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Codeine Addiction and Abuse

Codeine addiction

Codeine is an opiate used to treat mild to moderate pain, usually pain that isn’t quite managed by over-the-counter treatments. As a milder opiate codeine it is quite widely available, in some countries it is even available without prescription, and it can be found in small doses and combined with other drugs in commercially available remedies.

However, being one of the less potent medical opiates does not mean there is no risk of abuse or addiction. Indeed, its wide availability means that, on some measures, it carries a bigger public health risk because it exposes more people to opioids and, therefore, the risk of opioid abuse.

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How is codeine used?

Codeine is used widely because of its effectiveness and convenience in managing pain. The drug is usually prescribed for short periods, to help assist recovery from procedures and injury. It is, like other opioids, fast acting, and the effects generally last for about six hours. Usually prescribed in tablet form, it makes it a useful drug to prescribe to enable people to return to normal life while their body recovers. Because of the risk of abuse and addiction it is generally only prescribed for short periods.

How is codeine abused?

A strict definition of abuse is any use that isn’t medically directed. This might mean that someone who takes more than prescribed, or more frequently than directed, to manage their pain is abusing the drug. However, more generally, any use that is not for the intended use is defined as abuse.

One of the difficulties, and drawbacks, of codeine abuse is that it can be hard to detect when it starts. Because codeine will offer both pain relief and feelings of pleasure, a legitimate user might not be able to differentiate the two feelings; the pleasure might, to them, be a consequence of the pain relief rather than the drug, and perceptions of pain are subjective, meaning that a transition from use, to abuse, to addiction can be gradual and unnoticed until too late.

However, the wide availability of codeine means that recreational use is commonplace. Whether using tablets sourced legitimately and taken from, or given by, the original patient, or tablets sourced illicitly or from overseas, there are many cases of opioid abuse and addiction that started with recreational codeine use.

How codeine addiction develops

Opioids, including codeine, work by binding themselves to the opioid receptors in the body. These have a range of effects. One is to block, or change, pain signals, which is the desired effect of the drug when prescribed for pain relief. However, they will also stimulate the production of neurotransmitters including endorphins, that create feelings of pleasure. It is these that can make opioids addictive.

While understanding and knowledge of the addiction process is still developing, the role of the brain’s neural pathways are being seen as increasingly important. This is one of the reasons that behavioral addictions are becoming increasingly recognized. In this model of addiction, the brain responds to the stimulus, in this case an opiate, by activating the reward centers. As these pathways develop and gain prominence within the brain’s function, the addictive behavior, in this case taking codeine, develops.

The more traditional model of addiction also has relevance. In this model, the body develops a tolerance and starts requiring more and more of a drug to have the same effect. Eventually, this develops into a dependency, and an addiction is formed.

In either case, it is easy to see how opiates can be so addictive, by both stimulating the brain’s pleasure centers with endorphins to create a psychological addiction, and by altering the way the brain works to create physical dependency and addiction.

What are the risks of abuse and addiction?

Opioids not intended for prolonged use because of the risks they pose. Although they are sometimes prescribed for chronic, long-term, pain this is usually for patients with terminal or degenerative conditions where the risks are outweighed by the relief the drugs will offer.

When prescribed and used as directed, they should not pose any risk and will work as intended, relieving pain, and assisting the healing process. However, while it’s not understood why some people develop addictions and others do not, it’s worth being mindful of opioid use if you have any risk factors for addiction.

Those who might have a higher risk of addiction include those with a personal or family history of addiction, or an existing mental health problem, such as depression or anxiety that might be affected by the changes in neurotransmitters. Lifestyle can also have an effect, exposure to stress or being in an environment that exposes them to other addicts and addictive behaviors can increase risk.

The risks from prolonged codeine abuse and addiction include physical effects such as kidney and liver damage. In some cases, if the abuse is particularly severe, codeine can depress the heart and respiration rates, causing tissue damage because of a lack of sufficiently oxygenated blood circulating.

And like any other addiction, codeine addiction can have profound effects on other areas of life. Addicts will frequently experience adverse effects in their professional and personal lives as their addiction dominates their thoughts and behavior. The consequences can range from work and financial difficulties to strained and broken relationships with friends and loved ones.

At very high doses, codeine, like any opiate can be fatal. Symptoms can include gastro-intestinal distress, confusion, and loss of motor control. The effects of respiratory distress can lead to brain damage or fatality. The risks are particularly high if the drug is taken with other drugs that have a depressant effect, such as alcohol or other opioids. Medical assistance should be sought in the event of an overdose.

Treatment of codeine abuse and addiction is possible. As a milder opiate it is, usually, possible to find alternative drugs to address the symptoms that required pain relief, if still present, and as a milder opiate, if the abuse has not been severe or long-lasting, the withdrawal effects can be managed with professional help, allowing the patient to focus on recovery and living a drug-free life.