Codeine (3methylmorphine) is an alkaloid found in opium. An alkaloid is a group of naturally occurring compounds consisting mostly of nitrogen atoms. Codeine is an opiate medication in the same class as other narcotics such as morphine (from which codeine is derived) and heroin.
As a medication, codeine has several major uses:
- Pain relief
- Cough suppressant
- Sleep inducer
- Used to control cravings for sugar in people with diabetes (This use is more common in countries outside the United States, but it still may be used by some for this purpose in the United States.)
Other uses for codeine exist. Codeine is typically taken in pill or liquid form. It is often combined with other medications, such as in cough medicine, or with medication such as Tylenol, making it one of the most widely prescribed and used narcotics in the world. Codeine is an ingredient in many cough suppressants, cough medicines, painkillers, and other drugs.
Classification
The United States Drug Enforcement Agency has classified as codeine is a Schedule II drug, meaning that it has high potential for abuse and addiction, and it can only be legally obtained with a prescription from a physician. However, drugs containing less than 90 mg of codeine are classified as Schedule III drugs, suggesting a lower potential for addiction and abuse but still needing a prescription.
Development
Opium was a popular drug in England in the 1700s and sold in elixirs that were often used to control pain. In 1804, morphine, a drug that is still currently in use, was isolated from opium, and this led to the discovery of codeine by a French chemist, Pierre Robiquet, in 1832.
Codeine is named after the Greek word that refers to the head of the poppy plant from which opium is derived. Its most common use in the United States is as a cough suppressant in prescription cough medicine, but it may be used for other purposes as well.
How Codeine Affects the Mind and Brain
As a narcotic medication, codeine’s mechanism of action is similar to other opioid drugs like morphine. It binds to receptors in the brain that are specialized receptors for endogenous opioid-like neurotransmitters. These particular neurotransmitters are involved in controlling pain and reducing the sensation of fatigue. Along with dopamine-facilitated neurotransmitters in the brain that are abundant in areas associated with reward and reinforcement, they produce feelings of euphoria, relaxation, and a sense of the general overall wellbeing. The reinforcing effects of opioid drug use contribute primarily to their potential for leading to abuse and addiction. The cough-suppressing effects of codeine are the result of its affinity for binding in the neurons in the brainstem.
Potential Adverse Reactions to Codeine
One potential serious effect of codeine use appears to be the potential to develop depression. Research findings have suggested that many individuals who use cocaine over a lengthy period of time may eventually develop at least some depressive symptoms.
Other potential adverse reactions to codeine include:
- Drowsiness
- Lightheadedness
- Vomiting
- Constipation
- Difficulty or painful urination
- Stomach pain
- Dizziness
- Nausea
- Headache
- Other changes in mood
More serious potential side effects include:
- Confusion or other mental status changes
- Difficulties with breathing or swallowing
- Changes in heartbeat such as fast, irregular, or even pounding heartbeat
- Seizures or convulsions
- Changes in vision
- Extreme lethargy or sleepiness
- Unconsciousness
- Rashes or hives that may represent allergic reactions
Indications of overdose include:
- Unconsciousness
- Excessive drowsiness
- Coma (becoming comatose is obviously an extremely serious side effect that may indicate overdose)
- Extremely slowed breathing or extreme difficulty breathing (a potentially fatal reaction due to overdose would include respiratory depression)
- Extremely decreased heart rate
- A loss of muscle tone
- Clammy or cold skin
- Dizziness
Other potential serious side effects from long-term codeine use are its potential to result in physical dependence and/or the development of a substance use disorder.
Causes of Codeine Addiction
Withdrawal from codeine may include:
- Cravings
- Nausea
- Flu-like symptoms
- Disturbances in sleep
- Increased irritability
- Increased feelings of tension and anxiety
- Sweating or trembling
- Rash or hives
- Sneezing or runny nose
- Panic attacks
At this time, there are no definitive causes to explain the development of a substance use disorder to any particular drug or in any particular individual. Research indicates that the development of substance use disorders is caused by a combination of factors that include the person’s genetic makeup, family history, psychological history, experiences, peer group, and a number of other potential factors.
However, drugs that typically are capable of inducing physical dependence are also drugs that are believed to have a high potential for addiction. The reason for this is that the withdrawal syndrome associated with these drugs makes it particularly difficult for individuals to stop using the drug on their own, and when they experience withdrawal symptoms the quickest way for them to address these symptoms is to take more of the drug. Continuing to take more and more of a drug in spite of negative consequences is a hallmark of addictive behavior.
In some people, the symptoms can be very serious and resemble serious psychiatric disorders. Codeine is a relatively short half-life (about 2.9 hours). For people who have developed physical dependence to codeine, withdrawal symptoms can begin to appear rather quickly following last use.
Signs of Addiction to Codeine
A number of signs can point to addiction. Some general signs include:
- Cravings for codeine
- Losing interest in activities that used to be interesting and engaging
- Taking larger doses of codeine than prescribed or taking the drug more frequently than prescribed
- Obtaining codeine illegally
- Taking codeine for reasons other than its normal intended use, such as to cope with everyday activities or to feel good
- Taking codeine for reasons other than its normal intended use, such as to cope with everyday activities or to feel good
- Sudden changes in mood
- Continuing to use codeine in spite of experiencing negative consequences
- Experiencing a decline in performance at work or school
- Having relationship problems as a result of codeine use
- Spending more and more time obtaining codeine or recovering from its use
- Unsuccessful attempts to quit use of the drug
- Missing important commitments as a result of use or intoxication
- Expressing a desire to quit using codeine but being able to
- Getting angry when confronted about use of the drug
- Coming to work or attending family functions while under the influence of the drug
- Changes in physical appearance that include being disheveled or lax in one’s grooming habits
Treatment for Codeine Addiction
As codeine is a narcotic medication with the potential to induce some fairly powerful withdrawal effects, it is advisable to include a physician on the treatment team for any person attempting to discontinue codeine use as a result of an addiction or abuse issue.
The physician can supervise a program of tapering off the codeine use or institute a program of opioid replacement therapy to assist the person through the withdrawal process. Such supervision can be performed in either inpatient and outpatient programs for treating addictions.
In general, inpatient and outpatient recovery programs display similar rates of recovery, but there are some advantages to both types of treatment programs that the individual should consider.
It is extremely important for any individual attempting to discontinue use of codeine and deal with a substance use disorder (addiction) to understand that undergoing a program of medical detox alone is not going to be sufficient for recovery from addiction. It is extremely important to become involved in an ongoing treatment program that offers comprehensive counseling and therapeutic support.
Choosing Inpatient or Outpatient Treatment
Inpatient programs for the treatment of addiction will be limited in the time period that they cover and are often 30-90 days in length, although they can be longer. Some individuals remain in inpatient programs for as long as a year, though those who remain in these programs for more than 90 days typically have special needs or situations that require distinctive attention.
Reasons to consider inpatient treatment include:
- The need for close supervision
- The need for medical detox
- The presence of a multidisciplinary team that can cover different aspects of recovery
- Extensive interactions with other people who have addiction issues
- Not having to worry about other daily activities, such as shopping, making meals, etc.
- A safe environment (It may be crucial for individuals who live in conditions that are detrimental to recovery from addiction, such as being homeless, having family members that are addicted to drugs, and so forth, to reside in a safe environment during recovery, provided by inpatient care.)
A person in an inpatient program may also be less prone to relapse in the first month of the recovery. Eventually a person attempting to recover from a codeine abuse disorder will need to become involved in some form of outpatient treatment.
Outpatient treatment programs may offer:
- More freedom in scheduling and therapy choice
- The ability to immediately apply the principles one learns in therapy to aspects of daily life
- No need to take a leave from work, family, and other commitments
Individuals with severe problems associated with addiction or legal consequences are often more apt to become involved in inpatient treatment programs initially. For many, ongoing involvement in some form of treatment, such as outpatient individual or group therapy, is a part of recovery from any addiction. Nearly everyone who recovers from codeine addiction will experience outpatient treatment at some point.
Group or Individual Therapy?
Many will also have the option of choosing group or individual counseling/therapy programs. Group programs have the advantage of having other members to learn from who are in similar situations. Group therapy also encourages the development of positive relationships with others.
Individual therapy programs are more intimate, so they often more specialized attention. They also allow the individual to be the focus of the therapy for the entire session, and tend to be a bit more confidential.
Most often, individuals in rehab programs participate in both individual and group therapy sessions.
Using 12-Step Programs
Most people are aware of 12-Step programs through groups such as Alcoholics Anonymous or Narcotics Anonymous, but there are a number of different 12-Step groups and other community support groups that are targeted at all types of different behaviors and addictions.
The research on the effectiveness of 12-Step groups, such as Alcoholics Anonymous, is limited, and this may be due to the anonymous nature of these groups. However, many individuals attend these groups, and they do offer several advantages. Some of these advantages may be particularly attractive to individuals who are recovering from addictions to codeine.
- These groups are free; individuals may donate money or choose not to.
- They offer a structured program with plenty of social support.
- They are very available, and a person can find a 12-Step meeting in nearly every city at nearly every time of day.
- There are online 12-Step groups available.
Finding a Treatment Program
There are few considerations that can help individuals decide whether a particular treatment program is the right choice:
- If there is a need for medical detox, an inpatient program is often the best program choice.
- Consider the affordability of any program, and the potential for insurance to cover the costs of care, before committing.
- If possible, try and use a program that offers several different therapeutic approaches as opposed to one singular approach.
- Consider if the program allows family members to become involved, as social support can be very helpful during recovery.
- Understand one’s personal commitment to recovery and if the objectives and stipulations of the program match those.
