Codeine is an opioid used to treat mild to moderate pain symptoms. Codeine often contains other medications like acetaminophen, promethazine and carisoprodol. Codeine is commonly prescribed as a cough syrup and because it lacks the strength of opioids like morphine or oxycodone, it can also be used to treat allergies, severe cough, and cold symptoms.
Codeine Side Effects
- Feelings of euphoria and relaxation
- Stomach cramps
- Nausea and vomiting
- Slowed breathing (from respiratory depression)
- Dizziness and confusion
How Does Codeine Addiction Occur?
Once in the body, codeine is broken down into morphine where it dispenses throughout the central nervous system effectively blocking pain signals. While in the brain, codeine triggers the production of dopamine in areas that regulate self-control, motivation, and reward. If a person continues to use opioids like codeine, overtime these areas can show significant changes.
Taking prescription codeine can also result in tolerance to its painkilling effects. While this can vary significantly from person to person, tolerance in many can lead to misuse of the drug. This can happen when individuals are more concerned about treating their symptoms than they are the risks of their prescription.
Another force at work when taking opioids like codeine is dependency. Dependency occurs when the body becomes reliant on the drug to function normally. With codeine, this usually occurs just 12 hours after the last dose.3
When unable to procure more codeine, individuals experience withdrawal symptoms such as:
- Anxiety and Depression
- Shaking, sweating, chills and fever
- Suppressed Appetite
- Nausea and Vomiting
As changes in the body and the brain coincide, individuals find themselves compulsively using codeine despite any obvious dangers of using or calls from friends and family to stop. This is what is also known as drug addiction or more superficially opioid use disorder (OUD).
When a person is addicted to codeine, their behavior can change drastically. A person, for example, may prioritize obtaining codeine over eating, sleeping, working and other important activities. They may also engage in illegal behaviors like buying street drugs, forging prescriptions, theft, or intoxicated driving.
Codeine addiction like other kinds of substance use disorders, is driven by an interplay of genetics and environment. Genetics, according to research accounts for 40-60 percent of all addiction risk, but other situational factors such as upbringing, mental health, and financial well-being also play critical roles.5
Codeine and Other Substances
Combining codeine with other drugs can cause interactions that can range from minor to severe. In some cases, these interactions can nullify the effects of the drug. In other cases, the risk of adverse symptoms and overdose can occur especially when abused.
If you are using any of these substances together with your prescription, talk with your doctor to determine whether or note it is safe to do so.
- Acetaminophen (used in medications like Tylenol, APAP, Capital and Pyregesic) When taken in larger amounts or abused using acetaminophen with codeine can cause liver damage or death.1
- Benzodiazepines (the key ingredient in medications Xanax and Valium) while benzos are commonly prescribed with other opioids, using them together in large amounts can result in drug overdose.6
- Alcohol – Taking alcohol and codeine has been found to increase the effects of respiratory depression which when used in large doses can result in overdose and death.
- Buprenorphine (Medications like Subutex, naloxone, Suboxone and Zubsolv are used to treat opioid dependance). When used alongside with codeine, buprenorphine can reduce its painkilling effects)
- SSRI’s (Selective Serotonin Reuptake Inhibitors are commonly found in anxiety and depression medications such as Zoloft or Prozac. These can reduce the analgesic effects of opioid painkillers like codeine)
- MAO inhibitors (Are found in depression and anxiety medication includes Marplan, Nardil, Parnate and Emsam) MAOI’s when taken with opioids can cause serotonin toxicity a serious condition which in some cases can be severe or fatal.
Sizzurup – A Dangerous Mixture
“Sizzurup” or “Purple Drank” is a mixture made by combining codeine cough syrup with sprite and sometimes alcohol. This practice has its roots in Houston, Texas, and has overtime spread to other areas of the south. In recent years, however, its popularity has skyrocketed because of its association with popular music.
While codeine lacks the potency of drugs like morphine or oxycodone, those taking purple drink are more likely to consume dangerous amounts of codeine. It is speculated that a cup of lean can reach up to 25 times the recommended dose.
Abusing codeine cough syrup comes with additional health risks Codeine syrup commonly contains promethazine: which when taken in large amounts can cause heart problems, seizures and organ failure.
Codeine Abuse Signs and Symptoms
Codeine abuse can result in a variety of side effects and behavioral changes such as:
- Intense feelings of euphoria and pleasure
- Loss of consciousness (also called being on the nod)
- Difficulty breathing
- Hypoxia (Serious lack of oxygen to the body’s vital organs)
- Opioid Withdrawals
- Cold and clammy skin
- Mood Swings
Prescription Opioid Abuse Statistics
- In 2018, 75% all overdoses involved an opioid like codeine.
- In 2019, 9.8 million people abused prescription painkillers.
- Overdose deaths due Percocet and other opioids totaled 3.8 per every 100,000 individuals in the US