Overview

Codeine is a highly addictive medicinal opiate with a long history of recreational abuse. Prescription opiate abuse is a serious danger in the United States, with nearly 18,000 deaths being attributed to opioid painkiller abuse in 2015 alone.¹ Codeine is so addictive due to its close interaction with dopamine production in the brain. Codeine remains one of the most deadly recreational drugs found today due to its potency, its common use alongside substances that can produce deadly potentiation of the drug’s effects, negative physiological effects, and how easy it is to build a tolerance to it. Codeine exhibits short-term effects similar to other painkillers including drowsiness, euphoria, pain reduction, and lethargy. Long term abuse of Codeine can lead to a variety of physiological and mental ailments including infections, body deterioration, cardiovascular problems, and neurological decay. Recovery from Codeine can be effective through the use of various medications and therapeutic treatments, and rehabilitation facilities offer extensive resources for recovering from Codeine addiction in a safe, stable, and comfortable manner.

What is Codeine?

Codeine is one of the most common opiates abused recreationally today. Codeine carries a reputation for its very common recreational usage, often being mixed in its syrup form to create a drink known as “lean”. It also carries infamous reputation for its extremely potent addictiveness, common overdoses, and difficult withdrawals when abused recreationally. Opiates are a class of drugs that include opium, heroin, and morphine, among many others. Opiates are differentiated from opioids by the manner in which they are created. Opiates are created from naturally occurring organic compounds called alkaloids that are found in poppies. Poppies are a type of flower common all over the world, but are grown in particular abundance throughout the Middle East and particularly in Afghanistan where they are grown, harvested, and sold in the opium trade. This differs from opioids, which are synthetically created in a lab and include common prescription painkillers such as Oxycodone, Hydrocodone, and Methadone. Codeine comes from a long line of related opiates that have held historical significance in their prevalence and addictiveness. This lineage includes opium, which remained popular throughout the 19^th century, followed by morphine, and later heroin during the mid-20^th century. Both opiates and opioids are responsible for a deadly epidemic both in the United States and abroad. The National Institute of Drug Abuse estimates nearly 35,000 overdose deaths due to opioids and opiates in 2015, with numbers growing drastically every year.² Overdosing Codeine is a frequent risk factor and leads to death if not treated immediately. Those who survive Codeine overdose are at risk of brain and neurological damage from cerebral hypoxia. Codeine is classified as a Schedule II drug by the CSA, meaning that Codeine has severely restricted medical usage and is not considered safe for use in personal settings due to its high potential for abuse.

How Does Codeine Addiction Work?

Codeine’s deadly addictiveness can be attributed primarily to its effectiveness at mimicking the brain’s natural opiates, which work to allow dopamine to be released. Dopamine is a neurotransmitter that is colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and pleasure when released into the brain. When the body is hurt, the brain produces natural opiates that allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and stress, which works to reduce overall feelings of pain. Codeine mimics this process in the brain, allowing dopamine to constantly be produced and released, over-stimulating the brain and associating Codeine with the pleasure and happiness that comes from dopamine release. Because the brain isn’t capable of handling such intense rushes of dopamine, dopamine receptors become damaged and make it more difficult to feel pleasure, leading users to use more and more Codeine to chase the fleeting euphoria it once offered them. These numerous issues compound to create a strong addiction potential for Codeine, which becomes more and more difficult to feed the more it is abused. This deadly self-feeding cycle of addiction is at the root of Codeine’s effectiveness at becoming addictive.

Short and Long Term Effects

Codeine can be taken orally through compressed tablet or syrup form. Onset of effects varies with the method used to take it, but generally takes around 40 minutes. Effects can last up to 6 hours.

The short term effects of Codeine are similar to the effects of dopamine in general – only amplified. Users report short-term mental effects such as feelings of:

• Pain reduction
• Intense pleasure
• Relaxation
• Contentment
• Confusion

And physical effects such as:

• Heaviness of limbs
• Itchiness
• Nausea
• Drowsiness
• Slowed breathing
• Lethargy
• Elevated body temperature

Repeated long-term use of Codeine leads to physical side effects such as:

• Neurological damage – Frequent abuse of opioid receptors through Codeine can lead to both physical and chemical damage, and has shown to diminish the presence of white matter in the brain, which reduces important neural activity such as decision making and judgment skills.
• Diminished digestive health – Digestive health is severely diminished in the body of a frequent Codeine user due to a reduction in digestive activity. This can lead to weakened gut fauna, cramping, nausea, constipation, and diarrhea.
• Liver and kidney damage – Frequent use of Codeine has shown a correlation with an increased risk of both kidney and liver disease as the body is not capable of healthily processing Codeine. The use of additives in Codeine such as Acetaminophen also poses a particular threat to the liver and kidneys, as many additives are not meant to be ingested in such great quantities..
• Increased risk of bacterial infection – Codeine has shown to significantly increase the risk of bacterial infections both externally and internally due to a diminished immune response.
• Insomnia – Due to a general decay in personal health as well as frequent interruptions in ordinary circadian activity, Codeine users often experience worsening sleeping problems that can develop into insomnia.

Long-term use of Codeine also carries several mental side effects including:

• Severe addiction – Because of Codeine’s addictiveness, both mental and physical addiction are developed very quickly, leading to a complete dependency on the drug.
• Depression – Due to overstimulation of dopamine receptors, Codeine frequently leads to depression due to the brain’s inability to properly manage its circadian rhythm and dopamine production.
• Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in Codeine abuse due to internal factors from the psychological and physical effect of the drug itself, as well as external factors such as pressure family, friends, and work that may all be affected by addiction. This can compound and develop into chronic paranoia.

Other risks posed by Codeine abuse include:

• Risk of overdose – Codeine holds a reputation for how easy it is to overdose on for a good reason. Because Codeine and Codeine tolerance are so volatile, it is very easy to misjudge the amount you can handle and overdose. Death by respiratory failure is common, and survivors are at risk of permanent neurological damage.
• Additives – Codeine almost always comes with a variety of other chemicals such as paracetemol which has beneficial effects when taken at the recommended dosage. However, these chemicals have a much higher capacity for overdose and organ damage, and when taken at psychoactive doses these chemicals frequently lead to death. Death can come as a result of liver failure, respiratory failure, or cardiac damage.
• Allergic reaction – Allergic reactions to Codeine are not uncommon, and can often be fatal. Common symptoms of allergic reactions to Codeine include skin rashes, difficulty breathing, and swelling of the throat. Action should be taken immediately when an allergic reaction occurs to avoid suffocation.

Codeine withdrawal is a notoriously difficult process to go through, and includes withdrawal symptoms such as:

• Cold sweats
• Uncontrollable shaking and shivering
• Diarrhea
• Nausea and vomiting
• Elevated heart rate
• Muscle aches and cramps
• Insomnia

Methods of Treatment

Pharmacological:

Treatment for Codeine addiction via medication is one of the most common and effective forms of treatment available. Due to the strength of Codeine’s addictive potential and the severity of withdrawal symptoms, treatment through medication aims at minimizing as many adverse reactions to withdrawal as possible. Treatment through medication begins with a detoxification process in which the body is given time to expel Codeine from the body, which is often accompanied by common withdrawal symptoms such as diarrhea and vomiting. Once the user has gone through detox, they begin treatment with certain opioid substitutes. These drugs function similarly to Codeine in their reaction with dopamine, but to a lesser degree, and through significantly safer and less addictive chemicals. This allows a gradual transition from addiction to sobriety while minimalizing unpleasant side effects of withdrawal that are likely to lead to relapse. Buprenorphine is a common medication used in Codeine treatment. Buprenorphine is particularly effective due to its ability to satiate opiate cravings without producing any high, which is due to it being a partial opioid agonist. This means that when

Buprenorphine is ingested, it will only activate opioid receptors in the brain to the point where cravings are satiated, but without producing a high. Other medications include Methadone, one of the earliest medications used in Codeine treatment that works as a full opioid agonist, and Naltrexone, an opioid antagonist which completely blocks the functioning of opioids when ingested. Each of these medications functions differently and is prescribed on a case-to-case basis to best fit the needs of the individual undergoing treatment.

Therapeutic:

Other forms of treatment for Codeine addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as Codeine addict as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting Codeine addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

References

1. “Overdose Death Rates.” NIDA, National Institute on Drug Abuse, 6 Jan. 2017, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
2. Center for Behavioral Health Statistics and Quality (CBHSQ), et al. “Results from the 2011

National Survey on Drug Use and Health: Detailed Tables.” SAMSHA Web Archives, SAMSHA, Sept. 2011, http://archive.samhsa.gov/data/NSDUH/2011SummNatFindDetTables/NSDUHDetTabsPDFWHTML2011/2k11DetailedTabs/Web/HTML/NSDUH-DetTabsTOC2011.htm.