Codeine

Main type

Codeine is a narcotic opiate drug derived from poppies. It is used in a medicinal capacity primarily for pain relief, although it is also used to treat other afflictions such as diarrhoea, coughs and mild inflammation. In large doses it produces a feeling of euphoria which, when combined with its painkilling properties, make it a drug that is prone to abuse. Codeine is addictive, and prolonged use can have adverse effects on users.

Codeine, along with morphine and paparevine, is one of the active ingredients found in poppies, and was first isolated in the 19th Century in France. Whilst not as powerful as morphine, it is still the most widely used opiate in the world, and is often added as an ingredient of cough syrups and tablets. In many countries it is available only with a prescription, although in some countries codeine-based products can be bought over the counter in pharmacies. The relative ease with which it can be obtained makes abuse of it a widespread problem for drug enforcement agencies and health professionals around the world

There are many dangerous side effects associated with codeine, particularly when taken in large doses or when mixed with other substances such as alcohol. These can include itching, depression, nausea, headaches and drowsiness. In some cases severe allergic reactions can occur, resulting in rashes, swelling, respiratory difficulty and, in extreme cases, death. It can also cause damage to internal organs including the kidneys and liver.

Whether it is used for medicinal or recreational purposes, as an addictive drug cessation of codeine use can also result in withdrawal symptoms including irritability, nausea, cravings, sweating and sleeping problems.

Other Types

Due to its beneficial applications in medicine, codeine is a difficult drug to control the abuse of, as its availability from pharmacies mean that there is little in the way of a black market or illegal trafficking. Addicts will most often obtain codeine through deception, fabricating symptoms of illness so as to get a prescription. Alternatively, they may steal it from people who have supplies of codeine for entirely legitimate reasons.

Codeine is manufactured mostly by pharmaceutical companies, and usually as an ingredient in medicine. As such, codeine does not have many slang street names, and is often referred to either by the brand names of drugs that contain it, or simply as “codeine”. Some of these brands include Tylenol, Paracod and Empirin, although codeine can also be found in wide range of other pharmaceutical medicines.

It is sometimes known informally by abusers as “cody”, “captain cody” or “schoolboy”, although since the drug is not traded in large quantities on the street these terms are not all that widely used.

Codeine is available all over the world, and whilst it is naturally occurring in poppies, it is more often synthesised by pharmaceutical companies.

Major Effects

Codeine is most commonly used for legitimate medicinal purposes as a painkiller and cough suppressant, and in small doses as directed by a doctor or pharmacist can relieve mild to moderate pain. However as an opiate, in larger doses codeine can also produce a feeling of euphoria in users. These effects will often last for a few hours before wearing off.

There are also negative effects associated with codeine use including dry mouth, nausea, abdominal pain, constipation, itching, dizziness, urinary retention and lack of sex drive. Some users may have an allergic reaction to codeine, symptoms of which may include swelling, fainting and seizures. An overdose of codeine can lead to respiratory depression where the lungs do not operate at their full capacity, which in extreme cases can result in death. The adverse effects of codeine can sometimes be exacerbated when combined with other substances, particularly alcohol.

Codeine is both physiologically and psychologically addictive, and prolonged abuse can lead to users building up a tolerance to its effects, subsequent developing a dependence on the drug. When a user stops taking codeine there may be withdrawal symptoms such as cravings, sweating, difficulty sleeping, nausea, diarrhoea, muscle spasms and irritability. In the cases of severe addiction, these withdrawal effects can last for many months after the user has stopped taking the drug. Its painkilling properties can also lead to reliance upon codeine to treat chronic conditions.

Long term codeine abuse can cause damage to internal organs including the kidneys and liver, and the risk of this is compounded by the fact that codeine is often mixed with other drugs such as paracetamol. Codeine is also harmful for mothers and pregnant women, as it can pass through breast milk or cause damage to an unborn child.

Production countries

Codeine is manufactured commercially by pharmaceutical companies around the world, and for these purposes it is most commonly synthesised artificially. It is however naturally occurring in the opium poppy, and along with morphine can be isolated and extracted from the plant, although this process is rarely used by modern drug companies. This however has not always been the case, and until the 1970s all codeine was produced from poppies.

It was only a shortage of opium in the US as a result of Nixon’s “War On Drugs” that forced American scientists to come up with an alternative means of production. This turned out to be a far more convenient manufacturing method than relying on potentially unstable opium supplies, and so nearly all legitimate codeine supplies worldwide are now produced artificially. As such, whilst illegal trafficking of opium poppies is prevalent in parts of South America and Asia, this is usually for other opium derivatives such as heroin.

As codeine has a range of legitimate medicinal applications, its channels of supply are for the most part completely legal. Whilst it is a controlled substance in many countries, it can still be obtained from pharmacies with or without a prescription, depending on its classification in that particular country. In these cases it is mixed with other drugs such as paracetamol or caffeine, and almost never supplied in a pure form.In smaller amounts as an ingredient in other drugs, it can sometimes be obtained without a prescription, although given the minuscule quantities abuse of codeine in this fashion would be unlikely. In some countries, such as Ireland and Australia, codeine based medicines can be obtained without a prescription, albeit at the discretion of a pharmacist.

Whilst uncommon, there are known instances of illegal trafficking of codeine, although these are most often in supplies procured from drug companies or pharmacists, rather than through illegal production. Cases of this are exceptionally rare however, especially when compared to other illegal drugs, which can be largely attributed to the ease with which it can be obtained over the counter in many countries.

As a controlled substance, possession of codeine without a prescription or license is illegal in many places and can potentially carry prison sentences, although it is not unheard of for supplies to be smuggled out of countries where regulations are not necessarily as strict.

Some of the largest pharmaceutical companies in the world are based in North America, and this region represents the biggest global supplier of codeine and codeine-based medications. However, there are suppliers based all over the world including Europe, Asia, Africa and South America. India and China in particular represent significant emerging markets in the production and sale of codeine-based medicines.

Facts and stats

FACTS

  • Codeine is the most widely used opiate drug in the world. It is used commonly for medicinal reasons to treat mild to moderate pain and as a cough suppressant. It can also be used to treat diarrhoea and irritable bowel syndrome.
  • It is completely legal in some countries, and available only with prescription in others. This makes it relatively easy to obtain, and so is prone to abuse by drug addicts who either obtain fraudulent prescriptions or steal codeine supplies from others.
  • As well as its painkilling properties, in sufficient concentrations codeine can produce a euphoric high.
  • However this can be accompanied by a range of adverse side effects including nausea, dizziness, itching and depression.
  • It is also both physiologically and psychologically addictive, and repeated abuse will result in users building up a tolerance to its effects, with users requiring higher quantities to achieve the same high. They may also develop a dependency on the drug.
  • Codeine is naturally occurring in opium poppies, and was first isolated by a French chemist in 1832. It is far less potent than morphine, which is also found in opium poppies.
  • Techniques for artificial synthesis of codeine were first discovered in America in the 1970s, and such processes account for a large proportion of codeine production today.
  • Owing to the relative ease with which codeine can be obtained from pharmacies, illegal trafficking of the drug is uncommon. However it is not uncommon for large quantities of codeine to be smuggled from countries where enforcement is less strict.

STATS

  • The effects of codeine begin to become apparent within 15-30 minutes of ingestion, and can last for up to 6 hours depending on the dose.
  • It is estimated that codeine and prescription abuse costs Americans over $484 billion a year. As well as healthcare costs, this figure also takes account of lost working hours, traffic accidents, and the costs of policing and restricting the drug.
  • In Hong Kong, the maximum penalty for trafficking codeine, or manufacturing it without a license is $5,000,000 (HKD) and life imprisonment. Illegal possession is punishable with a $1,000,000 (HKD) fine and up to 7 years imprisonment.
  • Depending on its concentration and combination with other ingredients, codeine is considered either a Schedule II or Schedule IV drug around the world in accordance with the Single Convention on Narcotic Drugs.
  • In Denmark, codeine can be sold over the counter in quantities up to 9.6mg without prescription although only in mixture with other drugs. Stronger amounts require a prescription.
  • The strength of codeine is thought to be roughly 8-12% that of morphine, although this varies from person to person depending on metabolism.
  • An oral dose of approximately 200mg of codeine would have to be ingested to produe a comparable painkilling effect to 30mg of morphine. However it is typically not used in doses any higher than 60mg, and no more than 240mg in any 24 hour period.
  • Approximately 16 million Americans reported using prescription drugs for recreational reasons over the previous year in 2010, with 7 million in the previous month.

Addiction Signs

Codeine has legitimate uses in medicine, and is often prescribed to provide pain relief. This can make it difficult to differentiate between what constitutes regular use and what constitutes abuse, as dependency can creep up on regular users. The primary reason that addicts abuse codeine is for the feeling of euphoria that it produces, however there are also other symptoms of being on the drug to look out for. These can include nausea, headaches, itching, lack of sex drive and dry mouth, all of which can be greatly exacerbated by the consumption of alcohol.

Chronic codeine abuse can cause both physiological and psychological dependency, as the body builds up a tolerance to the effects of the drug and increasing quantities are subsequently needed to achieve the same high. Withdrawal symptoms may also be present when not on the drug, which whilst being relatively sedate when compared to withdrawal symptoms from stronger opiates, can include runny nose, difficulty sleeping, sweating, nausea and irritability.

Codeine can be obtained from pharmacies for a range of afflictions, although in stronger concentrations is generally only available with a prescription. Frequent visits to doctors and/or pharmacies could potentially be a warning sign of addiction. Visiting separate pharmacies in succession is also cause for concern, as this is a known tactic among addicts to avoid suspicion. Unexplained diminishing of codeine supplies used by others for medicinal purposes is another potential sign that the drug is being abused.

Treatments

Codeine can to an extent be self-treated with a cold turkey approach, however recovery from serious addiction can still be very difficult and the assistance of medical professionals is recommended for the best chance of recovery. Withdrawal symptoms can last for many months, sometimes for years after ceasing abuse, and its relative availability can make it all too easy for an addict to fall into relapse.

It is recommended to consult a doctor before attempting to recover from codeine addiction. The withdrawal effects such as nausea and sleeping difficulties can be treated, and support can be used to increase the chances of full recovery. Long term internal damage to organs such as the liver and kidneys can also be caused, not necessarily by the codeine itself but more by the substances it is commonly mixed with like paracetamol. For this reason it is important to assess the damage that may have been done, and attempt to mitigate its effects.

It is thought that the best way to recover from codeine addiction is to gradually reduce the intake over time, rather than risk withdrawal symptoms by suddenly stopping. This can create problems however. The body builds up a tolerance to the effects of codeine after prolonged use, and if the drug was being taken to alleviate pain an abuser may revert to a state of addiction, or look for relief in other damaging substances. For this reason it can be advantageous to engage in behavioural therapy to analyse how the addiction developed, and how best to break the habit.

Treating the condition that led to codeine dependency may also be effective, however an addict may still be psychologically in the habit of frequent codeine abuse even when not in any pain. Ensuring that an addict cannot procure codeine supplies should be a priority, as the ease with which it can be obtained either through fraudulent prescriptions or spurious afflictions can make it a difficult addiction to recover from. In the case of an addict stealing otherwise legitimate codeine supplies intended for medicinal use, such supplies should kept away from people who may potentially abuse them.

Whilst residential treatment should not be necessary for all but the most severe cases of codeine addiction, rehab centres can help with treatment in dealing both with the physical symptoms of abuse and the behavioural tendencies that may have contributed to it. An addict may have underlying problems such as job status or general wellbeing that may have led to their addiction, and so these are problems that should be dealt with in order to reduce the possibility of a relapse.

Codeine is not necessarily as addictive as other opiates such as morphine, however it can still be very difficult to recover from addiction to it. It is therefore advisable to consult a doctor before embarking on recovery who can provide support, treat withdrawal symptoms or refer an addict to a specialised recovery facility.