5 Potential Consequences of Codeine Abuse

Codeine is one of the main psychoactive alkaloids extracted from the opium poppy, Papaver somniferum, and used to treat mild to moderate pain, coughs, and diarrhea. It is prescribed in a wide range of medicines ranging cough medicines for children to extended release medications with higher milligram dosages for long-lasting relief from chronic pain. Although codeine occurs naturally in the opium poppy, most codeine used in pharmaceuticals is derived from the more abundant morphine content of opium.

It’s likely that many codeine medications are diverted to the street from family medicine cabinets or acquired through family and friends and codeine may be one of the first drugs abused by adolescents who mistakenly think the drug is safer to use than other opioids. According to the DEA 2014 National Drug Threat Assessment, controlled prescriptions drugs (CPDs) “are increasingly the first drug abused by initiates of illicit drug abuse” with “More than 1 in 4 initiated with nonmedical use of prescription drugs (26.0 %, including 17.0 % with pain relievers..”

The most common consequences of codeine abuse are:

1. Dependency and Addiction
2. Overdose
3. Physical Health Impairments
4. Psychological Health Impairments
5. Impaired Social Functioning

Codeine Dependency and Addiction

Codeine abuse usually involves taking more of the drug than prescribed, taking it for purposes other than intended, taking it via ways other than intended, by someone other than prescribed for, or in combination with other substances such as alcohol.

As the brain tries to maintain stability throughout the course of codeine abuse, tolerance increases requiring more codeine to elicit the desired effects. According to the The Scripps Research Institute, “Addiction is presented as a cycle of spiralling dysregulation of brain reward systems that progressively increases, resulting in compulsive drug use and a loss of control over drug-taking.” Beyond the positive reinforcements of the pleasurable effects that lead to codeine addiction, the process is maintained by the negative state of emotions and adverse symptoms of withdrawal that act as negative reinforcements to continue the abuse.

Depending on the amount of neurobiological adaptations that have taken place, codeine dependency can result in physical and psychological withdrawals when the person attempts to cease codeine abuse. The most common symptoms include cravings, anxiety, emotional instability, and physical symptoms of sickness that resembles the flu.

Codeine Overdose

A Codeine overdose can be potentially fatal.

Codeine’s analgesic and opioid effects that elicit calmness, sedation, or euphoria, in comparison to morphine, are around 10% of morphine’s potency, but, that doesn’t make it any less dangerous. In fact, those who abuse high amounts of codeine combination products that include ingredients such as acetaminophen or promethazine may be at a higher risk of toxicity dangers and overdose.

As a central nervous system depressant codeine slows breathing and heart rate. Mixing codeine with other substances such as alcohol or benzodiazepines is potentially fatal. Unfortunately, many codeine abusers abuse codeine this way to enhance or intensify the effects. An alarming trend for codeine abuse is the use of codeine cough syrups mixed with alcohol and known on the street as “drank” or referred to as “sippin on syrup”. According to NIDA, “Promethazine-codeine cough syrup has been linked to the overdose deaths of a few prominent musicians.”

Physical Health Impairments

Compromised health from codeine abuse can include pulmonary or cardiovascular problems and the risk of diseases and infections increases with intravenous injectors. Codeine medication combinations with acetaminophen are often abused in high amounts leading to acetaminophen toxicity, second only to alcohol in liver failure causes.

Diabetes, hypertension, and neurological disorders that lead to impaired motor functioning or increased risk of seizures are potential consequences of codeine abuse. Other physical problems may include decreased immunology, pancreatitis, renal, and gastrointestinal problems.

Psychological Health Impairments

According to the National Institute on Drug Abuse, “Scientists have also found that chronic drug abuse alters the brain’s anatomy and chemistry and that these changes can last for months or years after the individual has stopped using drugs.”

Like the more potent opioids, heroin, oxycodone, and morphine, codeine elicits its pleasurable effects by increasing dopamine and closely interacting within the reward circuits of the brain and central nervous system. Over time, the reward circuits become dysfunctional and the brain stress systems become more active.

The psychological health impairments from codeine abuse may include:

• Anxiety
• Depression
• Aggressive Behaviors
• Drastic Mood Swings
• Preoccupations
• Cognitive Problems
• Loss of Interest
• Motivation Loss
• Memory Loss
• Loss of Inhibitions or Moral Reasoning

Impaired Social Functioning

Codeine abuse causes damages to relationships as the abuser loses interest in people and activities outside of those that promote or encourage codeine abuse.According to the Institute of Medicine (US),”Drug abuse leads to reallocation of economic support away from the family; lack of participation in family activities, including caregiving; lack of emotional commitment and support for parents and children; and the inability to provide a reliable and adequate role model for other family members, especially children.”

Codeine abuse can lead job loss from poor performance and loss of motivations to overcome the difficulties. Financial distress, homelessness, and a general sense of inadequacy is compounded by the inability to regulate emotions and behaviors reducing the abuser’s quality of life and possibly leading to relapse after significant efforts and time in abstinence.

Impaired Social Functioning

Codeine abuse causes damages to relationships as the abuser loses interest in people and activities outside of those that promote or encourage codeine abuse. According to the Institute of Medicine (US),”Drug abuse leads to reallocation of economic support away from the family; lack of participation in family activities, including caregiving; lack of emotional commitment and support for parents and children; and the inability to provide a reliable and adequate role model for other family members, especially children.”

Codeine abuse can lead job loss from poor performance and loss of motivations to overcome the difficulties. Financial distress, homelessness, and a general sense of inadequacy is compounded by the inability to regulate emotions and behaviors reducing the abuser’s quality of life and possibly leading to relapse after significant efforts and time in abstinence.

Codeine medications are controlled substances under various CSA schedules with most being classified by the DEA as schedule II substances. On the street, illicit codeine diversions for sale can be very costly to the abuser and yet, quite profitable to the seller. In order for many abusers to obtain the codeine, they resort to theft, prostitution, or other violent means to support their habit. This increases their risks for arrests and convictions that follow them throughout the remainder of their life and limits their future opportunities to get ahead.