Codeine Addiction and Rehabilitation
Codeine is a prescription painkiller that comes from the opium poppy. It’s one of the most commonly prescribed medicines in the world, usually used to dull pain, prevent cough and stop premature labor and heart attack. Despite codeine’s many benefits, taking it beyond how it is prescribed can often lead to dangerous abuse and addiction.
What is Codeine
Codeine is a member of the opiate drug family. The Federal Food and Drug Administration (FDA) restricts codeine availability by concentration. A dose larger than 90 mg is a controlled substance, although smaller doses diluted with other ingredients are available over-the-counter.
There is codeine in many nonprescription cold medicines, including these popular brand name products:
- Nalex AC
- Robitussin AC
- Guiatuss AC
Codeine is naturally concentrated in the unripe poppy pod. The opium poppy produces a number of essential and dangerous drugs. In addition to codeine, drugs such as morphine, heroin, Vicodin, OxyContin and Percocet all derive their effects from the opium poppy. Opiate drugs, such as heroin, morphine and codeine, only contain natural ingredients. Opioid drugs, on the other hand, are partial synthetics that have some natural and some synthetic ingredients. The class of drug referred to as opioid analgesics include both naturally occurring drugs such as codeine and partial synthetic drugs such as Vicodin. Regardless of origin, however, all opioids produce similar effects, although strength and speed of action vary.
The Origin of Codeine
Civilizations around the world have used the poppy’s unique products for hundreds of years, and raw opium – a strong elixir known as laudanum – was popular until the beginning of the 1800s. German and French chemists further refined opium and isolated morphine in 1804 and codeine in 1832.
Codeine was first used to relieve pain and suppress coughs in the early 1800s. At that time, chemists thought that heroin, another opium derivative, was safer than codeine. Up until recent years, codeine was believed safe and included in most cough syrups on the market.
In the 1960s, the war on drugs restricted the availability of opium, so drug manufacturers synthesized a product to replace the natural ingredients in codeine. As a synthetic opioid, drug manufacturers could easily produce codeine.
Today, manufacturers usually synthesize codeine directly from morphine rather than from opium poppy itself. As medicine discovered its potential as a reliever of pain, diarrhea, cough and anxiety, it exploded in popularity to become one of the most commonly prescribed drugs in the world.
With the worldwide increase in opioid use and overdoses, codeine use has come under new scrutiny. The FDA issued warnings in recent years to restrict the use of codeine in children following tonsil or adenoid surgery. In 2015, they began a complete re-evaluation of the safety of codeine, especially in children.
What to Know About Codeine
Codeine comes in a variety of forms, including tablets, syrup and suppositories. Users can also inject the drug into the muscle or vein. Codeine produces its effects by forcing the brain to release its stores of dopamine. Dopamine is the body’s natural pain reliever, and the dopamine rush is the high that individuals experience. Unfortunately, chronic abuse of codeine changes how the brain manages its production and storage of dopamine. This is why it’s easy for people to develop codeine addiction.
All opioid drugs change how the brain perceives reward and pleasure. The brain learns that abusing the opioid is the quickest way to feel good. When a person begins using codeine – and especially when the individual uses more than prescribed, and for longer than necessary – the brain learns that it doesn’t need to release dopamine on its own. All it has to do to feel happy is get more codeine, and that is the birth of a chemical dependency.
Like all opioids, codeine attaches to certain receptors in the brain and other areas in the central nervous system. It interferes with normal signals meant for those receptors. This is how the codeine blocks the pain messages from getting through. The condition that is causing the pain still exists, but the brain is not registering that pain.
While codeine remains attached to those receptors, blocking regular messages from getting through, it releases a flood of feel-good chemicals. Codeine interferes with the pleasure centers in the brain, which is primarily where addiction forms.
Pleasure centers in the brain are designed to incentivize positive behaviors like procreation and eating for survival. This is how habits form. The pleasure sensations are used as a reward for certain behaviors and become an incentive for repeating those behaviors.
Opioids like codeine insert themselves into this habit and reward cycle and end up promoting addictions. They overload the pleasure center with more feel good chemicals than it could ever naturally produce. The brain registers pleasure that it cannot get from any other substance, so it develops a habit of seeking more codeine.
While the brain learns to rely on the codeine to feel good, it starts to need more and more of the drug to achieve the same effects. This is why people who abuse codeine for a long time can take huge amounts of the painkiller without suffering overdose. If a non-addicted person tried to take the same amount, the individual would likely suffer a fatal overdose. In fact, those who abuse the drug casually by getting pills from a family member or friend are more likely to overdose than those who have a chemical dependency.
How Addictive is Codeine?
Addiction is a complicated concept to measure. It usually occurs on two levels, physical and mental/emotional. The number and intensity of the withdrawal symptoms determines the intensity of the physical addiction. The definition of physical addiction, or dependency, includes that the cessation of use results in physical symptoms.
Generally, the physical symptoms of withdrawal are signs that the body had adjusted its operations based on the presence of the drug. When the user first introduced the drug into their system, the body made changes in an attempt to maintain its delicate balance. When the user quits, the body again must make changes to survive.
By many accounts, the mental level of addiction is more serious and harder to overcome than the physical. In most instances, medical intervention can help ease physical symptoms of withdrawal until the body makes the necessary changes to maintain vital systems on its own again.
It’s possible, however, to develop an emotional addiction to a substance that is not physically addicting. In fact, people develop emotional addictions to otherwise healthy substances or activities, like exercise and even people. When the brain believes it cannot survive without something, and that belief is strong enough for the body to continually seek out that object, addiction is formed.
In the case of codeine, the rate of mental addiction, or at least the part of addiction that takes place in the brain, is accelerated compared to many other abused substances. Just like morphine, heroin and other opioids, codeine goes right to the part of the brain naturally designed to create habits.
By working on the pleasure centers of the brain, codeine ingratiates itself into the system faster and more completely than many other substances. In its recommended doses, codeine is not as strong as morphine or heroin. However, many people who use codeine for a long period (or recreationally) end up taking larger doses. The effects of these large doses of codeine can be equal to or greater than morphine or heroin.
The Physical and Psychological Effect of Codeine
Even when used precisely as directed, codeine causes distinct physical and psychological effects. As a central nervous system depressant, codeine naturally slows heart rate and breathing, which can cause fatigue; people who chronically abuse codeine nod off frequently. Other normal effects include constipation, dizziness, nausea and irregular breathing.
People who become addicted to codeine suffer these effects as well as much more serious symptoms, including withdrawal. If you notice these symptoms, get professional medical help immediately. They include:
- Blue lips, nails or skin
- Loss of Consciuosness or extreme lethargy
- Stopped heart, or slow and irregular heartbeat
- Chest Pain
- Intense anxiety and woresing phusical illness after trying to quit codeine
- Vomiting and/or diarrhea, along with other flu-like symptoms
In larger doses, codeine presents a risk of overdosing. Like other opioids, codeine reduces pain by depressing certain activities in the central nervous system. These include respiration and heart rate. A large dose of codeine can completely stop the heart or the respiratory system.
This is one of the dangers of using codeine with children. Although codeine is a relatively mild opioid pain reliever, suitable for post-surgery pain, its side effects can be overwhelming. Children with respiratory issues recovering from tonsil or adenoid surgery are at increased risk for death due to the side effects of codeine.
How Do People Become Addicted to Codeine
Many codeine addictions start out innocently when doctors prescribe codeine for pain. The situation may range from post-surgery pain to the pain from an injury. The number of orthopedic surgeries to replace or repair joints in people over 50 has increased dramatically in the last decade. Doctors also commonly treat sports injuries with codeine in people of all ages, especially teenagers.
People who begin taking codeine for legitimate reasons can become addicted. At first, they don’t realize there is a problem. The doctor tells them to take a dose whenever they feel the pain. When they visit the doctor for their follow-up, he asks if they still have pain. If they say yes, he refills their prescription.
Meanwhile, the codeine has already begun to influence the pleasure centers of the brain. People have different thresholds for pain and varied tolerances for drugs. There is no way of predicting what size dose of codeine will be enough to trigger the brain to want to get more.
When you take codeine for pain, you feel relief. The pain subsides, as does all of the anxiety that goes along with the injury. Codeine makes you feel good. It’s easy to blur the lines of when you need more codeine for pain and when you need it just to feel good. Because these feelings are closely associated, the brain blends the absence of pain and the presence of good feelings into one.
Once the codeine begins acting on the pleasure centers of your brain, it’s difficult to stop taking it. If you realize the problem right away, you may be able to stop before addiction becomes a problem. However, most people are not looking for addiction, so it takes a while to realize what is happening. By then, quitting the codeine without help is very difficult.
To add to the intensity of a codeine addiction, most people don’t want to admit they have a problem. Addiction has a stigma in our society, which keeps people from asking for help right away. Instead, they hide their addiction and find ways to satisfy it.
When the codeine prescription runs out and the doctor refuses another refill, some people turn to friends for help. They may bargain for the left over codeine from a friend’s recent ankle injury. Codeine is such a popular pain reliever that it isn’t hard to find someone who has some.
As the codeine addiction becomes more intense, it requires more of the drug to achieve the same high. Heroin, however, produces the same high and is readily available on the streets in most communities. In fact, the abundance of heroin makes it cheaper than codeine.
What starts out as a legitimate need for codeine can turn quickly into a serious addiction problem.
In addition to the medical uses for codeine, which sometimes lead to addiction, there is also a street market for the substance. When taken in large doses, codeine can produce euphoria or hallucinations. These effects especially seem to attract young drug users.
For teenagers, access is one of the key elements to drug abuse. Codeine is available without a prescription in many drug stores across the country. Teens often experiment with drug use by combining medicines that contain codeine or drinking codeine-containing cough syrups.
In order to hide their drug abuse, teens often develop code words for drugs. This gives them a way to communicate with each other about recreational drug use without discovery. They also invent new ways to get high by combining substances.
One popular way to consume codeine is a cocktail or cough syrup mixed with soda, known as “syrup” or “sizzurp.” Codeine may also be referred to as schoolboy or Cody. Tylenol with codeine is sold by its strength using a numbering system on the label, one being the smallest dose and four the largest. The street names for these substances containing codeine are T-1 and T-4.
Other street names for codeine concoctions include:
- Fours and doors
- Pancakes and syrup
- Purple Drank
Effects of Codeine Addiction
The short-term effects of codeine abuse are similar to feeling drugged. There is a euphoric feeling, sedation and possible altered consciousness. The long-term effects of codeine use are much less pleasant.
Long-term codeine users can experience insomnia and nightmares. The drug causes changes to the structures of the brain, disrupting normal sleep patterns and sending erroneous pain signals. Long-term codeine users have pain when they are not using codeine.
Some codeine addicts continue to experience phantom pain for years after they stop taking the drug. Nerves are capable of regeneration, but they heal very slowly. The changes in brain chemistry that codeine causes over a long period can take years to heal or even be permanent.
Codeine can also cause liver damage and seizures. Some of the damage, namely organ damage, caused by codeine addiction can be permanent. The liver is a vital organ that can regenerate itself. If a certain amount of damage occurs to the liver, however, it needs to be replaced. It’s impossible to live without a functioning liver.
Other lasting effects, in addition to the organ damage, include coma and death. Long-term codeine abuse puts added strain on vital organs like the heart and lungs. Depending on the situation, these organs become too damaged to repair.
When a codeine addiction goes on for a long period of time, there is also damage done not directly related to health. Continuing to satisfy a drug addiction costs money, and often puts people into financial trouble. Financial problems often lead to crime, because when a person is addicted to codeine, getting their next dose becomes the most important thing in their day.
Addiction leads people to do things they would not otherwise do. Stealing to support their habit, lying to keep it a secret and deceiving doctors to get prescription refills are all behaviors brought on by long-term addictions. It also puts a strain on their relationships with family, friends and co-workers.
Some of these social effects of codeine addiction can become permanent. If you are arrested for committing a crime, for example, you may have trouble getting work after that. Your financial situation may never recover from the debt of the codeine addiction. Some relationships can be mended, but others will not survive the deception of codeine addiction.
There are several reasons why codeine abuse puts you at high risk for overdose. As codeine creates dependence, your brain gets used to the substance. You need a larger dose each time to feel the same effects. This is how your tolerance for the drug increases over time.
When you take codeine in higher doses, you are at greater risk for overdose. As you continue to increase your doses, you get closer to that point at which your respiratory system becomes completely depressed and stops working entirely.
The other danger for codeine overdose is mixing drugs. When you take a medication that contains codeine, it’s important to avoid taking another one. With codeine as an ingredient in many cold medicines, it’s possible to double your dose without realizing it.
In addition, combining codeine with other depressants like alcohol increases the risk of overdose. Codeine depresses the respiratory system and so does alcohol, although they act in different ways. You may not be taking two doses of opioids, but by taking codeine and alcohol you are doubling the dangerous effects.
Fortunately, there is a drug available that works as an antidote to opioids, including codeine. If you are suffering from an overdose of opioids, a dose of Narcan can bring you out of the danger zone. Within a few seconds after administration, Narcan blocks the effects of opioids. When administered in time, Narcan can save you from a fatal overdose of codeine.
While Narcan will reverse the effects of opioids, it cannot bring you back to life after you have stopped breathing. It needs to be administered while there is still some respiration activity in order to be effective. The side effects of Narcan are immediate onset of opioid withdrawal.
Those who have been administered Narcan often need immediate medical intervention to cope with withdrawal. Saving a long time codeine addict’s life with Narcan doesn’t completely put them out of danger. Severe withdrawal symptoms can also be life threatening and require treatment.
Identifying Codeine Addiction and Abuse
Codeine is part of a huge increase in the use of opioids in the last several years. Here are some statistics that put it in perspective:
- Approximately people in the US were addicted to substances in 2014
- Of the Americans suffering from addiction in 2014, about 1.9 million involved prescription pain killers
- In addition to the 1.9 million Americans addicted to opioids in 2014, another 586,000 were addicted to heroin
- In 2008, sales of prescription opioids spiked to four times that of 1999
- The overdose death rate in 2008 also spiked by four times the rate in 1999
- There were 259 million opioid prescriptions written in 2012, more than one bottle for every American adult
- Four out of every five heroin users started by abusing prescription opioids
- The rate of heroin overdose in the US increased by 37% between 2010 and 2013
Although codeine is not as strong as some other opioids, it can still lead to serious addiction. The availability of codeine in over-the-counter medications may be a signal to some that it’s not a dangerous drug. The way it affects the brain, however, makes codeine just as dangerous as heroin and other opioids.
Because codeine addiction often develops from a legitimate use of the drug, identifying someone with an addiction problem can be tricky. The general demographic of people addicted to codeine is a little different from the stereotypical addict. Codeine addicts are more likely to be wives and mothers, or even grandmothers.
It may be difficult to recognize the physical and psychological symptoms of abuse and addiction. If you haven’t observed serious signs of abuse or overdose, certain behaviors also indicate a need for getting help from a codeine rehab.
- Getting more than one prescription from more than one doctor and filling them at more than one pharmacy
- “Losing” prescriptions frequently
- Lying about, hiding or denying codeine abuse is a problem
- Periods of euphoria or deep relaxation followed by anxiety and agitation
- Problems with money and relationships, even if they don’t seem related to drug use
- Reduced motivation or professional aspirations
- Worsening money or legal problems
- Neglecting family and household responsibilities
- Using bigger-than-prescribed doses of codeine more often than prescribed
- Spending more time trying to buy and use drugs
Do these symptoms sound familiar? If so, it’s time to get help.
Codeine Detox and Withdrawal
The first step in any addiction recovery program is detoxing. It sounds technical, but detoxification is really a process your body goes through naturally when you stop taking any drug, codeine included. There is no way to force the drug out of your system. You just have to wait for it to run its course.
Codeine remains detectable in your system for a couple days after you stop taking it. Your tolerance to the drug and how long it takes your system to metabolize it will determine how long it takes you to detox. It is dangerous to go through detox without medical supervision, no matter the drug.
During your detox from codeine, you will begin to experience withdrawal symptoms. The severity of these symptoms will be based on a number of variables, including the size of your last dose, the length of time you have been using codeine and your individual metabolism.
The onset of withdrawal symptoms occurs because your brain goes through an adjustment period. At first, it’s shocked to not receive the expected dose of codeine. Over the course of your addiction, your brain has made adjustments to accommodate the periodic influx of chemicals. During detox, your brain (and body) struggles to cope without the drug.
Remember that your brain is not used just for sensing pleasure, but also regulating vital functions. Codeine blocks pain messages by depressing parts of the central nervous system. Its side effects include slowing heart rate and respiration.
While you were actively using codeine, your brain made changes to the way it operates, so it could maintain your vital signs within acceptable parameters. When the drug is no longer there, the brain doesn’t know how to perform these functions and it starts sending erroneous signals.
Withdrawal symptoms from codeine can include:
- Runny nose
- Muscle aches
- Increase tear production
- Dilated pupils
- Stomach cramps
Many of these withdrawal symptoms are the opposite of codeine side effects. For example, codeine can cause drowsiness while withdrawal causes insomnia. These are signs that your brain is scrambling to figure out how to cope with the severe changes detox brings.
Depending on your situation and the severity of your symptoms, you may require medical intervention to protect your vital systems and ease the discomfort. For severe opioid addiction detox, professionals may administer replacement medications to let your system down more slowly. The doctor supervising your detox at 12 Keys Rehab will discuss these options with you.
In time, your brain will get used to the lack of codeine and will return to normal functioning. This is when the withdrawal symptoms will subside. Withdrawal from codeine can take anywhere from a couple days to a couple weeks.
Codeine Addiction and Co-Occuring Disorders
Addiction is a complicated situation, partly because it involves both physical and psychological components. Addiction has various origins and triggers, often occurring simultaneously with other mental health illnesses.
The exact causes of addiction are still not clear, but we know what factors can lead to addiction. The fact is that not everyone who drinks alcohol, for example, becomes an alcoholic. Some people, however, become addicted after their first drink, while others take longer to develop an addiction.
Addiction rates to various substances are different. Codeine and other opioids tend to produce addictive behaviors rather quickly. Not everyone who takes opioids becomes addicted, however, and some opioid addictions take longer to develop than others.
Although scientists have not completely mapped out the causes, several factors can produce a predisposition for developing addiction, such as:
- Gender– Women are more likely to become addicted to codeine than men
- Family dynamics– People from dysfunctional families are more likely to be addicted to drugs. They receive less positive support and may begin using drugs to hide unpleasant emotions.
- Genetics– People with a family history of addiction are more likely to become addicted themselves. Finding this predisposition through genetic testing is still not possible. It can be diagnosed through anecdotal evidence, though.
- Loneliness– People who suffer from depression, anxiety, or loneliness are more susceptible to drug addiction.
- Mental health disorders– Anything from Attention Deficit Disorder to Schizophrenia can predispose you to addiction.
Addiction is a mental illness that can be caused by other mental illnesses (and paradoxically can create other mental illnesses even where none existed before). Addiction and mental illness is a bit of a chicken-and-the-egg situation. It’s often difficult to discern which came first.
When diagnosing addiction and any other mental illness, the addiction is considered primary with the other referred to as underlying. Sometimes, it is impossible to identify the underlying condition right away. It isn’t until after detox, when the user achieves partial recovery, that the underlying mental illness is revealed.
In diagnosing the underlying mental illnesses, some come up more often than others. These are the mental illnesses more likely to co-occur with addiction:
- Sleep Disorders
- Post Traumatic Stress Disorder
- Attention Deficit
- Bipolar Disorder
Each of these mental illnesses requires treatment to manage or resolve. When combined with addiction, they require special treatment.
The traditional approach to treating addiction with co-occurring disorders was to deal with the addiction first. Many treatment facilities for mental disorders other than addiction will not accept patients actively addicted to any substance.
We have since learned that the most effective way to treat addiction and co-occurring mental illnesses is to do so simultaneously. Whether the addiction caused the mental illness or the other way around, these two conditions are now inextricably linked. To overcome one will require overcoming the other.
Not all rehab programs are designed to handle co-occurring conditions. At 12 Keys Rehab, we have the experience and understanding to develop an individualized program to treat any combination of mental illnesses and addiction. We use the latest treatment modalities to take our clients from where they are to where they want to be.
Our frequent assessments identify progress and newly revealed problems as quickly as possible. We are able to make changes to the recovery program to incorporate this new information, so the program remains relevant to your changing needs.
Codeine Rehab and Recovery
Many people who develop a codeine addiction start with a legitimate prescription. Sometimes, and especially with long-term use, the withdrawal symptoms are so uncomfortable that the individual continues using long after the original problem has ended. Other people become addicted because they used the drug to relax, and then they found they couldn’t stop. Regardless of how long you’ve been taking codeine or how much you take, quitting is possible. If you want help, 12 Keys Rehab is here.
At 12 Keys Rehab, our staff is compassionate, qualified and experienced. We diagnose and treat all aspects of addiction and provide long-term independent aftercare. Our codeine rehab only enrolls a limited number of clients at one time, and because we maintain a large staff, we can provide more one-to-one treatment than most other rehabs in the world.
When you enroll at 12 Keys, our staff will help you manage withdrawal symptoms with 24-hour care. Next, you’ll learn why addiction became a problem through progressive, evidence-based treatments and therapies. You’ll design your own plan for sober living through 12 Step care- still the most successful recovery program in the world. You’ll rebuild your life and your relationships at 12 Keys.
If you or someone you love is addicted to codeine, contact 12 Keys Rehab for more information and find your path to freedom, starting today.