An opiate, codeine is considered one of the most widely used drug in the world. Already in the generic form, codeine is part of a group of drugs that are used as narcotic pain medicines to treat mild to moderate pain. It is also used as a cough suppressant and a small amount in the body converts to morphine. The drug is available in both white scored tablets and a liquid solution for injection.
Codeine binds to receptors in the brain that are important for transmitting the sensation of pain throughout the body and brain. While the drug reduces pain in the patient, it does not erase the presence of the pain, nor the patient’s knowledge that the pain exists.
Addiction to codeine is common with prolonged use, or use that lasts more than 2-3 weeks. Codeine can be habit forming and produces dependence similar to that of morphine. In repeated use and abuse, a person can develop psychic dependence, physical dependence and tolerance. If a person becomes addicted, it can be easy to overdose on the drug. Someone who is abusing the drug may show any or all of the following signs:
• Extreme drowsiness
• Pinpoint pupils
• Cold and clammy skin
• Weak pulse
• Shallow breathing
• Breathing that stops
Codeine can be a preferred drug for recreational use because it is absorbed quickly from the GI tract. As a result, its first pass through the liver will cause very little loss of the drug. As an opioid, codeine has stimulating effects and it blocks the inhibitory neurotransmitters. Those who use the drug repeatedly are likely to notice long-term changes in the function of their nervous system:
• Stomach bleeding
• Liver damage
• Kidney damage
• Blurred and/or poor night vision
• Sexual problems
Someone who is addicted to codeine is likely to demonstrate a faulty respiratory exchange and as a result, the re-establishment of an adequate functioning of this system is generally the first priority in treatment. The patient is generally given patent airway and assisted or controlled ventilation. One antidote that has been used in treatment is the narcotic antagonist naloxone which is specifically used for respiratory depression.
The patient is generally kept under continued surveillance and repeated doses of the antagonist are administered as needed. Treatment also tends to include oxygen, intravenous fluids, vasopressors and other supportive measures.
Once the physical aspects of the addiction are addressed, treatment of the psychological reasons for the use and addiction must also be part of the treatment. Even if the physical side effects subside, the addict may still yearn for the intense reward feelings associated with the narcotic which can lead back to abuse.