Codeine is a highly addictive prescription opioid that relieves pain without impairing consciousness. Approved in the United States in 1950, it is a derivative of the poppy family and was first discovered in a French lab in 1830. In addition to being an analgesic, it also works as a sedative, sleeping pill and cough medicine. Like other opiates, it induces pleasant feelings of euphoria and deep relaxation. A synthetic form of codeine made from morphine is also available as a prescription drug.
Legal Forms of the Drug
The drug comes in a variety of mixtures. The following combinations have been approved for prescription use:
- Fioricet, Phrenillin with caffeine, Colrex Compound
- Tylenol, Soma
- Phenflu CD, Maxiflu CD, Fiorinal
- Emperin, Nalex AC, Mar-cof BP
- Nowuss-NX, CapCof, T-Koff and Pediatuss
- Other mixtures with aspirin acetaminophen or cough syrup
On the street, it goes by these names:
- T-1, T-2, T-3, T-4
- Cody, schoolboy
- Cough syrup, sizzurp
- Drank, purple lean
Codeine can be applied under the skin, injected into muscles, swallowed or taken rectally. Abuse often starts unintentionally with the use of a prescription for pain or a bad cough. It is more likely to be prescribed than stronger narcotics, but it is similar in structure to the highly addictive morphine. Codeine is also a popular street drug.
How It Works
Codeine is legally prescribed for relief from mild to moderate pain, relentless cough, diarrhea or difficulty breathing. It also relieves depression and anxiety and lowers blood pressure. The drug works by causing the brain to release feel-good endorphins that stimulate the brain’s reward center and create mild states of euphoria. Unfortunately, this can lead to physical and psychological dependence.
Young people with easy access may use it to get high, and older people get addicted when they depend on it to relieve pain. Opioids change the way nerve cells, or neurons, communicate in the brain. Neurons send signals by releasing chemicals known as neurotransmitters. Neurons then attach themselves to molecules on the neurons, known as receptors, and alter the way the reward centers in the brain work. Although codeine is not as strong as many street drugs, it is an opioid and can lead to addiction. It attaches to the same brain receptors as heroin.
Side Effects and Signs of Use
Signs of use vary depending on how much is taken and how long the misuse takes place. Some of the early signals to watch for include the following:
- Mood swings that change from euphoria to depression, anxiety or quiet
- Physical symptoms like muscle twitches, nausea, fainting, dry mouth, itching, urinary tract problems, slow breathing, seizures, low sex drive, dizziness, constricted pupils and bluish lips, skin or nails
- Behavior that includes sleepiness, lack of appetite, lack of interest, frequent visits to doctors, stealing or lying
- Psychological symptoms like forgetfulness, confusion, lack of emotions, hallucinations or delusions
Long-term Side Effects
Long-term use can lead to a wide range of physical complaints and side effects, including these:
- Acute pancreatitis
- Liver or kidney damage, especially from Tylenol combos
- Loss of muscle tone or muscle twitches
- Painful muscle spasms and cramps
- Extremely low blood pressure
- Damage to the immune system, organs and muscles
- Dependence and risk of overdose
Long-term use may also lead to legal, domestic or financial problems, unemployment, poor relationships, loss of productivity or jail.
Dangers of Mixing with Other Drugs
Codeine can be especially deadly when mixed with other drugs. The use of alcohol, sedatives, antihistamines, antipsychotics or central nervous system depressants with it can cause breathing problems, low blood pressure or a coma. A combination of codeine and drugs, such as some antidepressants, that block neurotransmitters may cause severe urinary tract problems or complications from extreme constipation. Tricyclic antidepressants or MAO inhibitors should never be taken with codeine.
Detox and Withdrawal
Going through detox and withdrawal is a gradual process that lasts around seven days, but symptoms like depression may persist for weeks or months. Although it may feel like the flu and be uncomfortable, it is not usually life-threatening.
Addiction specialists and healthcare workers, however, recommend professional guidance when giving up codeine. Stopping immediately can lead to severe withdrawal symptoms like chills, sweating, stomach cramps, muscle spasms, nausea and vomiting, anxiety, hallucinations and thoughts of hurting oneself or others.
Doctors warn that pregnant women should not go through opioid withdrawal because it can cause miscarriage or early labor. The standard treatment for expectant mothers is methadone treatment. Opioid use during pregnancy can result in neonatal opioid withdrawal syndrome in newborns, a condition that requires medical care. The syndrome can be a result of painkillers given by a doctor during pregnancy or the result of opioid abuse.
Medication-assisted Drug Treatments
Sometimes, medications are used to treat dependency. Three of the most commonly used are buprenorphine, methadone and naltrexone. Buprenorphine is the first that can be administered in a doctor’s office, making it more accessible than other drugs. Methadone, a drug that works by changing how the brain reacts to pain, has been used for decades and is considered a safe treatment for opioid addiction. It must be given under the supervision of a physician. Naltrexone can be given as a shot or pill and can be described by healthcare providers licensed to prescribe medication.
Another drug, Naloxone is prescribed to reverse opioid overdoses. It is sometimes added to buprenorphine to lower its risk of misuse.
Symptoms of overdose resemble those of use, but they may be more severe and include dangerous signs like breathing problems, a weak pulse or a coma. Emergency responders will need this information:
- Name of the drug
- Person’s condition, weight and age
- When it was taken
- How much was taken
- If it was prescribed for that person
Codeine is usually combined with other medication, such as Tylenol, and that makes it even more dangerous. Pneumonia, shock, brain damage and death are possible with an overdose.
The drug is a poison in large doses. The national toll-free Poison Help hotline at 1-800-222-1222 is open 24 hours a day. Anyone can call for confidential information.
Helping someone you love get treatment for an addiction can be a difficult and lengthy process. Assistance usually falls into one of two broad categories: inpatient treatment centers and outpatient treatment centers.
Inpatient centers provide 24-hour care and are usually the best choice for severe cases of drug abuse. Outpatient centers provide care during the day but allow the patient to go home after appointments. This is sometimes a good choice for patients who are otherwise healthy, have a supportive environment at home and can follow a treatment regime without a lot of supervision.
Staging an Intervention
An intervention is a prearranged meeting between an addicted individual and their loved ones, but it often takes place in the presence of a trained specialist. Interventions are needed when the addicted individual doesn’t want to talk about drug use or denies its harmful effects on family and friends. Interventions also help when loved ones don’t know what to say or are afraid to bring up the problem. These are signs that someone may need an intervention:
- Problems at school, work or home
- Secretive behavior
- Borrowing or stealing money
- Disheveled personal appearance
- Lack of interest in things once enjoyed
- Health problems
The interventionist knows how to communicate with both sides and defuse arguments before they escalate. Talking to an addict alone sometimes makes things worse. When people feel cornered and defensive, they often become stubborn and say no to stay in control of the situation.
After finding a professional to help, everyone gets together and comes up with a plan. Different approaches work for different people, and it’s important to consider special needs and circumstances. Parents, spouses, siblings, partners, close friends or co-workers often participate. The choice to include children, elderly parents or family members who are not well is one that needs to be weighed in each situation. Confrontational meetings may be too stressful for some people.
The intervention specialist will share information about addiction and recovery with members of the group. Understanding what the addicted individual is going through can help family members and friends be more compassionate, and it can help them be more articulate in their arguments for change. Participants usually prepare and rehearse what they’re going to say before the intervention.
People who become dependent on a substance to get through the day don’t always realize how their behavior is affecting them or their loved ones. Addiction changes the way the brain works and leads to self-centered behavior. During the intervention, family and friends can share stories about how drug use has hurt them or complicated their lives. This will hopefully provide at least a brief window of insight during which the individual can be persuaded to get help.
Treatment Centers Versus Hospitals
In a 2017 study, researchers examined deaths among opioid users who were treated in hospitals versus those treated in addiction rehabilitation centers. They found that those who went through formal treatment faced significantly lower death risks than those who relied on hospitals for treatment. Patients do better when they are surrounded by well-trained professionals who specialize in opioid addiction and can provide well-rounded medical and psychological care.
According to the FDA, doctors wrote prescriptions for medications that contained codeine for almost 1.9 million patients aged 18 or younger in 2014. Almost 1.4 million pediatric patients received an analgesic prescription for products that contained the drug, and 483,000 received products that contained codeine for coughs and colds.
Between 2015 and 2018, 15.5 percent of high school seniors reported abusing prescription drugs during their lifetimes. In the previous year, 9.9 percent had abused prescription drugs. In the previous month, 4.2 percent had misused prescription drugs.
Codeine is in high demand as a street drug, and reports say that buyers may spend up to $200 for one bottle of cough syrup for illicit use. When it becomes too expensive or unavailable, users may turn to more readily available and stronger illegal drugs.
Codeine’s availability and reputation as a safer alternative to dangerous painkillers can be misleading. It is weaker than morphine, but it has the same structure and the same effect on the reward system in the brain. Because it is often mixed with other medications like Tylenol or cough syrup, it is relatively available as a prescription drug. It can be highly addictive and lead to the abuse of stronger, illegal drugs like heroin and hydrocodone. Doctors should advise patients carefully about the medications they are taking to avoid overlapping prescriptions that cause problems. It’s important to remember that help is available if you or a loved one is struggling with a substance use disorder, and even though recovery is difficult, it is worth it.