A Guide to Codeine Addiction & Abuse

Many people that develop a substance use disorder with codeine were seeking a more effective pain management medication when others such as paracetamol or ibuprofen were not proving helpful, unfortunately unsupervised, long-term codeine prescribing coupled with poor access to alternative or holistic pain treatments have created the perfect environment for addiction to grow. Although considered a ‘mild opioid’, long-term codeine use can lead to tolerance and dependence.

What is codeine addiction/codeine dependency?

Codeine is a commonly prescribed painkiller from the opioid group of painkillers, only available in a pure form under prescription. In the UK codeine may also be an active ingredient in over-the-counter medications, as cough suppressants, painkillers – generally coupled with paracetamol and as well as in some anti-diarrheal treatments.

Most people do use codeine for genuine medical reasons, namely the treatment of pain. However, those who were dependent upon codeine were less likely to have continued using codeine for pain treatment and more likely to have abused codeine to help relax, to stop worrying about a problem, and to ease withdrawal symptoms of other opioids, compared with those who were not dependent

woman taking codeine

Codeine Addiction VS. Abuse

Whilst the line between abuse and addiction is blurred when socially discussed, there are differences, not everyone who abuses codeine will go on to develop an addiction, however, both abuse and addiction have detrimental effects on your life.

What is codeine abuse (prescribed)?

If you find yourself taking codeine more regularly than prescribed, in doses higher than recommended or in a manner other than intended, then you are abusing the medication. Other signs that of codeine abuse include:

  • Denial of use
  • Missing work, school, family events
  • Failing to meet your responsibilities
  • Feeling moody or irritable when not able to take codeine

How does codeine addiction develop?

Addiction is incredibly difficult to control, and often abuse of codeine leads to addiction due to the changes in a users brain structure and function causing people to have intense cravings, changes in personality, abnormal movements, and other behaviours.

Addiction isn’t caused solely by the medication or substance that is being used, other factors also contribute:

Repeat Exposure

Availability to both prescribed and over the counter doses of codeine (OTC medications include other analgesics such as paracetamol) means that from the age of 12yrs, a person may have been exposed to repeated doses and as tolerance builds so to can dependence, abuse, and then the risk of addiction (Codeine: medicine to treat pain and diarrhea. Also a cough syrup.)

A Family History of Codeine Use

In trials a family history of substance use disorder showed higher rates of impulsivity, lower decision-making skills, as well as higher obsessive-compulsive tendencies, increasing a person’s risk of addiction.

Nature versus nurture plays a big role here, exposure to addictive substances and shared beliefs about addiction can increase the risk of trauma, abuse, and mental health issues. (Does Addiction Run in the Family? Genes and the Home Environment)

Trauma & Pre-existing Mental Health Conditions

With prescribed medication addiction, there is a close correlation between poorly managed prescriptions with no clear plan of how to stop, unavailability of information or lack of access to affordable alternative pain management options, and the existence of mental health issues including:

  • past or current substance misuse disorders,
  • Post Traumatic Stress Disorder from physical, sexual, and emotional abuse in childhood,
  • schizophrenia,
  • major depression,
  • bipolar disorder which can lead to substance abuse in teens and young adults.
  • (Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population)

    Persons with a dual diagnosis (mix of mental health issues and existing substance use disorders) are more likely to receive opioid prescriptions for pain, use problematic high doses and be co-prescribed other medicines including benzodiazepines. This phenomenon has been described as ‘adverse selection’. Terminology and prevalence

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      the signs and symptoms of amphetamine addiction

      Signs & Symptoms of Codeine Addiction/Dependency

      Whilst it is helpful to know that codeine abuse can exist without addiction, it often leads to addiction and abuse.

      • Cravings, drug-seeking behaviour – constantly thinking about codeine, how to get it and how it makes you feel
      • A need for higher doses, or needing to use additional pain-relief medicines to feel better
      • Allocating finance and time to obtaining codeine over other financial responsibilities
      • Experiencing withdrawal side effects when codeine use is stopped suddenly and needing to take top-up doses to feel better
      • Losing interest in what used to bring you happiness
      • Behavioural and hygiene changes

      (Drug Safety Update: Opioids: risk of dependence and addiction)

      Diagnosing Codeine Addiction

      Often being dependent or addicted to any substance, not just codeine comes with a certain amount of denial, despite knowing and recognising the warning signs, if you are concerned about your or a loved one to use of codeine, you can speak to your GP or a treatment centre that will be able to assess and go about diagnosing your addiction:

      The NHS recommends that the DAST-10 (Drug Abuse Screening Test) assessment (Policy for alcohol referral pathway/clarify services between CAT & DAS services) and CAGE questionnaire (CAGE Questionnaire: Questions, Scoring, Variations, and Accuracy) be used by your medical provider or chosen treatment centre.

      a man high on amphetamine

      The Dangers of Codeine Addiction

      There are many unpleasant side effects of codeine abuse:

      • Stomach distress.
      • Brain fog and impaired judgment.
      • Depression.
      • Sudden drops in blood pressure.
      • Slowed heart rate.
      • Liver problems (especially with the paracetamol formulations).
      • Central nervous system depression.
      • Seizures.
      • increased sensitivity to pain

      Codeine Use in Pregnancy

      Codeine can easily cross the placenta causing:

      • Dependency in babies and they may experience neonatal syndrome at birth.
      • Risk of fetal abnormalities
      • Risk of miscarriage

      Pregnant women should see a doctor before using or stopping the use of codeine. In many cases, a doctor may recommend medically supervised withdrawal or the use of a drug such as methadone. (https://www.gov.uk/drug-safety-update/opioids-risk-of-dependence-and-addictionabstinence)

      girl aged because of addiction

      Is Codeine Addiction a Disease?

      Addiction is a chronic disease, that manifests as an intense need to use a substance (in this case codeine) to the point where your ability to function is impaired, there is an uncontrollable use despite any negative consequences, be it financial, breakdown in relationships, or even health.

      Facts around Codeine addiction in the UK

      Whilst it is hard to separate codeine only dependency or addiction from the overall Opiate statistics in the UK (55% of persons seeking treatment in 2018/2019 had reported a problem with opiates) Often codeine addiction is as a polydrug (in conjunction with other substances, morphine, crack etc) and only about 2.2% of persons seeking help in 2014 reported codeine as their only problem substance.
      There does seem to be an even split between prescribed codeine in a pure formulation and over the counter codeine as part of a formulation as a source of the medication and this could be leading to the increased ease of abuse.

      Supporting someone with codeine addiction

      Starting a conversation with someone regarding their medication use and your concerns isn’t easy, providing a safe space filled with compassion, understanding and love will go a long way to open communication, chose a time when you are both calm and free from distractions then offer your help and support without being judgemental.

      Treatment options for codeine addiction

      A prescription drug rehab programme within a private rehab is beneficial to the treatment of codeine addiction, receiving medical supervision where your unique needs are taken into consideration when structuring a treatment plan to include a combination of medical care, psychiatric services, counselling, behavioural therapy (CBT), vocational training, and other services to best support the whole of you throughout recovery.

      Participating in other twelve-step groups, or non-twelve-step recovery programs such as SMART Recovery. (Self-Help Addiction Recovery | UK Smart Recovery)

      The NHS also offers outpatient care for the treatment of addiction. But there can be waiting lists before you may start treatment, if you require urgent admission, contact us and we will help you find the right private treatment centre for your needs.

      There are also counselling groups available for yourself and support groups for your loved ones if needed.
      NA – Narcotics Anonymous UK Narconon Drug & Alcohol Rehabilitation Programme in the UK