Is Codeine Addictive?
How is codeine addictive? Here’s a theoretical example: Victoria is a woman in her early 30s who would normally be employed and married with children or enjoying her hobbies – but instead of living her life and dreaming of the future, she is addicted to codeine. Victoria’s addiction to codeine began several years ago, when her doctor prescribed codeine after she was in a car accident. Her pain continued for months, so she kept taking codeine. Victoria became addicted to codeine because she did not know any other way to cope.
Not everyone who takes codeine will become addicted, but for some it can be very problematic. While many people believe that codeine is relatively safe compared to painkillers like OxyContin or morphine, the reality is that codeine is just as addictive when used continuously. Victoria’s story is not unique. There are tens of thousands of people who were unable to stop taking codeine after they got a prescription to deal with pain after an accident or injury – and many more people who became addicted to cough syrup with codeine after an illness.
Codeine is the most widely-used opiate in the world. It is sold as a pill to treat moderate to severe pain. Codeine is a depressant that is also used in some cough syrups or cold-and-flu medicines to stop coughing and relieve diarrhea. Like other opiates, such as morphine or heroin, codeine is highly addictive.
What is Codeine Dependence?
Codeine is an effective painkiller and one of the quickest medications to get rid of a persistent cough. It can be very useful, but there are risks associated with using codeine for more than 3 days. Taking codeine continuously for 3 to 10 days will cause symptoms of physical dependence in nearly anyone. Dependence means that your body has become tolerant to the effects of codeine and your brain needs more of it to function properly. Discontinuing codeine can lead to intense withdrawal symptoms and cravings to take more and more codeine to feel the same pain-relief or other desired effects.
How quickly you develop a tolerance to codeine depends on your genetics, how long you have been taking codeine, how much you were taking, and your behavior. One of the most common symptoms of dependence is feeling that you need to take codeine to feel normal. This is a precursor to addiction.
What is Codeine Addiction?
Addiction is not the same thing as dependence. Physical dependence is a normal response to using codeine and it can be managed by gradually tapering off the dosage of codeine until the body recovers.
Addiction, on the other hand, involves a powerful craving for codeine and a loss of control over the use of codeine. People with an addiction to codeine crave the effects and they will do whatever it takes to get more of the drug, regardless of the consequences. Addiction can lead to fatal overdoses and it often requires a specialized treatment plan.
How Common is Codeine Abuse?
Every year, nearly 34 million people take codeine. The vast majority of people who use codeine do not abuse their medication. However, according to the National Institute on Drug Abuse, 2.1 million people in the United States abused prescription painkillers like codeine in 2008. An estimated 30 million people abuse opiate painkillers worldwide.
Why is Codeine Addictive?
Codeine produces a feeling of well-being and pleasure because it activates the “reward system” in the brain. People who abuse codeine may seek to intensify these good feelings by taking codeine in ways other than how it was intended. For example, one of the most popular illicit concoctions mixes soda and candy with codeine cough syrup.
The long-term use of codeine causes dramatic changes in the brain. Within days, nerve cells in the brain reduce their production of endorphins and dopamine, which are the body’s natural “feel-good” chemicals that reward us for doing activities that promote basic life functions, like eating and sex. Codeine attaches itself to the same receptors in the brain that endorphins and dopamine normally use.
High doses of codeine create a short-lived feeling of euphoria, but the consequence is that the receptors in the brain become less sensitive. These receptors can recover and the brain will eventually start making its own endorphins again, but it takes a long time – weeks or months.
In the meantime, the body craves codeine and goes through withdrawal. These effects make it extremely difficult for a person to stop taking codeine, and reward a person for taking more and more codeine. The result is often an unstoppable cycle of dependence and abuse that leads to addiction. Without treatment, it can lead to death.
How Can Withdrawal be Avoided?
It is not recommended to quit codeine “cold turkey.” Codeine withdrawal is not usually life-threatening, but people who have been using codeine for a long period of time will experience some very unpleasant symptoms if they suddenly stop taking codeine. Gradually tapering off the dose of codeine over a few days can lessen the severity of withdrawal and speed up recovery. It also reduces the risk of a relapse into addiction.
Are Some People More Likely to Get Addicted Than Others?
Nobody knows what causes addiction, but some people are certainly more vulnerable to becoming addicted to codeine than others. For example, children who are born into families with a history of addiction tend to have a higher chance of developing addictions later in life.
One explanation for this addiction risk-factor is genetics. You may be surprised to learn that your genetics play an important role in how your body processes codeine. For example, about 3-10% of white European or Northern American people are “ultra-rapid metabolizers” of codeine, which means they were born with an ability to break down codeine into morphine much faster and more completely than normal. These people experience more painkilling and euphoric effects from a dose of codeine – and they may also be more likely to get addicted.
On the other hand, 10-15% of people are very bad at converting codeine into morphine because they were born with two nonfunctional copies of the CYP2D6 gene. They experience far less painkilling and euphoric effects compared to people who are “ultra-rapid metabolizers,” so they may be less tempted to take more.
How do I Know if Someone is Addicted to Codeine?
People who are addicted to codeine might not understand the damage they are doing. Instead, they believe codeine is preventing them from feeling pain and nothing else matters. They think codeine is having a positive effect on their life, despite obvious evidence to the contrary – job loss, broken relationships, financial hardship, health problems, and an obsession to keep using codeine regardless of the consequences.
Family members might notice that something doesn’t seem right with a loved one who is addicted to codeine, but it can be hard to know for sure. People who are abusing substances are often very good at hiding it or lying to avoid any stigma that might threaten their use.
People who are addicted to codeine might also have dramatic mood swings, rapidly going from calm or euphoric to depressed and anxious.
They may lose interest in activities they once enjoyed and spend less and less time with friends and family members. They will rarely admit that they are dependent on codeine because they are embarrassed or ashamed, which can delay treatment. The longer it takes for a person who is addicted to codeine to get the help they need, the harder it is to stop, and the more likely it is that they will suffer long-term health problems – or overdose on codeine and die.
What Happens When You Overdose?
Codeine overdoses occur when a person ingests more than the prescribed amount in a short period of time. Codeine depresses the central nervous system in the brain, which can slow down breathing until it stops. Other symptoms of a codeine overdose may include extreme sleepiness, pinpoint pupils in the eyes, confusion, cold and clammy skin, weak pulse, shallow breathing, fainting, coma or death.
What Signs of Codeine Addiction Should I Watch For?
- Using codeine every day, or trying to
- Fear of running out of codeine
- Repeated requests for codeine prescriptions
- Increased tolerance to codeine
- Not being able to stop using codeine
- Withdrawal symptoms
- Wanting codeine even when it causes health problems
- Negative impacts on relationships or employment
- Spending a lot of time and money seeking codeine
- Excessive sleepiness
- Losing a lot of weight or gaining weight
- Neglecting personal hygiene or appearance
- Stealing or lying to get money for codeine
Can You Get Addicted to Codeine in Combination Medications?
There are a variety of over-the-counter and prescription painkillers that contain a combination of codeine with other drugs like acetaminophen, ibuprofen, caffeine, decongestants, promethazine, and many more.
You can get addicted to codeine even if you are taking a combination medication, such as Tylenol with codeine. In fact, this addiction can be even more dangerous than an addiction to codeine alone, because Tylenol (acetaminophen) is extremely harmful to the liver when too much is used, despite its reputation as being one of the safest over-the-counter painkillers on the market.
Codeine also has a reputation for safety because it is the weakest opiate and it is easily available in cough syrup. The reality is that codeine is converted into morphine in the body and it can be just as addictive as heroin when taken excessively, although it may take a longer time to become addicted.
What Are the Long-Term Effects of a Codeine Addiction?
Codeine is considered less dangerous than other opiate medications, but it has the same dangerous long-term side effects. People who become addicted to codeine can develop health problems in nearly every part of the body and aspect of their life. Some of the most common long-term effects of codeine include liver damage, kidney damage, gastrointestinal issues (constipation, nausea, pain, etc.), low blood pressure, low heart rate, vision problems, pancreatitis (pancreas inflammation), cramps, muscle spasms, seizures, and persistent sexual dysfunction.
There are also a variety of mental health problems that can arise after long-term use of codeine, such as depression and anxiety. In fact, people who are dealing with emotional problems may try to self-medicate with codeine to block out painful memories, often in combination with alcohol. This can exacerbate mental illnesses.
What is the Outlook for Codeine Addiction?
People who abuse codeine or become addicted are at an increased risk of serious health complications, including overdose and death. The only way to eliminate these risks is by quitting codeine or entering a drug treatment program. The good news is that plenty of people have overcome codeine addiction. The bad news is that even with treatment, codeine addiction can have long-lasting effects. The abnormal changes in the brain can produce cravings to relapse for months or years after a person is no longer dependent on codeine.
How Can I Avoid Addiction to Codeine?
It is possible to prevent codeine addiction. The easiest way to avoid a painkiller addiction is to not take codeine continuously. If you were prescribed codeine by a doctor, do not abuse it by taking more than you were prescribed, or for a longer period of time than your doctor intended.
It is also a good idea to tell your doctor if you start to develop cravings for codeine, obsessions with taking your next dose, or a persistent fear of running out of codeine. Your doctor will probably recommend a schedule for tapering off your dose, or switch you to another painkiller.
Although it is tempting to use codeine to relieve mental health disorders like depression, anxiety, or an inability to cope with stressful circumstances, this is an extremely bad idea. Instead, tell your doctor how you are feeling and get treatment for the underlying mental health problem.
Mental health problems increase your risk of addiction, and using codeine to self-medicate can make these problems far worse. Before taking codeine for pain or for a cold, always consult with your doctor to determine the amount you will take, and what length of time you will take it for to ensure safety.
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