United States, doctors will prescribe, on average, about 71 opioid medications per 100 people, although in some states it can be as high as almost 150 prescription opioids per 100 people. When this fact is taken into account, it’s unsurprising that, according to the U.S. Centers for Disease Control and Prevention, more than 1,000 people a day are sent to the emergency room as a result of prescription opioid misuse.
In 2015, there were more than 50,000 fatal drug overdoses, with just under half of them related to prescription painkillers. Of these medications, codeine might be seen as a relatively harmless opioid, significantly weaker than morphine and often available even without a prescription when used as an ingredient in over-the-counter cough medicine.
However, this does not mean that codeine is safe to misuse. In fact, misconceptions about codeine’s safety combined with the ease of which it can be obtained by children and teenagers make it plenty dangerous, especially when mixed with alcohol.
Codeine can also easily serve as a gateway to stronger opioids, and statistically speaking, those who become dependent on prescription opioids are 40 times more likely to eventually abuse heroin as well.
But without even escalating to stronger drugs, codeine addiction on its own can have serious health consequences, including permanent organ damage, memory loss, muscle problems, and even death.
Codeine is a prescription pain reliever in the opioid family along with drugs like OxyContin, Vicodin, and more. Along with treating symptoms of moderate pain, codeine is also commonly used as a suppressant in cough medicine and can be administered to treat diarrhea. Codeine is also frequently used in combination with aspirin, ibuprofen, and acetaminophen.
Codeine is one of the most commonly-taken opioids, and depending on its preparation, the DEA classifies codeine as either a Schedule II, III, or V substance, which means that some versions and combinations of codeine are more dangerous and addictive than others.
One of the biggest issues surrounding codeine use is that, in its cough syrup form, it often serves as an opioid gateway drug for children and teens, either on its own or mixed with alcohol, which is referred to as Purple Drank, Lean, and Sizzurp and frequently referenced in music and on TV.
Codeine in the form of cough syrup is an over-the-counter medication and is extremely easy for teenagers to either buy or find in their house. Young people with no real experience with drug or alcohol use are likely to start with a substance that they would perceive as harmless.
Of course, codeine is harmless, with side effects such as hypotension, anaphylaxis, and of course, the danger of becoming dependent on it.
The other issue is that while codeine is on the weaker end of the opioid spectrum and is only about eight to 12 percent as powerful as morphine, this means that anyone, including teenagers and children, will find themselves quickly building up a tolerance, which can lead them to seek out stronger opioids, potentially even heroin.
Codeine works in essentially the same way that all opioids do, by entering the body, binding to the brain’s opioid receptors, and stimulating their production.
Opioid receptors are a type of neurotransmitter or brain chemical that are in charge of regulating stress and how we respond to pain as well as transmitting pain signals throughout the central nervous system and to and from the brain. Codeine binds to these opioid receptors and provides a huge boost in activity to the following areas, in specific ways:
Codeine both blocks the brainstem from receiving pain signals and slows down breathing, which is what causes the feelings of sedation and relaxation as well as suppresses any coughing
THE SPINAL CORD
The spinal cord is actually what receives the sensations in the body before passing them along to the brain. Codeine creates a block around the spinal cord so that it cannot receive or send pain signals.
THE LIMBIC SYSTEM
Frequently referred to as the “pleasure center” of the brain, the limbic system is where codeine stimulates dopamine, which is another neurotransmitter that regulates emotions and cognition as well as how the brain processes motivation and reward. This increase in dopamine levels is what creates the feelings of intense euphoria.
Depending on the dosage and method administration, codeine takes between roughly 10 and 30 minutes to take effect, with the effects lasting about four to six hours. Because it is a fairly weak opioid, many people who abuse codeine and build up a tolerance to it soon go looking for more powerful opioids, frequently heroin due to the fact that it’s much stronger and cheaper to obtain than most prescription opioids.
Despite its status as a comparatively weaker opioid, codeine abuse still comes with very serious health consequences. Short-term abuse of codeine on the brain’s opioid receptors and dopamine levels has the following effects:
If taken at extremely high doses, codeine abuse can also cause:
Long-term effects of chronic codeine abuse include:
The signs of codeine addiction can sometimes be difficult to spot, but being able to recognize the early signals of a growing codeine addiction can make all of the difference in ensuring that someone can get the proper treatment before it is too late.
However, as obtaining and using codeine becomes the biggest motivator for someone’s decisions, there are many recognizable signals that are able to be observed in both yourself or others that point to a codeine addiction, as well as noticeable changes in behavior that are commonly associated with substance use disorders in general.
Some of the signs of codeine addiction include:
Whether you have seen these signs of codeine addiction in someone you care about or yourself, it is absolutely critical that you seek out medical detoxification services for you or your loved one to flush out the codeine and prevent as much physical and psychological damage as possible.
The first step in codeine addiction treatment, as well as in addiction recovery treatment, in general, is to detox. In order to ensure that your codeine detox is a safe and successful one, it should be done at a professional medical detox center. While codeine withdrawal, like most opioids, is not a life-threatening situation, it can be extremely uncomfortable and dangerous if it is not done properly with some level of medical supervision.
When someone chooses to detox under the supervision of a medical professional, they can avoid the dangers of certain withdrawal symptoms. They can also avoid the risk of relapsing before making it all the way through the withdrawal process and potentially overdosing in an effort to find relief from the symptoms of codeine withdrawal.
A professional detox facility can also ensure a much safer codeine detox experience by establishing a tapering regimen to slowly wean people down to smaller doses until it is safe to stop using completely. A detox medical professional can also provide medications to decrease any unnecessary discomfort caused by the symptoms of codeine withdrawal, as well as for medical maintenance therapy in conjunction with the tapering process.
After completing detox, the next step in codeine addiction treatment should always be entering an addiction recovery treatment program. Depending on the severity of the addiction, this can be done on either an outpatient or inpatient basis, but it is still absolutely necessary to be able to gain the necessary tools to maintain sobriety and manage your addiction in the long-term.
Detoxing is extremely important to the beginning of the recovery process, but if it is not followed by at least some form of aftercare, whether it is on an inpatient or outpatient basis, there is an extremely high risk of relapse.
An addiction recovery treatment program will help to address the root of someone’s issues with their addiction and gain the understanding and skills required to avoid relapse. While there is no one-size-fits-all approach to drug recovery, research shows that treatment that lasts a minimum of 90 days is the most effective for significantly reducing or stopping drug use.
As previously mentioned, although codeine possesses only a fraction of morphine’s strength, it is possible to overdose on and also even more likely than other opioids. This is often because someone will be quicker to take dangerously high amounts of codeine because it is seen as a safer drug and also because it has a weaker high and they will try to take more for a stronger effect.
Codeine slows down breathing and heart rate, which can lead to dizziness and a loss of consciousness. Signs of a codeine overdose include:
If someone has overdosed on codeine, it is vital that emergency medical services be sought out immediately to avoid serious, permanent organ damage and death.
Apart from the possibility of an overdose, another serious danger codeine addiction presents is when it is mixed with alcohol. Mixing alcohol with cough syrup containing codeine is perhaps one of the most common forms in which people, especially teens and young adults, abuse codeine.
Since alcohol is a central nervous system depressant, taking it together with codeine slows down someone’s breathing, blood pressure, and heart rate even further, leading to extremely intense symptoms of mental impairment, lightheadedness, and respiratory distress.
Using alcohol and codeine together also causes greater damage to the liver and kidneys than either would on their own. Alcohol also speeds up the effects of codeine, bringing it into the bloodstream much faster than it would be able to on its own, which increases the likelihood of an accidental overdose.
DEA / Drug Scheduling. (n.d.). from https://www.dea.gov/druginfo/ds.shtml
National Institute on Drug Abuse. (n.d.). Heroin. from https://www.drugabuse.gov/publications/drugfacts/heroin
National Institute on Drug Abuse. (n.d.). Principles of Effective Treatment. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment