Codeine misuse: Exploring the risks and promoting safe use

What’s included?

1. Introduction
2. What is codeine misuse?
3. What are the reasons for codeine misuse?
4. What are the risks of taking too much codeine?
5. What can we do to promote safe use of codeine?
6. How can Delamere help with codeine misuse?

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Whether we realise it or not, most of us will have taken codeine at some point in our lives. Traces of codeine can be found in a number of over-the-counter pain relievers, such as Nurofen Plus and Solpadeine, as well as numerous cough medicines. It’s also available in its purest form on prescription to treat ongoing pain. When taken as directed, codeine is well tolerated. But as codeine is so easily accessible, and highly addictive, it’s also open to abuse.

The Office for National Statistics reports that codeine-related deaths have almost doubled in the last 10 years and that two-thirds of drug poisonings are cause by misuse. In the US, codeine is the most widely taken opioid medication and is at centre of their opioid epidemic (1). So, what can we do to prevent this? Why are people so susceptible to codeine misuse? What are the risks and how can we promote safer use?

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What is codeine misuse?

If you take a higher dose than prescribed or use codeine in an unintended way, this is classed as misuse. Some people may accidentally take too much medication if they struggle with following instructions or suffer with memory problems. However, generally, codeine misuse is a deliberate act as the result of addiction.

As an opioid, codeine has the same potential for abuse as morphine and heroin. It acts in a similar way, blocking pain signals from the brain and inducing feelings of euphoria. Used regularly, a person will develop a tolerance to codeine and begin to crave more. The resulting addiction to codeine then drives the person to pursue other avenues to purchase and finding new ways to intensify its effects.

Evidence of codeine misuse includes:

• Taking higher doses of codeine or more frequently than prescribed
• Making codeine more potent by mixing it with alcohol or other drugs
• Pretending to be in more pain or making up illnesses
• Visiting multiple doctors or private clinics at once
• Crushing, snorting or injecting codeine to alter bolster the effects
• Buying codeine from the ‘dark web’ or on the street

Need help for prescription drug addiction? Speak to Delamere.

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What are the reasons for codeine misuse?

Codeine is used to treat mild to moderate pain and as a cough suppressant. Whether you’ve picked up a pack at your local pharmacy or been prescribed codeine by your GP, there are multiple reasons for succumbing to its charms.  

Chasing the high

In a study on over-the-counter medicine abuse one of the top reasons for codeine misuse was to recreate the ‘buzz’ or ‘calm’ feelings it gave users. Some people may simply get used to the euphoric or sedative effect and want more. 

Self-medication 

Misuse of codeine can also be caused by a need to self-medicate against stress, anxiety, chronic pain or depression. People who are suffering from trauma or neglect may abuse codeine to escape their problems. 

Peer pressure 

Friends may encourage experimentation, and this is a growing concern online. Research into how people discuss codeine misuse has revealed posts about codeine ‘trips’ and the glamorisation of codeine on Instagram and Twitter is influencing illegal sales (2). 

Ease of access

Codeine has been prescription-only for years in many countries. However, the recent rise in the number of codeine abuse cases has resulted in a call for even tighter legislation. Even though it’s a drug with high potential for abuse, online sales of codeine are unregulated.

Fear of withdrawal symptoms

Many people are aware they have a problem with codeine but find it difficult to stop taking it due to the awful side effects. Withdrawal symptoms can include diarrhoea, stomach pain, hot sweats, chills, aches and pains, as well as psychological problems including mood swings and depression. This fuels the cycle of codeine misuse. 

Need help for codeine misuse? Speak to Delamere

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What are the risks of taking too much codeine? 

We all know the pitfalls of taking any drug to excess. Let’s not forget actor Matthew Perry, who revealed that his colon burst due to his enduring painkiller addiction. Long-term use of codeine can result in multiple physical and mental health problems including chronic constipation, stomach problems, liver damage, kidney damage, hormonal imbalances, anxiety and depression. But there are other risks of codeine misuse you may not have considered:

Respiratory depression

Though rare, this is one of the most dangerous risks of codeine misuse. As opioids have a calming effect on the central nervous system, too much codeine can slow down breathing to dangerous levels. In the worst case, this can even be fatal. 

Codeine overdose

There’s a reason codeine is often only prescribed in small amounts. Misusing codeine can lead to overdose with horrific symptoms. Expect extreme drowsiness, confusion, shallow breathing, slow heart rate and loss of consciousness. In some cases, codeine overdose can cause coma or death. 

Psychological problems 

Taking codeine in high doses can also mess with your mind. Not only causing problems with attention and concentration but numbing the brain’s ability to enjoy pleasurable activities. As the brain becomes desensitised this can contribute to mental health issues, such as anxiety and depression. 

Work and social life consequences

It goes without saying that misusing codeine will ultimately affect your personal life. A person who is trying to hide their reliance on codeine may become deceptive and secretive, putting strain on relationships. Work life can also suffer from the health effects of codeine on the brain and body. 

Risky alcohol and drug taking

Probably the biggest risk of all is when codeine is mixed with drink and/or other drugs. Alcohol and other opioids, whether over-the-counter painkillers or illicit drugs, have the same effect on the central nervous system as codeine, effectively amplifying the sedation, depressing respiration and increasing the risk of overdose. 

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How can we promote safe use of codeine? 

Promoting safe use of codeine isn’t just down to the individual. It involves educating patients, engaging healthcare professionals and ensuring the proper preventative measures are in place. Taking more of these measures can help:

• Providing clear instructions on the correct dosage, frequency and duration of codeine use.
• Raising awareness of its potential risks and adverse reactions.
• Putting clear warnings on labels and packaging.
• Restricting access by implementing stricter guidelines.
• Using medicine review programmes to help identify potential codeine misuse.
• Working with pharmacists to ensure users receive the best advice and alternative treatments, where possible.
• Making addiction treatment service more accessible for people struggling with codeine misuse. 

Remember, if you’re concerned about your codeine intake or worried about someone else’s codeine addiction, there is help available. Always speak to a healthcare professional and taper off opioids slowly with a proper treatment plan to avoid dangerous withdrawal symptoms. 

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How can Delamere help with codeine misuse?

We help people from all walks of life overcome codeine dependence and addiction at our wellness retreat in Cheshire. Set in tranquil surroundings on the edge of Delamere forest, our purpose-built private clinic has everything you need to address your problems and emerge a new person. 

Our holistic therapists use a combination of evidence-based psychotherapies, such as Cognitive Behavioural Therapy (CBT), and emerging techniques to uncover the reasons for your reliance on codeine and help you find a way forward. We have a full team of multi-disciplinary medical professionals who can support you physically, mentally and emotionally.

If you have been using codeine with alcohol or other drugs, we can also offer a clinical detox in safe and comfortable surroundings. You will have an individualised treatment plan that focuses on your specific needs to give you the best chance of recovery. 

If you are concerned about codeine addiction, call us confidentially to speak to a member of the team today.

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References

1. Peechakara BV, Tharp JG, Gupta M. Codeine. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available here. 

2. Lee E, Cooper RJ. Codeine Addiction and Internet Forum Use and Support: Qualitative Netnographic Study. JMIR Ment Health. 2019 Apr 25;6(4):e12354. doi: 10.2196/12354. PMID: 31021328; PMCID: PMC6658256.

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