Codeine is one of the most commonly prescribed painkillers in the UK, found in medicine cabinets across the country. While it can be very useful for managing mild to moderate pain and other medical issues, codeine abuse is a serious issue, with many people becoming unintentionally dependent on it. Codeine addiction has potentially severe health implications as well as wide-ranging impacts on individuals’ social and emotional well-being. To avoid these risks, it is crucial that individuals are fully informed about the dangers of codeine misuse and that effective addiction support and treatment are available for anyone who needs it.
What Is Codeine?
Codeine is an opiate that is used as a treatment for pain, as a cough medicine and as an antidiarrheal medication. It is frequently provided in combination with paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and aspirin. Codeine is typically taken orally, either in tablet form or as a syrup and is also available in suppositories and, in some circumstances, via either intravenous or intramuscular injection.
Some brand names of popular medicines containing codeine include:
- Nurofen Plus
- Panalgesic
- Aspalgin
- Panadeine Forte
- Co-Codamol
- Panamax Co
- Mersyndol
- Solpadeine
- Codral
In the UK, codeine is a class-B controlled substance (class-A if prepared for injection) with serious penalties, including imprisonment for unlawful possession and supply. Neat codeine and higher-strength formulations are prescription-only medicines, while lower-strength formulations and combinations with paracetamol, ibuprofen or aspirin can be sold over the counter.
How does codeine work?
Codeine is an agonist (a chemical which binds to a receptor in the brain or body and activates it to produce a response) of the µ (mu) opioid receptor (MOR). Typically, rather than acting directly upon that receptor, codeine is metabolised in the liver to produce morphine, which is ten times more potent in terms of its impact on the MOR.
Codeine acts upon the central nervous system to produce an analgesic and sedative effect due to the reduced excitability of neurons caused by the inhibition of the release of key neurotransmitters. These include substance P, gamma-aminobutyric acid (GABA), dopamine and noradrenaline.
By inhibiting these neurotransmitters, codeine decreases the perception of pain, induces feelings of relaxation and drowsiness and can also create a sense of euphoria. This action on the central nervous system is what contributes to both its therapeutic effects and its potential for abuse.
Codeine addiction and how it develops
Codeine addiction manifests as a compulsion to take codeine despite an awareness of the adverse consequences. Addiction can develop from recreational use, self-medication or genuine medical use.
Recreationally, individuals may start using codeine to experience its euphoric effects produced by the increase of dopamine that codeine triggers. This “high” can then lead to repeated use of codeine, which then escalates as tolerance develops, requiring higher doses to achieve the same effect.
In the case of self-medication, some individuals may turn to codeine to alleviate physical pain, emotional distress or mental health issues such as anxiety or depression. While codeine can temporarily relieve these symptoms, reliance on it for ongoing self-treatment can actually end up making them worse. This then creates a cycle of misuse, with even more codeine being used to try and cope with the escalated distress.
For those using codeine for genuine medical reasons, addiction can develop even when the drug is taken as prescribed. As with recreational abuse and self-medication, continuous use can create tolerance and then a physical dependence where the body experiences codeine withdrawal symptoms without the drug. These can include:
- Restlessness
- Muscle and bone pain
- Insomnia
- Diarrhoea
- Vomiting
- Spasms
- Cravings
- Anxiety
- Depression
This can drive individuals to continue using codeine to avoid these unpleasant symptoms, further pushing them towards addiction.
Codeine addiction symptoms
Recognising codeine addiction symptoms can be challenging, particularly as many individuals in the grips of addiction are often in denial about their situation. This is a common defence mechanism where they may not acknowledge the severity of the issue or may rationalise their drug use as being under control. The gradual nature of addiction development, particularly if it began with genuine medical codeine use, can make it hard for both the individual and their loved ones to spot the warning signs.
It is important to understand, however, that early identification of these signs can make a huge difference in treatment outcomes. In addition to tolerance and withdrawal symptoms, some of the most common signs include:
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Causes and risk factors of codeine addiction
While much is known about addiction, science has still not fully established why one person will develop an addiction while someone else doesn’t. However, there are a number of factors that are identified as playing a potential role in the development of codeine addiction, including:
Genetics
A person’s genetics have long been shown to influence their susceptibility to addiction. This means that a family history of substance abuse and addiction and/or other mental health disorders are a leading risk factor for codeine addiction.
Brain chemistry and mental health
The role of the brain in the development of addiction is an area of major scientific research, with irregularities in the brain’s reward centres, often resulting from illness or injury, greatly increasing the risk of codeine addiction. Mental health issues are also very important risk factors for codeine addiction, as people struggling with these conditions may use drugs like codeine to soothe or self-medicate for the symptoms.
Environment
Environmental factors, including childhood abuse, stress, trauma, associating with a peer group in which substance abuse is common, having easy access to codeine, poverty, financial issues and suffering from an injury or illness requiring pain medication are all known to increase the likelihood that a person will abuse codeine and develop an addiction to it.
Psychological and personality factors
Individuals who have low self-esteem, are prone to risk-taking behaviour, have a tendency to show off or have an inclination towards substance abuse generally are all more likely to develop addiction through codeine use.
The dangers of codeine abuse and addiction
Codeine abuse and addiction can lead to a range of serious health risks and other dangers, impacting the individual, their loved ones and wider society. Understanding these risks is crucial for recognising the severity of codeine misuse and ensuring that the right preventative measures and treatment options are in place.
Health dangers
- Respiratory depression: High doses of codeine can significantly slow down breathing, leading to hypoxia (insufficient oxygen reaching the brain). This can result in permanent brain damage or even death, particularly when codeine is combined with other depressants like alcohol or benzodiazepines.
- Liver damage: Codeine is often combined with paracetamol, which in high doses can cause severe liver damage and potentially fatal liver failure.
- Gastrointestinal issues: Long-term use of codeine can cause chronic constipation, abdominal pain and other digestive problems.
- Mental health problems: Codeine abuse can exacerbate or trigger mental health issues like depression and anxiety. It can also impair cognitive functions over time, affecting memory, decision-making and emotional regulation.
- Codeine overdose risk: Accidental codeine overdose is a significant risk, especially as tolerance develops. Overdose can lead to fatal respiratory depression, especially in combination with other central nervous system depressants.
Personal and societal issues
- Social and relationship problems: Addiction can strain relationships with family and friends, leading to social isolation and disrupted family dynamics.
- Financial issues: Maintaining a codeine habit can be costly, leading to financial strain or engaging in illegal activities to fund the addiction.
- Legal consequences: Possession of codeine without a prescription or obtaining it through fraudulent means can lead to legal repercussions.
- Workplace impact: Addiction can affect work performance, leading to absenteeism, decreased productivity and potential job loss.
- Risk of polydrug abuse: Individuals with a codeine addiction may turn to other substances, increasing the risk of polydrug abuse and its associated dangers.
- Impact on quality of life: Overall, the quality of life can significantly deteriorate due to health issues, mental health problems, relationship breakdowns and financial difficulties.
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Treatment for codeine addiction
There are now many effective treatment options for codeine addiction, including outpatient NHS rehab and private inpatient treatment facilities operating across the country.
Inpatient codeine rehab
Inpatient rehab means the individual stays as a resident for the duration of their stay, which provides a safe, secure environment where recovery can be the sole focus.
Outpatient codeine rehab
Outpatient treatment means living at home and attending regular treatment and therapy sessions. While both have their advantages, outpatient treatment can be problematic in that it does not remove the individual from their daily environment of substance abuse, so preventing relapse can be a challenge.
Codeine detox
Whichever option is chosen, detox is usually the first stage of treatment. It should always be monitored and managed by experienced medical professionals, as withdrawal can be uncomfortable, and some symptoms can be potentially dangerous. This is most safely and effectively done in an inpatient setting where the individual can receive 24/7 care.
Rehab therapy for codeine addiction
Therapy enables the individual to identify the underlying causes of addiction and remediate the behaviours which have reinforced it. Codeine addiction therapy comes in a wide variety of forms and methodologies and may be provided in both group and one-to-one settings. Some of the most effective therapies include
Cognitive behavioural therapy (CBT)
CBT is one of the most common forms of psychotherapy. It focuses on identifying and challenging negative thoughts and behaviours and on developing personal coping strategies for difficult moments during recovery.
Motivational interviewing (MI)
MI is a client-centred counselling approach to elicit behavioural change by examining and resolving ambivalence. It allows individuals to identify why they want to change and guides them to take charge of their recovery.
12-step programmes
These are a set of 12 guiding principles defining a course of recovery from addiction. They focus on the physical, mental and spiritual health and development of each individual and are often long-term efforts, with individuals completing the first few steps in rehab and then attending group meetings after they leave.
Relapse prevention and aftercare
This is the final stage of treatment, and it focuses on maintaining the progress made during detox and rehab. Relapse prevention and aftercare involve a variety of strategies and support systems to help individuals avoid returning to codeine use. This stage is crucial because the risk of relapse is high, especially in the first few months after treatment. Common strategies include:
- Continued therapy, often as part of an aftercare programme
- Trigger identification and management
- Joining support groups like Narcotics Anonymous (NA)
- Healthy lifestyle changes
- Stress management techniques such as mindfulness, meditation and yoga
- Developing new hobbies and interests to stay busy and meet new people
- Building a supportive social network
Get help for codeine addiction today
If you are suffering from codeine addiction, the faster you seek professional help, the sooner you can begin the road to recovery. Speak to your GP or get in contact with a professional rehab centre, and they can help you find the best treatment option.
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