Codeine is a very common opioid and one of the most prescribed worldwide. It is an opiate analgesic that is used to relieve pain and discomfort for various medical issues.
This drug is derived from morphine and is stronger than over the counter medications like ibuprofen or acetaminophen. Codeine comes in a liquid or pill form and is mostly used for mild or moderate pain, diarrhoea, and coughing.
This drug is in many other medications and comes in various strengths. Despite being readily available, codeine is an opioid and has the potential to become an abused substance.
Over the counter forms of codeine are often used in conjunction with other pain medications for maximum pain relief. Codeine also provides a sense of calmness and wellbeing which can become addictive in some individuals even at this low dosage.
Medical professionals may also prescribe it in much higher doses depending on the needs of their patient. Misuse of codeine used to relieve coughing or mild pain has been on the rise in recent years, and there is a concerted effort to lower the risk of new users becoming addicted by educating them of the dangers.
Currently, most forms of codeine, including over the counter medications include a note on the label warning of the potential for addiction.
Codeine is considered a class-B controlled substance in the UK. This is escalated to a class-A when it is injected. Individuals caught using or selling codeine without proper documentation can be subjected to hefty fines or even jail time under “unlawful possession”.
This is a part of the effort being made to lower the number of people addicted to this easily procured opioid.
There are legal forms of the drug. “Neat codeine” and prescription-strength codeine medications are legal in the UK if they are prescribed by a medical professional.
They cannot be sold or given to someone else for whom they are not prescribed. It is also legal to possess over the counter forms of codeine as long as it is mixed with a minimum of one other ingredient (e.g., aspirin, paracetamol, ibuprofen, etc.).
For over the counter pills, they must be 100 mg or less and liquid forms of codeine are only legal to sell or purchase with a concentration of 2.5% or less.
Most opioids are prescribed to counter pain. They are fast-acting and are meant primarily for short-term pain management (e.g., surgery, accident trauma, etc.) and not chronic conditions.
Some exceptions are made in the case of terminal illnesses (e.g., cancers, etc.) where pain regulation is necessary to remove the pain and add a sense of calm.
There are several different common opioids, and each one is meant to work against mild, moderate, or severe pain.
They can also be prescribed for persistent coughs. Codeine and other opioids are known to cause constipation, so they are also sometimes used for cases of severe diarrhoea.
Long-term use for any reason is not recommended and can lead to substance abuse.
All opioids have the potential for addiction due to the way that they interact with neurotransmitters in the brain. Codeine is no exception, and long-term use should be avoided whenever possible. It is a fast-acting drug that quickly builds up tolerance in the body.
This means that a higher dose is necessary to achieve the same amount of relief. The body will then readjust to the higher dosage, and the process will repeat until it reaches unsafe levels.
By the time tolerance has become an issue, it is already possible that dependency has set in. The brain cannot function properly once it becomes reliant on the drug.
Any cessation or lowering of the dosage at this point will cause withdrawal symptoms. Taking codeine in amounts higher than prescribed can lead to serious injury, overdose, or death.
Codeine is used in various forms and strengths. It is often mixed with other drugs to create a tailored medication designed to provide a certain level of pain relief.
The following codeine-based over the counter pain relief medications are often misused and abused:
The pain-relieving effects of codeine are created through the body’s reaction to opioids. There are opioid receptors in the brain that are manipulated by codeine, causing some nerve signals to slow.
This imitates how natural endorphins lower pain. There are also the accompanying feelings of wellbeing and euphoria that becomes more evident in higher doses.
There is a risk of overdose at this point because some people will continue increasing how much of the drug they are taking to get this same high even after they become dependent on codeine.
Withdrawal symptoms will replace the perceived positive effects of codeine if an individual stops taking it or significantly lowers the dose all of a sudden.
These symptoms will range in severity depending on several factors, including how long code was being used and the magnitude of the dose. One should never quit a drug without being under the care of a medical professional as there is the potential for adverse side effects.
As mentioned in the previous section, codeine works by connecting itself to neurotransmitters in the brain and spinal cord which inhibits their ability to send and receive signals.
This leads to pain relief. Opioids also have the ability to create warm feelings of euphoria, which is one of the leading causes of addiction. Individuals chase that feeling, but it ends up taking more and more of the drug to create the same effect.
Over time the brain becomes so dependent on the chemicals provided by codeine it is not able to function correctly without them. The body’s floundering attempt to overcome this loss of the drug is what causes withdrawal symptoms.
Not everyone who becomes addicted to codeine will develop a psychological dependency, but those that do will have the most challenging time quitting.
It will make them crave the drug and do whatever is necessary to keep getting the same warm, contented feeling that codeine provides. This is the most common type of addiction.
No one person experiences withdrawal in precisely the same fashion. Still, there are a number of well-known symptoms for physical and psychological dependence that start within a few hours of the last dose.
A few of the factors that determine what symptoms a person will feel when they stop taking codeine and how long they will last include the following.
Codeine is a fast-acting opioid which means that anyone with a dependency will begin to feel withdrawal symptoms within hours of the previous time they took it or if their last dose is significantly lowered.
The higher the average dose of codeine, the more likely there will be noticeable symptoms. These include a wide variety of physical and mental reactions to the changes in brain chemistry produced by the lack of codeine.
Compared to other drugs, the symptoms are generally relatively mild. They are still dangerous, however, and one should never attempt to quit “cold turkey” or without the aid of a medical professional if they have been taking the drug or longer than seven days.
Symptoms of codeine detox and withdrawal include the following:
These may not seem too bad listed out, and some people are tempted to go through detox and withdrawal alone out of a sense of guilt or shame.
Even seemingly innocuous symptoms like dehydration can lead to life-threatening situations if left unchecked. Whenever possible, it is recommended that any detox happens under the care of trained medical supervision.
There are many factors that will play a part in determining the withdrawal timeline for any particular person.
This means there is no set length of time for the symptoms and cravings to last, although most people do share similar experiences as far as stages of withdrawal and a vague timeline.
While symptoms can begin within only a few hours, some of the effects of quitting can last for weeks or even months (e.g., depression, etc.) while others come and go sooner. Thanks to the fast-acting nature of the codeine, it works through the body’s system quite quickly.
How a person chooses to stop taking codeine will have the most considerable impact on how long it takes for them to work through the withdrawal fully.
If they quit “cold turkey”, then it will be over relatively quickly, but this method is potentially hazardous and not recommended. Most rehabilitation facilities and medical centres will slowly taper a person off of codeine.
This can take a couple of weeks or months depending on how high their average dose was and how long they had been using the drug and what form of codeine they were taking.
The average timeline is a few weeks to a month following three main stages. This will vary based on individual circumstances.
Symptoms will usually appear and peak during the first four days thanks to the fast-acting nature of codeine. People going through withdrawal are likely to experience intense flu-like symptoms, including the following. Nausea and vomiting Diarrhoea Insomnia and sleep disturbances Restless legs and agitation Muscle and stomach aches Sweating
Physical symptoms will begin to lessen during this stage, and psychological ones will become more evident. This includes an increase in cravings for the drug and instances of depression. It is also incredibly common to be dehydrated by this time, and it is important to keep an eye on the symptoms that can cause it (e.g., diarrhoea, sweating, etc.) and regularly ingesting fluids to stay hydrated.
By stage three, most symptoms are entirely gone, but the depression and cravings can continue for weeks or months beyond this point and should be managed with the help of medical treatments, including therapy.
In most cases, it is encouraged that the individual is tapered off of codeine slowly to lessen the likelihood of symptoms becoming overwhelming or too uncomfortable.
The treatments for codeine detox and withdrawal include taking various other drugs to help counteract any adverse effects. Therapy is also helpful for the psychological symptoms and should be continued even after the withdrawal period is over.
Aftercare is essential for mental wellbeing. Medications may be used depending on the severity of symptoms experienced during detox and withdrawal.
Mild symptoms are usually treated with non-narcotic pain relievers and over the counter medications to assist with discomfort. They include the following:
Moderate pain and symptoms can be treated with the following medications.
For people who were on codeine for an extended period or on larger than average doses, the symptoms will be more intense. Other factors come into play as well. Below are the standard treatments for severe pain, cravings, and discomfort during opioid withdrawal.
For severe withdrawal, most people will almost always be switched over to a codeine substitute to lessen the risk of relapse and lower cravings while they are being tapered off the drug.
The most common drugs used as substitutes are methadone and buprenorphine with the majority of cases using the latter, which can give a weak imitation of the euphoria experienced while taking codeine. It makes it easier to resist relapsing and continue with the tapering process.
Substitutes are introduced while codeine is being slowly decreased in dose to help steady the brain’s chemical balance during detox and withdrawal.
Because these drugs themselves are also addictive, they will be tapered off once the worst of the codeine symptoms are gone to cut down on the possibility of becoming dependent.
Not every doctor will recommend a codeine substitute. It will depend on several things, including the severity of the withdrawal symptoms and the medical history of the patient.
There several helpful treatments and resources that can be utilised to make the process of withdrawal and recovery more comfortable.
These include counselling, prescribed medications, group support, and a holistic approach to personal wellbeing. Below are a few common treatments of addiction recovery.
Any treatment plans and goals should include aftercare for continued recovery.
The psychological withdrawal symptoms of depression and drug cravings may last for months after the rehabilitation programme is complete, so it is vital to have a strong foundation of support to fall back on.
This can include one-on-one therapy, community support groups, family therapy, or alternative therapies.
Many facilities offer several months to a year of aftercare services for their clients.
Individuals can work with a local medical clinic to find resources in their area. The NHS may cover some rehabilitation services such as in-patient detox depending on the severity of the symptoms and other qualifying criteria.
Counselling, support groups, and other treatment options can all be found by reaching out to a doctor or checking the local council website for more information on the services provided in that area.