Codeine Addiction Treatment

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What is Codeine?

Codeine is an opioid and can be prescribed as a cough medicine. It is used as an alternative to morphine because its side effects are less severe at similar doses, but still works effectively as an antitussive (cough relief). When codeine is prescribed as a cough syrup, it typically contains both codeine and promethazine, which treats allergy symptoms and motion sickness. In pill form, it is often combined with acetaminophen, commonly known as Tylenol. Codeine is also used for the treatment of chronic pain, although it should only be prescribed for acute pain in non-cancer pain patients.

Depending on what form it is prescribed in, codeine has varying classifications as a controlled substance. By itself, it is a Schedule II controlled substance and is highly addictive. However, the most common forms of these prescriptions contain small amounts of codeine, leading to the belief that it has a low abuse potential. Unfortunately, abusing codeine prescriptions in high enough quantities can still lead to opioid addiction. Codeine’s propensity for addiction has led to it being sold illegally on the street. When codeine pills are sold illegally, it is sometimes referred to as Cody; when codeine cough syrup is mixed into a beverage, it may be described as sizzurp, lean or purple drank.

Codeine side effects and dangers

Even when taking codeine correctly, there are common side effects. These include:

  • Dryness of mouth, nose, throat
  • Restlessness
  • Nausea
  • Sleepiness
  • Dizziness
  • Sedation
  • Vomiting
  • Sweating

It is important to note that some people carry a gene in which they rapidly metabolize codeine into morphine in the body. If a codeine prescription has been made without taking this into account, the patient may be at risk for the side effects, overdose, dependency and addiction to this metabolized morphine.

The path to codeine abuse and opioid addiction begins when it is tampered with, shared or otherwise misused. It is illegal to share, give away or sell codeine because of its abuse potential and adverse effects when taken in incorrect doses. If your current codeine dosage is not providing effective relief, it is important to talk to your doctor about what to do, instead of increasing doses on your own. With codeine, doctors are recommended to look for alternatives before prescribing an increased dosage; it is critical to follow their instructions for your health.

Opioid overdose symptoms, which can be fatal if not treated immediately, include:

  • Respiratory depression or trouble breathing
  • Sleepiness progressing to stupor or coma
  • Low blood pressure
  • Cold and clammy skin
  • Pinpoint pupils
  • Circulatory collapse
  • Cardiac arrest
  • Death

Dangerous misuse and abuse of codeine can begin when the desired effect is the high produced by the drug instead of pain relief. Tampering with codeine pills by crushing, snorting or injecting them allows the body to absorb the drugs faster. Codeine pills typically include acetaminophen (brand name Tylenol), so there is an added risk of permanently damaging the liver. Drinking codeine cough syrup recreationally or in excess also produces this high, but increases the risk of overdose and addiction.

It is possible to find codeine illegally if a user cannot refill prescriptions.  Buying codeine on the street can also lead to the use of other drugs, such as heroin. This is a very common scenario in today’s opioid epidemic.

Codeine abuse and addiction signs

Any use of codeine outside of a doctor’s instructions is considered drug abuse. This includes drinking codeine cough syrup in excess or recreationally, or tampering with codeine pills by chewing, crushing, cutting or dissolving them in order to ingest, snort or inject a higher dose than prescribed. Even if it is not tampered with, taking more codeine than prescribed is also abuse of the drug.

Codeine addiction signs include:

  • Taking more than the prescribed dosage
  • “Doctor shopping” for multiple prescriptions
  • Tampering with codeine before taking it
  • Incorrectly measuring codeine doses with household objects (teaspoons) instead of the calibrated measuring device
  • Refusal to undergo appropriate examination, testing or referral
  • Repeated “loss” of prescription

Opioid withdrawal symptoms and treatment

It is possible to develop a physical dependency on codeine, which should be discussed with your doctor. A physical codeine dependency occurs when the body adjusts to the presence of the medication and depends on that medication to function normally. A codeine prescription can include dosing instructions from your doctor to taper off the dosage to reduce and eliminate this physical dependency. This type of medication management is important — those who are physically dependent on codeine will experience opioid withdrawal symptoms if they stop their codeine prescription too suddenly.  If the opioid withdrawal symptoms are extreme, they could drive the patient to continue using the substance despite significant harm — the definition of addiction.

Withdrawal from codeine depends on a number of factors, including the typical dosing, the duration of use and the ability to rapidly metabolize codeine into morphine. Withdrawal symptoms are similar to other opioids, especially morphine.

Opioid withdrawal symptoms can include:

  • Restlessness
  • Tearing eyes
  • Runny nose
  • Yawning
  • Sweating
  • Chills
  • Muscle aches
  • Dilated pupils
  • Nausea
  • Loss of appetite
  • Vomiting
  • Diarrhea
  • Irritability, anxiety
  • Increased blood pressure, heartbeat or breathing

Codeine withdrawal stabilization, also known as detoxification or detox, is usually done in a similar way as other opioid withdrawal treatment. In general, the opioid withdrawal stabilization procedures resemble those used for withdrawal from sedatives: longer-acting opioid are substituted for shorter-acting ones and the patient is stabilized on the longer-acting opioid medication, such as Suboxone. The patient will be most uncomfortable during the first one to three days of the opioid withdrawal phase, so a combination of clonidine (an alpha-adrenergic agonist), a sedative such as phenobarbital, and a non-steroidal anti-inflammatory such as Motrin (generic name ibuprofen) is frequently combined with the longer-acting opioid to help make the patient more comfortable for the first two to three days of the conversion to Suboxone. Usually after day three of the correct dose of Suboxone, a patient’s opioid withdrawal symptoms and cravings have almost completely subsided.

Treatment options for Codeine addiction

Most opioid users need help getting clean and require residential drug treatment. Few people can safely stop using without a certified detoxification and completing an evidence-based addiction treatment program.

Withdrawal and recovery from codeine addiction is most effectively accomplished under the supervision of board-certified medical professionals, who are able to assist with the intense cravings for the drug, along with dangerous withdrawal symptoms, such as disturbed sleep patterns, high blood pressure, abnormal heart rate, nausea, vomiting and diarrhea, muscle aches and flu-like symptoms.

Typically, codeine abusers go through a detoxification program — or withdrawal stabilization — before beginning a long-term treatment program. Patients can be prescribed anti-addiction medications to lessen the withdrawal symptoms.

The supervised drug and alcohol detox process alone is not a cure for opioid addiction. A comprehensive, personalized addiction treatment program, like the program at Enterhealth, is crucial for a successful recovery. A combination of therapeutic and pharmacological addiction treatment can help those with opioid addiction regain a stable and productive life and address the underlying issues creating the desire to use. Research shows that integrating both types of treatment is the most effective approach to restoring a degree of normal function to the brain — and provide a more positive, life-long outcome.

Effective behavioral treatments for opioid addiction can be administered in a residential or outpatient setting after withdrawal stabilization. A treatment plan may include:

  • Individual counseling
  • Group therapy
  • Family therapy sessions
  • Intensive Outpatient Programs (IOP)
  • Nutrition, wellness and stress management treatment services

Anti-addiction medications approved for opioid addiction treatment work through the same receptors in the brain that codeine affects. Medications such as Suboxone (buprenorphine) and Vivitrol (naltrexone), block the effects of codeine, reduce cravings and allow healing to continue. These medicines treat opioid addiction through the same receptors as the addictive drug, but are safer and less likely to result in addiction.

Opioid addiction recovery with Enterhealth

People suffering from codeine addiction may feel hopeless, but they are not alone. Enterhealth Ranch and Enterhealth Outpatient Center of Excellence can help you or a loved one begin recovery at our 43-acre residential codeine addiction treatment center just north of Dallas-Fort Worth in Texas, and our outpatient codeine addiction treatment center located in the Preston Center area of Dallas.

At Enterhealth, our goal is to treat the whole person for a lifetime. We offer a better chance to recover through our advanced, evidence-based treatment approach, designed and administered by board-certified addiction psychiatrists, physicians and other experts, that is proven to be more effective than traditional twelve-step approaches.