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Codeine addiction: signs, effects, and treatments

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Codeine is an opioid medication that doctors prescribe to treat pain, but it is also used in cough syrups. Codeine is also misused like other opioids such as hydrocodone or morphine. Some people develop Codeine addiction—a strong need to keep using the drug despite the consequences it causes.

Signs of Codeine addiction include strong cravings for Codeine, withdrawal symptoms when not using it, unsuccessful attempts to stop taking Codeine and spending a lot of time and money on getting, using, and recovering from Codeine. People with Codeine addiction may forge prescriptions and engage in other risky activities just to obtain it. They also experience various physical effects such as appetite and weight changes, dizziness, urinary retention, blood pressure and heart rate changes, and others.

The effects of Codeine can be short- and long-term. Short-term effects revolve around temporary reactions to the drug, such as nausea and vomiting, dry mouth, memory loss, and fatigue, just to name a few. Long-term effects of Codeine include organ damage, financial problems, legal troubles, relationship issues, and many more.

Close up of a woman pouring syrup into spoon.

What is Codeine addiction?

Codeine addiction is an overpowering desire to use Codeine, increased tolerance to it, and withdrawal symptoms when discontinued. Codeine has abuse potential and can lead to both physical addiction as well as dependence. People with Codeine addiction have a strong urge or craving to keep using it, despite the problems they experience as a result. 

Codeine is a prescription drug used to treat mild to moderately severe pain. It is a type of opioid medication. Codeine comes in the form of tablets, but it’s also available in syrup form to treat cough. All opioids are habit-forming including Codeine. People abuse Codeine for its calming effects. 

Codeine is less potent as compared to other opioids such as morphine. However, it has a similar structure to stronger drugs such as morphine and hydrocodone. For that reason, it causes similar reactions in the body.

Codeine addiction is included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) by the American Psychiatric Association among opioid use disorders. 

What are the street names for Codeine?

Street names for Codeine are listed below:

  • Cody
  • Captain Cody
  • Little C
  • Schoolboy 
  • Lean
  • Sizzurp
  • Purple jelly
  • Purple stuff
  • Purple tonic
  • Sip-sip
  • Player potion
  • Purp
  • Barre 
  • Purple drank (when combined with promethazine)
  • Doors & fours (when combined with glutethimide)
  • Loads (when combined with glutethimide)
  • Pancakes and syrup (when combined with glutethimide)
  • Texas tea (when combined with promethazine)

What are the signs of Codeine addiction?

Sad female sitting on a bed

Codeine addiction manifests itself through mood, behavioral, and physical symptoms. Signs of codeine addiction depend on the length of time a person abuses this medication. The amount of codeine abused also influences the symptoms of addiction to this opioid. The most common signs of codeine addiction are listed below:

  • Depression and anxiety
  • Euphoria
  • Emotional numbness
  • Mood swings
  • Sense of calmness and well-being
  • Low blood pressure
  • Dizziness and fainting
  • Urinary retention
  • Reduced sex drive
  • Hallucinations and delusions
  • Impaired memory
  • Worsening of mental health
  • Trying unsuccessfully to stop taking Codeine
  • Withdrawal symptoms when not using Codeine
  • Developing tolerance thereby having to use higher amounts of Codeine to experience the same effects
  • Social withdrawal or isolation
  • Doctor shopping i.e. visiting multiple doctors (often using fake names) to obtain prescriptions for greater amounts of Codeine
  • Forging prescriptions to obtain Codeine
  • Frequent ER visits and/or faking illness, just to get Codeine
  • Borrowing or stealing Codeine from family and friends
  • Financial and legal problems
  • Losing interest in activities once enjoyed
  • Ordering Codeine on the internet
  • Spending a lot of time and money on thinking about Codeine, buying, and using it
  • Engaging in risky activities such as healthcare fraud
  • Lying about the extent of Codeine use
  • Impaired performance at work or school
  • Sleepiness and nodding off in the middle of conversations
  • Indifference toward loved ones and life in general

What are the possible causes of Codeine addiction?

Man sitting by a sofa thinking

Possible causes of Codeine addiction aren’t entirely clear. Addiction is a complicated disease where different factors play a role. It’s more likely that a combination of different factors contributes to the development of Codeine addiction rather than a single cause. Possible causes of codeine addiction are listed below:

  • Genetics: some people have a genetic predisposition to develop an addiction. The journal Current Psychiatry Reviews published a paper that discussed genetics related to dopamine and opioid receptors. The paper reported that there is a genetic contribution to addiction disorders, including opioid addiction. In fact, the scientists observed a consistent contribution of variation within DRD2, OPRD1, OPRM1, and BDNF genes toward the development of opioid addiction. These genes encode signaling molecules and receptors that play a major role in the pathophysiology of substance use disorders. People whose first-degree relative such as a sibling or parent, is addicted to substances are more likely to develop addiction too. For that reason, Codeine addiction has a genetic component as well. Having a family member with addiction makes a person more susceptible to becoming addicted to Codeine too.
  • Biological: certain brain abnormalities and impaired levels of neurotransmitters can contribute to the development of Codeine addiction. Evidence shows people who develop addictive disorders have abnormalities in the prefrontal cortex, an area in the brain that plays a role in planning, judgment, and other executive functions. The prefrontal cortex signaling to the reward system is compromised in people with addiction. As a result, they have a decreased ability to utilize judgment to control their impulses and are predisposed to drug-seeking behaviors. When it comes to the reward system, the neurotransmitter dopamine is in charge. An impaired balance of dopamine and weakened dopamine receptors play a role in the development of addiction because the brain and body seek higher amounts of the drug just to experience the same effects.
  • Psychological: many people struggle with mental illnesses such as anxiety, depression, or something else. These conditions have a wide range of symptoms that affect a person’s emotions, behaviors, thoughts, and other aspects of life. In these cases, people may start using various substances, including opioids like Codeine, to “numb” the psychological impact of the mental illness and generate positive feelings. Repeated use leads to abuse, tolerance, dependence, and addiction to Codeine.
  • Environmental: people who are raised in turbulent, dysfunctional homes are more likely to develop an addiction to various substances, including Codeine. Substance abuse becomes a coping mechanism to deal with traumas they experience. Also, people whose family members were addicted to Codeine are at a higher risk of developing an addiction to this opioid too. It’s not just due to genetic predisposition but also because they are exposed to a behavior that is normalized in that environment. For that reason, socializing with people who are addicted to Codeine increases the risk of addiction as well.

What are the side effects of Codeine?

The side effects of Codeine are demonstrated in the table below. 

Short-term effects Long-term effects 
Nausea and/or vomitingLiver and/or kidney damage
Pinpoint pupilsIntestinal blockage
Dry mouthDifficulty sleeping
Memory lossChanges in vision
Fatigue Anxiety and/or depression 
Loss of consciousness Cognitive difficulties
Changes in heart rate and blood pressureBrain damage due to reduced oxygen flow
Dizziness Severe memory problems such as amnesia 
Reduced or depressed breathingSeizures 
Constipation Financial problems
Stomach painEmotional or relationship issues
Headaches Drug-seeking behaviors such as “doctor shopping”
Sweating Overdose, coma, and death

How is Codeine addiction being diagnosed?

Diagnosing Codeine addiction requires a thorough evaluation and includes assessment by a psychologist, psychiatrist, or licensed addiction counselor. Mayo Clinic reports that blood and urine tests are also necessary, but they’re not diagnostic tools for drug addiction. Instead, they’re used to monitor treatment and recovery.

In order to diagnose substance use disorder, in this case, Codeine addiction, a psychiatrist uses DSM-5 criteria. 

When it comes to diagnostic criteria for opioid addictions, such as Codeine addiction, a person needs to have at least two of them within 12 months. The criteria include taking the drug in larger amounts or over a longer period than intended, having the persistent desire and unsuccessful attempts to quit, and spending a lot of time on obtaining, using, and recovering from the drug.

Other criteria include strong cravings for Codeine, failing to fulfill obligations at home or work/school, continuing using the drug despite problems it causes, giving up social activities in favor of drug use, and using the drug in situations when it’s physically hazardous.

Continued drug use despite knowledge of persistent physical/psychological problem that is caused or worsened by the opioid, developing tolerance, and experiencing withdrawal symptoms are also diagnostic criteria for Codeine addiction.

What are the Codeine addiction statistics?

Codeine addiction statistics are relatively scarce mainly because the reports focus on opioid addiction in general. What we do know is that in 2020, a total of 142,816,781 prescriptions for opioid medications were issued, CDC reported. Codeine is one of the most frequently prescribed opioids in the United States. 

Numbers show that 33 million people use Codeine every day. Many people misuse their prescriptions. According to the U.S. Department of Health and Human Services, around 10.1 million people misused opioids in 2019, of which 9.7 million misused prescription pain relievers. Codeine is one of them. 

The CDC also reports that over 932,000 people died from drug overdose since 1999. About 75% of drug overdose deaths in 2020 were associated with opioids.

Even though it’s necessary to have official statistics regarding Codeine addiction, the abovementioned info shows millions of people use and abuse Codeine, and thousands of them overdose on this drug. 

What are the Codeine withdrawal symptoms?

Codeine Withdrawal Symptoms list

The most common Codeine withdrawal symptoms are listed below:

  • Craving for Codeine
  • Difficulty sleeping
  • Irritability or anxiousness
  • Runny nose
  • Teary eyes
  • Yawning
  • Sweating
  • Faster heart rate
  • Muscle aches
  • Loss of appetite
  • Weight loss
  • Stomach cramps
  • Nausea and vomiting
  • Enlarged pupils
  • Goosebumps or chills
  • Diarrhea 

Codeine withdrawal symptoms occur in two phases. The first phase happens a few hours after the last use of the drug, whereas the second phase takes place as the body readjusts to functioning without Codeine. 

Withdrawal symptoms may last for a week, or longer in some people. Physical withdrawal symptoms are the strongest in the first few days after stopping Codeine use and are usually gone within two weeks. Cravings and behavioral symptoms last longer than that. 

What are the treatments available for Codeine addiction?

Treatments available for Codeine addiction are listed below:

  • Detox: the first stage of addiction treatment. It’s a period when a person stops taking the drug, and the body experiences withdrawal symptoms as a result. Depending on the severity of withdrawal symptoms and the type of program, patients may receive medications to reduce their severity. Medicines are a part of medication-assisted treatment (MAT). According to SAMHSA, buprenorphine, naltrexone, and methadone can help ease cravings and withdrawal symptoms among people with opioid addiction. The main purpose of MAT is to improve patient survival, increase retention in treatment, reduce drug use, and support recovery.
  • Residential treatment program: this type of substance abuse treatment is mainly suitable for people with moderate to severe addiction to Codeine. Patients live in a treatment facility throughout the course of the treatment e.g., 60 or 90 days or longer. During their time in a rehab center, patients attend behavior therapy sessions. The most common type of behavioral therapy is CBT (cognitive-behavioral therapy) which teaches patients to identify negative thoughts that affect their emotions and contribute to unhealthy behaviors. Then, they learn to replace those thoughts with positive alternatives, which would ultimately lead to healthier behavior patterns. Patients also learn coping skills, communication skills, and other skills they need to know to maintain their recovery and prevent relapse. 
  • Outpatient treatment program: suitable for people with mild to moderate addiction as well as for persons who have completed a residential program and want more structure and support. For this program, patients don’t need to live in a facility. They live in their homes and attend therapy sessions regularly. That means patients can also maintain employment while receiving treatment for Codeine addiction. According to the National Library of Medicine, therapy sessions include CBT or other approaches such as support groups, counselings and their purpose is the same – to empower a patient to adopt healthier behaviors, develop new skills, prevent relapse, and more.

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