Codeine Addiction: Overdose, Signs & Treatment

Codeine is an opioid painkiller that can be purchased over the counter and prescribed in higher strengths by your GP.

Codeine is extremely addictive and can lead to codeine dependence and addiction within a matter of days with continuous use.

Due to codeine being easily accessible and providing an opiate high when abused, it is a popular drug of choice for recreational use and abuse.

What is vital to remember is that being an opiate, abusing codeine can easily cause overdose, coma and death

In this article we look at the dangers relating to codeine abuse and addiction, the signs and symptoms of codeine addiction and the treatment options that are available if you or someone you love has a problem with codeine.

What is codeine?

Codeine phosphate is a naturally occurring opium alkaloid painkiller used to treat mild to moderate pain that does not respond to other less potent analgesics such as aspirin, ibuprofen or paracetamol.

Codeine also has the effect of suppressing coughs and causing constipation. Because of this it can also be used to treat certain types of coughs and to relieve short term acute diarrhea (3,4)

Because of codeines numerous uses, it is the primary ingredient in many over the counter medicines including cold and flu remedies, analgesics and cough mixtures.

Codeine cough syrups are not recommended for the treatment of productive coughs. Productive coughs have a purpose in clearing the lungs from mucus and if suppressed could result in an infection.

Prescription strength codeine phosphate is only available from your doctor and is classified as a controlled drug. It comes in a number of doses, ranging from 10mg tablets up to 60 mg tablets. It is also available as a prescription grade syrup.

Codeine phosphate is derived from morphine but is far less potent and considered a much safer drug. Once ingested the body breaks codeine down back into a very low dose of morphine. Morphine is generally only used to treat severe pain or pain that has already become tolerant to other opiates (4)

Unlike morphine which causes neuronal depression, codeine causes neuronal excitation. With codeine, respiratory depression is also far less likely to occur, unless the drug is abused (4)

Codeine and dihydrocodeine are often combined with other analgesics to increase their efficiency. These codeine preparations are readily available to buy over the counter from your local pharmacy.

As codeine, like all opiate and opioid drugs, creates tolerance and dependence, its over the counter use is recommended for no more than 3 continuous days. All codeine containing medicines carry a warning label stating this.

Codeine phosphate is considered a very safe and well tolerated drug, when taken exactly as prescribed or indicated. The dangers associated with codeine overdose come when a person abuses the drug.

The effects of codeine

Codeine is usually well tolerated by most people but some may experience adverse effects.

If any of codeine side effects become troublesome you should contact your doctor or call 111 immediately for advice and stop taking the drug.
(Note: it is only safe to stop codeine immediately if you do not suffer from codeine dependence)

The common effects of codeine include:

• Nausea
• Stomach cramps
• Increased sedation
• Euphoria – A feeling of calmness and wellbeing
• Constipation
• Difficulty urinating

More serious effects of codeine include:

• Agitation
• Hallucinations (seeing things or hearing voices that are not there)
• Fever
• Sweating
• Confusion
• Fast, slow or irregular heartbeat
• Severe muscle stiffness or twitching
• lmpaired coordination
• Vomiting or diarrhea
• Loss of appetite
• Dizziness
• Erectile dysfunction
• Irregular menstruation
• Decreased sexual desire
• Shallow breathing
• Rash
• Intense itching
• Hives – raised red and itchy patches of skin
• Changes in vision
• Impaired cognitive ability and judgment
• Seizures

WARNING: Experiencing any of codeine’s serious side effects need to be immediately reported to your doctor. If they are severe, call your local emergency services at once.

You should also not drive or operate heavy machinery until you know how codeine affects your judgement, alertness levels and coordination

Codeine abuse and misuse

Strictly speaking, taking codeine in any other way than instructed or as prescribed is classed as codeine abuse.

Ways in which codeine is abused:

• Taking more codeine or taking it more frequently than prescribed
• Mixing codeine with alcohol, mediations your GP or pharmacist are not aware of such as benzodiazepines, sleeping medications or other opiate medications.
• Mixing codeine with other drugs to increase its effects
• Mixing codeine syrup with soda and sweets to produce a potentially lethal drink known as ‘Lean’, ‘Purple Dank and ‘Sizzurp’ (more information on this lethal drink can be found in the next section)
• Diverting the course of administration by either crushing tablets and snorting or preparing into a liquid for injection
• Taking codeine that is not prescribed for you
• Feigning symptoms in order to get codeine
• Taking codeine for longer than prescribed or once the initial symptoms have been resolved
• Using illicit means to obtain prescription strength codeine, including ordering on the darkweb, stealing from family and friends or buying from a street dealer
• Taking codeine purely for its sought after effects
• Manipulating doctors for early prescription renewals or stronger strengths of codeine because you have taken them not as prescribed.
• Using multiple chemists or multiple doctors to get codeine and avoid suspicion

Pharmacy over the counter medications containing codeine

There are numerous types of codeine available in pill, capsule, dissolvable tablet and syrup form over the counter at your local pharmacy.

Pure codeine phosphate can only be obtained from your doctor on prescription. This is due to the fact that codeine on its own has a far higher abuse potential.

Common codeine containing medicines that can be purchased over the counter include:

• Co-codamol
• Panamax Plus
• Codis
• Co-codaprin
• Nurofen Plus
• Care + Codeine linctus
• Solpadeine, Solpadeine Plus and Solphadine max
• Paramol
• Syndol
• Codex
• Migraleve

Many pharmacies will also produce their own brand formulations of codeine containing medicines, cheaper than brand named ones.

All medications that contain codeine or dihydrocodeine, by law must state the ingredient on the label with a warning of possible dependence and addiction occurring.

Cough syrups containing codeine are not recommended for the use in children under the age of 12. Infact, if you are buying a codeine containing medicine for a person under the age of 18, ALWAYS consult your doctor or pharmacist first.

Codeine allergy symptoms

Not everyone is able to take codeine safely and a number of people who are taking codeine for the first time may develop symptoms of being allergic to the drug.

Symptoms of a codeine allergy include:

• Severe vomiting
• Seizures
• Hallucinations
• Hives
• Widespread red itchy raised rash
• Respiratory depression (trouble breathing)
• Anaphylaxis (swelling of lips, face, tongue, throat, restricting airways and breathing)

If you experience any of these symptoms, call emergency services at once. Codeine allergies can become life threatening if not immediately medically treated.

Signs and symptoms of codeine overdose

As codeine is an opiate, taking large quantities of the drug or abusing it by mixing with alcohol or other drugs can easily lead to overdose.

Codeine overdose is more likely to occur if codeine is mixed with another depressant drug such as alcohol, opiates or benzodiazepines. The signs of a codeine overdose are very similar to that of any opiate or opioid overdose. In large quantities codeine is also poisonous.

Signs of a codeine overdose include:

• Extreme sleepiness
• Being hard to wake or unresponsive
• Reduced or compromised respiratory rate
• Cold and clammy to the touch
• Very slurred speech, not making sense
• Bluish fingernails and lips
• Weak pulse
• Confusion
• Tiny constricted pupils
• Unable to support themselves (5)

Signs and symptoms of codeine addiction

Codeine addiction is a drug addiction – A chronic and progressive brain disease that is diagnosed by a set of behaviours characteristic of the condition. Codeine addiction cannot be cured but it can be successfully treated if treatment is sought in time.

Left untreated codeine addiction will progress, leading you to take bigger and bigger risks with your life, potentially ending in death.

You can self diagnose an addiction to codeine if you identify with two or more of the following diagnostic criteria.

Signs of codeine addiction include:

• Codeine dependence – Developing codeine withdrawal symptoms if you miss a dose. Continuing to take codeine rather than face codeine withdrawal
• Preoccupation – Obsessively thinking and planning how and where you can get more, or stronger forms of codeine
• Continuation despite negative consequences – Your codeine use may have caused consequences physically, mentally, socially, occupationally or within your personal relationships, yet you still continue to take it
• Denial of problem – Take a good hard look at your codeine usage and ask if it really is legitimately and medically justified, or are you taking codeine because you like the effect or it has become habit forming
• Lying about your codeine use or hiding it from others, justifying it, or down playing the problem
• Frequently placing yourself at risk with your codeine use
• Others have expressed concern around your use of codeine
• Frequently or always intoxicated by codeine
• Displaying a distinct lack of control around your codeine use
• Abusing codeine frequently and taking bigger risk with your usage
• Experiencing powerful cravings for codeine that you cannot resist
• Wanting to reduce or stop codeine but not being able to
• Codeine tolerance – Over time you have found you have needed to take more (8)

You do not have to identify with all of the above statements to suffer from a problem with codeine that requires professional help. Identifying with three or more indicates that you have a severe problem with codeine that is out of your control.

Codeine abuse, dependence and addiction are all serious substance misuse conditions that require professional and medical intervention to help you recover.

Treatment for codeine abuse, dependence and addiction

Here at Delamere we provide uniquely bespoke treatment programmes to help you or a loved one make a full recovery from codeine abuse, dependence or addiction.

Codeine dependence can easily occur through a legitimate prescription. The withdrawal symptoms of codeine which are similar to any opiate withdrawal can easily lead a person to continue taking codeine rather than experience a long and drawn out withdrawal process.

If you have a codeine dependence, Delamere offer a bespoke codeine detox, managed 24/7 by qualified nursing staff and doctors.

Here, within our purpose built first class detox facility you will be able to rest and recuperate whilst letting us manage your withdrawal symptoms effectively.

Any individual that undergoes a codeine detox or cannot stop abusing the drug should also ideally undertake a bespoke rehabilitation programme with us. This is vital to preventing a codeine relapse and will enable you to heal on every level possible. You will also learn essential coping skills and relapse prevention techniques.

Here at Delamere we passionately help our guests to grow beyond addiction and become the very best version of themselves, supporting them each and every step of the way.

Call us today for a free and confidential codeine addiction assessment and advice on how we can help you or a loved one to become codeine free once and for all.

Codeine withdrawal symptoms

Taking codeine continuously for more than a few weeks can lead to a dependence that will produce mild to moderate opiate withdrawal symptoms on stopping the drug.

The longer you have been codeine dependent and the higher the dosages involved, the more severe codeine withdrawal symptoms will be and will last for.

A severe codeine dependence can cause very unpleasant symptoms that will be practically impossible to manage without a full medical detox

Common Codeine withdrawal symptoms include:

• Aches and pains
• Fever and chills
• Strong cravings for codeine
• Insomnia
• Stomach cramps and diarrhea
• Poor appetite
• Tremors
• Anxiety and depression
• Lethargy
• Muscle spasms and cramps
• Headache and clouded thinking

Codeine addiction and dependence causes opiate withdrawal if you suddenly stop taking codeine. These symptoms can be effectively managed with a full medical codeine detox.

Call us at Delamere to find out how we can help you to safely and comfortably stop taking codeine.

Codeine overdose statistics for the UK

England and Wales have both seen a steady climb of codeine related overdoses resulting in death in recent years.

The National Office for Statistics recorded 169 and 167 codeine related deaths in 2018 and 2019 respectively. 2018 saw the highest number of codeine deaths since records first began. This shows that codeine addiction and abuse is a growing problem (1,2)

Whilst lower strengths of codeine are still available in the UK to purchase over the counter, there have been many calls for the government to classify all codeine containing products and to make them available on prescription only.

Sadly, this is still to come into effect, despite many countries banning its over the counter availability due to its abuse potential.

What to do if you suspect a codeine overdose

If you suspect a person has overdosed on codeine call the emergency services immediately

• Try to keep the person warm, awake and talking. If they are unresponsive place them in the recovery position and ensure their airways are clear.
• If the person is unconscious and not breathing, the emergency services will talk you through administering CPR until medical help arrives.
• Do not give the person any further medications, drugs, food or drink.
• Gather any evidence you have relating to a codeine overdose and any medications they are taking to hand over to the paramedics.
• If you know the strength and type of codeine the person has been taking then relay this information to the emergency services during your phone call.

Above all try to remain calm. Most people who overdose on codeine make a full recovery providing they access emergency medical help.

References

1. Death registrations related to drug poisoning 2019 for England and Wales, Specific substances – Codeine
2. Death registrations related to drug poisoning 2018 for England and Wales. Deaths by specific substances – Codeine 
3. Codeine containing medicines, NHS information
4. Codeine – The comprehensive pharmacology reference
5. Codeine overdose
6. Lean Drug
7. The death of Big Moe – Leslie Casimir, Rapper’s death leads teens to re-evaluate lifestyle; Fans and friends wonder whether drug was a factor in his heart attack, Houston Chronicle, October 20, 2007
8. McLellan AT. Substance misuse and substance use disorders: Why do they matter in healthcare?. Trans Am Clin Climatol Assoc. 2017;128:112-130.