CODEINE

MAIN TYPE

Codeine is an opiate derived from the poppy plant. Medically, it is used primarily for pain relief, but is also used to treat other conditions such as diarrhea, coughs and moderate inflammation. In high doses, it produces a feeling of euphoria which, combined with its pain-relieving properties, makes it easy to abuse. Codeine is addictive and prolonged use can have adverse effects.

Codeine, like morphine and papaverine, is one of the active ingredients in the poppy plant and was first isolated in 19th century France. Although not as potent as morphine, it is still the most widely used opiate in the world and is often added as an ingredient in cough syrups and tablets. In many countries, it can only be obtained by prescription, although in some countries codeine products can be purchased without a prescription at a pharmacy. Given the relative ease with which it can be obtained, its misuse is a widespread problem for drug law enforcement agencies and health professionals worldwide.

Many dangerous side effects are associated with codeine, especially when taken in high doses or when mixed with other substances such as alcohol. These effects include itching, depression, nausea, headaches and drowsiness. It can, in some cases, cause severe allergic reactions, with redness, swelling, difficulty breathing and in extreme cases, death. It can also damage internal organs such as the kidneys and liver.

Whether used for medical or recreational purposes, as a potentially addictive drug, quitting can also trigger withdrawal symptoms such as irritability, nausea, cravings, sweating and sleep disturbances.

OTHER TYPES

Because of the beneficial applications of codeine in medicine, its abuse is difficult to control. Available in pharmacies, it can easily find its way onto the black market or be trafficked illegally. Addicts most often obtain codeine through deception, inventing symptoms of illness to obtain a prescription. They may also steal it from people who have it for perfectly legitimate reasons.

Most codeine is manufactured by pharmaceutical companies, usually as an ingredient used in medicine. As a result, it doesn’t have many slang names and is often referred to by the brand name of the drugs that contain it, or simply by the word “codeine”. These brands include Tylenol, Paracod and Empirin, although codeine is also found in many other medications.

People who take codeine sometimes refer to it colloquially as “cody”, “captain cody” or “schoolboy”, although these terms are not used much because the drug is not widely available on the street.

Codeine is available worldwide and although it occurs naturally in the poppy plant, it is most often synthesized by pharmaceutical companies.

MAIN EFFECTS

Codeine is most often used for legitimate medical purposes as a painkiller and cough suppressant and, in small doses prescribed by a physician or pharmacist, can relieve mild to moderate pain. As an opiate, however, in high doses, codeine can also produce a feeling of euphoria. These effects often last for a few hours before disappearing.

Some negative effects are also associated with codeine use, such as dry mouth, nausea, abdominal pain, constipation, itching, dizziness, urinary retention and lack of libido. Some users may have an allergic reaction to codeine, with symptoms such as swelling, fainting and seizures. A codeine overdose can cause respiratory distress, preventing the lungs from functioning properly, which in extreme cases can be fatal. The adverse effects of codeine can sometimes be exacerbated when it is combined with other substances, particularly alcohol.

Codeine is physiologically and psychologically addictive, and a person who takes it over a long period of time may develop tolerance to its effects and become dependent. A person who stops taking codeine may experience withdrawal symptoms such as craving, sweating, difficulty sleeping, nausea, diarrhea, muscle spasms and irritability. In cases of strong dependence, these withdrawal effects can last for several months. Codeine can also be used to treat chronic conditions because of its pain-relieving properties.

Prolonged use of codeine can damage internal organs such as the kidneys and liver, a risk compounded by the fact that codeine is often mixed with other drugs such as paracetamol. Codeine is also harmful to mothers and pregnant women, as it can pass into breast milk or harm the fetus.

PRODUCING COUNTRIES

Codeine is manufactured and marketed by pharmaceutical companies worldwide. It is most often synthesized artificially. It is however naturally present in the opium poppy and like morphine, it can be isolated and extracted from the plant, although this procedure is rarely used by modern pharmaceutical companies. This was not always the case, however, and until the 1970s all codeine was produced from the poppy.

It was only after a shortage of opium in the United States due to Nixon’s “war on drugs” that American scientists were forced to find another way to produce it. This method of manufacture proved far more practical than relying on potentially unstable supplies of opium, and so almost all legitimate codeine in the world is now artificially produced. As a result, although illicit trafficking in opium poppies is widespread in parts of South America and Asia, this generally involves other opium derivatives such as heroin.

Because codeine has a variety of legitimate medical applications, its supply routes are for the most part completely legal. Although 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 the country in question. In these cases it is mixed with other drugs such as paracetamol or caffeine and is almost never supplied in pure form.

In small quantities as an ingredient in other drugs, it can sometimes be obtained without a prescription, but given the minute quantities, it is unlikely that a person would seek to abuse it in this way. In some countries, such as Ireland and Australia, codeine-based medications are sold without a prescription, but at the discretion of the pharmacist.

Although it is quite rare, illicit trafficking in codeine does occur, most often derived from supplies provided by pharmaceutical companies or pharmacists, rather than from illicit production. These cases are, however, exceptionally rare, especially compared to other illicit drugs, a fact that can largely be attributed to the ease with which it can be obtained without a prescription in many countries.

Because codeine is a controlled substance, possession without a prescription or license is illegal in many places and can result in jail time, although there have been cases of supplies being smuggled in from countries where regulations are not as strict.

Some of the world’s largest pharmaceutical companies are based in North America, a region that has become the world’s largest supplier of codeine and codeine-based medicines. However, there are suppliers based all over the world, including Europe, Asia, Africa and South America. India and China, in particular, represent important emerging markets in the production and sale of codeine drugs.

FACTS AND STATISTICS

FACTS

• Codeine is the most widely used opioid in the world. It is commonly used medically to treat mild to moderate pain and as a cough suppressant. It can also be used to treat diarrhea and irritable bowel syndrome.
• It is completely legal in some countries and available only by prescription in others. It is therefore relatively easy to obtain and can easily be abused by addicts who manage to obtain it through fraudulent prescriptions or by stealing supplies of codeine.
• In addition to its pain-relieving properties, codeine, in sufficient concentrations, can produce a euphoric effect.
• However, this can be accompanied by various undesirable side effects such as nausea, dizziness, itching and depression.
• It is also physiologically and psychologically addictive and a person who takes it regularly may develop tolerance to its effects, needing to increase doses to achieve the same effect and become dependent.
• Codeine, which occurs naturally in the opium poppy, was first isolated by a French chemist in 1832. It is much less potent than morphine, also found in the opium poppy.
• Techniques to artificially synthesize codeine were discovered in America in the 1970s and these procedures now account for a large portion of codeine production.
• Given the relative ease with which codeine can be obtained from pharmacies, there is very little illicit trafficking. However, it is not uncommon for large quantities of codeine to be smuggled out of countries with less stringent law enforcement.

STATISTICS

• The effects of codeine are felt within 15 to 30 minutes of ingestion and can last up to 6 hours depending on the dose.
• It is estimated that codeine and prescription abuse costs Americans more than $484 billion annually. In addition to health care costs, this figure also takes into account lost work hours, traffic accidents and the costs of regulating and restricting the drug.
• In Hong Kong, the maximum penalty for trafficking codeine, or manufacturing without a license, is a fine of HK$50,000 and a life sentence. Illicit possession is punishable by a fine of HK$100,000 and up to 7 years imprisonment.
• Depending on its concentration and combination with other ingredients, codeine is classified in Schedule II or Schedule IV of the Single Convention on Narcotic Drugs.
• In Denmark, codeine is sold without prescription in quantities of less than 9.6 mg, but only mixed with other drugs. Larger amounts require a prescription.
• The potency of codeine is estimated to be about 8-12% of that of morphine, although this varies from person to person depending on their metabolism.
• An oral dose of about 200 mg of codeine would be required to produce a pain-relieving effect comparable to 30 mg of morphine. However, it is generally not used in doses higher than 60 mg and should not exceed 240 mg in a 24-hour period.
• Approximately 16 million Americans reported using prescription drugs recreationally in the previous year in 2010, including 7 million in the previous month.

SIGNS OF ADDICTION

Codeine is used for legitimate purposes in medicine and is often prescribed for pain relief. Because of this, it can be difficult to distinguish between what constitutes regular use and what constitutes abuse, as addiction can creep up on regular users. The main reason that addicts abuse codeine is the euphoric feeling it produces, but there are other symptoms of addiction that can be observed. These can include nausea, headaches, itching, lack of libido and dry mouth, all of which can be exacerbated by alcohol consumption.

Chronic use of codeine can cause physiological and psychological dependence, as the body develops tolerance to the effects of the drug and larger and larger amounts are then required to achieve the same effect. Withdrawal symptoms can also occur in the absence of drug use, and although they are relatively milder than the withdrawal symptoms associated with stronger opiates, they can include a runny nose, difficulty sleeping, sweating, nausea and irritability.

Codeine can be obtained from pharmacies for a variety of conditions, although in higher concentrations it is usually only available by prescription. Frequent visits to doctors and/or pharmacies may be a sign of addiction. A person who visits a different pharmacy each time should also be a red flag, as this is a tactic used by addicts to avoid detection. An unexplained decrease in the supply of codeine used by others for medical purposes may also be a sign of abuse of the drug.

TREATMENTS

A person addicted to codeine can, to a certain extent, wean themselves off it, but in the most serious cases, it can be very difficult and it is recommended to seek help from health professionals to put all the chances on one’s side. Withdrawal symptoms can last for several months, sometimes years, and codeine is relatively accessible, making it very easy to relapse.

It is recommended that you consult a doctor before trying to wean yourself off codeine. Withdrawal effects such as nausea and sleep disturbances can be treated and support can be provided to optimize the chances of recovery. Prolonged use can also damage internal organs such as the liver and kidneys, which is not necessarily the result of codeine itself, but more of the substances it is frequently mixed with, such as paracetamol. This is why it is important to assess the harm that may have been caused and try to mitigate its effects.

It is believed that the best way to combat a codeine addiction is to gradually reduce intake over time, rather than risk triggering withdrawal symptoms by stopping abruptly. This can lead to problems, however. The body develops tolerance to the effects of codeine after prolonged use, and if the drug has been taken to relieve pain, the user may fall back into a state of addiction or seek relief by taking other harmful substances. For this reason, it may be best to begin behavioral therapy to analyze how the addiction came about and how best to kick the habit.Treating the condition that led to the codeine addiction may also be effective, however an addicted person may psychologically retain the habit of frequent codeine use even when not in pain. Ensuring that an addicted person cannot obtain a supply of codeine should be a priority, as because of the ease with which it can be obtained, either through fraudulent prescriptions or through fake ailments, this addiction can be difficult to combat. If an addicted person has a tendency to steal supplies of codeine legitimately intended for medical use, these supplies should be kept out of their reach.

While hospitalization is only necessary in the most severe cases of codeine addiction, detox centers can help treat both the physical symptoms of abuse and the behavioral patterns that may have contributed to it. An addicted person may have underlying issues related to, for example, employment or general well-being that may have led to the addiction, and these issues should be treated to reduce the risk of relapse.

Codeine may not be as addictive as other opiates such as morphine, but it can still be very difficult to get off. It is therefore preferable to consult a physician before attempting to wean oneself off the drug, who can provide support, treat withdrawal symptoms or refer the patient to a specialized center.

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