Codeine Addiction and Treatment

Codeine Addiction and Treatment

Table of Contents

What is Codeine?

Codeine is a medication that can treat pain, cough, and diarrhea. It is typically used as a remedy for mild to moderate cough and pain.1 While it does have legitimate medical purposes, some people may abuse this drug to achieve what they believe to be pleasurable effects. Addiction may require treatment at a rehab facility or outpatient program.

Codeine’s Class

Codeine falls within the opiate class of drugs. It has the same effects as the body’s naturally-occurring opiates and binds to opiate receptors within the central nervous system to provide its pain-relieving and cough suppressant effects.1

Where is Codeine on the Schedule?

In general, codeine is a Schedule II controlled substance, alongside other opiate drugs like morphine and hydrocodone; however, its schedule varies based upon its specific formulation. For instance, the Drug Enforcement Administration (DEA) labels codeine as a Schedule III controlled substance when it is mixed with pain relievers like Tylenol in formulations containing under 90 milligrams of codeine. In addition, when it is included in cough syrups, it is a schedule V controlled substance.2

How is it Used?

Mixing codeine with alcohol or soft drinks to make “purple drank” is a common form of abuse, but there are other ways to misuse this drug. For example, some people may buy codeine cough syrup and drink it on its own. Teenagers may find codeine cough syrup in their parents’ medicine cabinets and abuse it.

In addition, some people may abuse the drug in pill form. They may receive a prescription from a doctor and take more pills than prescribed or begin buying pills from an illicit drug dealer so they can take a greater number of pills than a doctor would prescribe. Some people may crush the pills and snort them with a straw to achieve a stronger high.

Is Codeine Addictive?

According to the DEA

Given the DEA scheduling, it is reasonable to conclude that this drug can be addictive. For example, Schedule II controlled substances are those that people are likely to abuse, and they can lead to significant physical and psychological dependence. Even when mixed with pain relievers as a schedule III controlled substance, the DEA cautions that codeine may lead to low to moderate physical dependence and high psychological dependence if abused. As a Scheduled V controlled substance in cough syrups, codeine is associated with a more limited risk of physical or psychological dependence.2

According to Research

Given the potential for people to abuse codeine, researchers have conducted studies to assess risks of use. In one study, which was included in a 2013 publication of Addictive Behaviors, researchers analyzed use among a sample of 2,349 college students on a large public college campus in the Southern United States. They found that 6.5% of students in the study had used codeine.3

In addition to this finding about the overall prevalence of the drug’s use, study results reviewed the following facts:3

Abuse was more common among males compared to females, with 9.3% of males and 3.9% of females reporting they had ever used the drug.

Students of certain races were more likely to use codeine than others were. For example, 15.6% of Hispanic students and 16.7% of Native Americans had used it, whereas only 5.1% of Asians, 5.4 percent of African Americans, and 6.1% of Whites had ever used it.

Sexual minorities were more likely to abuse codeine, with 14.1% of gay, bisexual, or transgender students reporting they had used it, compared to 6.3% of heterosexual students.

Codeine use was more likely in students who used other substances; 100% of codeine users had used alcohol in the previous month, and 10.7% were also marijuana users.

Use of the drug was more common among students from large cities when compared to those from rural areas.

Proper Use Can Still Lead to Addiction

Additional research with those who take this drug for medical purposes shows that it can be addictive, even for people who have a legitimate reason to use it. For example, a 2013 study in PLOS ONE found that among people taking it for pain relief, 6.8% abused the drug, and 17.8% were dependent upon it.4 Given this finding, the abuse among college students, and current DEA scheduling, it appears that codeine can be an addictive drug when people use it in large amounts.

Is Codeine Safe?

While codeine can be addictive, it can also be safe when adults use it as intended under the direction of a doctor. According to the National Library of Medicine, it is very unlikely to cause fatalities in adults when used appropriately. On the other hand, some research has found that it can cause fatalities in infants and children, making it unsafe for these age groups.1

This drug is safe when taken for legitimate medical purposes, but abuse can be unsafe. For example, overdose is possible with abuse, and some famous musical artists have suffered from overdose deaths as a result of drinking codeine mixed with other substances.3 According to experts, codeine-related fatalities typically occur when people use the drug alongside other substances or when they intend to commit suicide.1 In addition to this risk, some research suggests that abuse can lead to severe brain damage.3 Based upon these facts, it may be safe for treating legitimate medical conditions, but abusing this drug carries serious safety concerns.

Street Names

The National Institutes of Health has reported that some people may use the following street names for codeine:5

Captain Cody
Loads and Pancakes

When people refer to codeine using street names, they are often referencing a drink that is made by combining codeine cough syrup with promethazine and either alcohol or a soft drink mixed with candy. Typically called “purple drank” this form of abuse originated as part of the rap music scene in Texas.

Street names of codeine mixed into “purple drank” include the following:3

Doors and Fours

Someone who abuses codeine may use one of the above terms to remain discreet and prevent others from learning about the drug use.

Effects of Codeine

Short-Term Effects

According to the National Institutes of Health, when codeine is taken in large doses, it creates a high that is similar to the effects of other opiates. For example, when users take large amounts of the drug, they will “feel good” and experience feelings of calmness. The drug also reduces the heart and breathing rate over the short-term, and can even lead to overdose deaths.6

Long-Term Effects

The National Institutes of Health reports that the long-term effects of abusing cough medicines with codeine are not known, but we do know that when people take large doses, they will eventually need more and more of the drug to feel the same high. Over time, this can lead to addiction, which is a long-term consequence of abusing the drug.6

Among those who become dependent, there are some negative physical and psychological effects, according to the study in PLOS ONE. For example, addiction was found to lead to constipation, nausea, dizziness, stomachache, depression, anxiety, fatigue, and attention difficulties. Another relevant finding in this study was that half of the people who used the drug daily experienced headaches which the authors attributed to codeine.3

In addition, people who begin by abusing codeine may move on to more potent drugs, such as heroin, if they find they are unable to achieve the same pleasant effects. This can lead to continued problems with addiction, as well as other severe consequences, like legal troubles, health problems, and increased risk of overdose death.

How Do I Stop Using Codeine?

Given the fact that codeine abuse can lead to addiction, it can be difficult to stop using it without professional intervention. If you are using larger quantities of the drug than intended and find that you are unable to stop using despite experiencing consequences associated with the use, you may have developed an addiction to this drug. If this is the case, you should contact an addiction treatment center to help you stop using codeine. You may first begin a detox program to help you through withdrawal.

What is Withdrawal Like?

Codeine belongs to the opiate class of drugs and therefore can create withdrawal symptoms similar to those seen with other opiates. These symptoms include stomachache and cramping, muscle twitching and tension, racing heart, sleep problems, feeling cold, and feeling ill in general.7 These withdrawal symptoms can be unpleasant, making it challenging to stop using the drug.

Treatment for Codeine Addiction

Getting through the initial codeine withdrawal can be challenging, but treatment can help with this process. Due to the effects of withdrawal, treatment may begin with a detox program, in which you receive medications to help with withdrawal symptoms. During detox, the goal is to keep you as comfortable as possible while your body rids itself of codeine.

After exiting detox, it is important to receive ongoing psychological care for codeine addiction, as detox is just the first step toward a drug-free lifestyle. Through an addiction treatment program that involves both individual and group therapies, you can address the underlying issues that led to codeine addiction and learn new strategies for coping with stress and drug-use triggers. Depending on the severity of your addiction, treatment may occur on either an inpatient or an outpatient basis.

If you are struggling with codeine addiction, reach out for help today to determine the best treatment option for you and begin a journey toward sobriety.

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