What is Codeine?

An alkaloid narcotic derived from opium or morphine and used as a cough suppressant, analgesic and hypnotic, codeine is a member of the drug class opiates. Codeine is the second-most predominant alkaloid in opium at up to three percent. Although codeine can be extracted from natural sources, a semi-synthetic process is the primary source of codeine for pharmaceutical use. Codeine, the most commonly taken opiate, is marketed as both a single-ingredient drug and in combination preparations. These combinations provide greater pain relief than either agent alone. Codeine-only products can be obtained with a prescription as a time release tablet. It is also marketed in cough syrups with zero to a half-dozen other active ingredients. Narcotics like codeine induce an “opioid analgesia” by altering the perception of pain at the spinal cord and brain. They also affect emotional responses to pain. Opioids have stimulating effects as well because they block inhibitory neurotransmitters. Repeated use of these drugs can cause long-term changes in the way the nervous system functions.(Please see Prescription Opioids under Types of Addiction/Prescription Drugs for more information about opioids.)

How is codeine used?

Codeine can be administered orally, subcutaneously, intramuscularly and rectally. Codeine cannot be safely administered by an intravenous injection as it may result in pulmonary edema, facial swelling, dangerous release of histamines and various cardiovascular effects. Although it cannot be administered intranasally (snorting), codeine free base can be smoked on aluminum foil, similar to smoking heroin. Absorbed quickly from the gastrointestinal tract, codeine’s first pass through the liver results in very little loss of the drug. This contrasts with morphine in which over 90% of the drug is metabolized in the first pass through the liver resulting in a considerable loss of potency when administered orally. Codeine is a short-acting narcotic prescribed by physicians and most often used for the treatment of pain. Codeine can be highly addictive and provides the user with an overall sense of calm and feelings of pleasure. When codeine is used, it enters the brain and causes the release of neurotransmitters that stimulate the reward center of the brain, leaving the user feeling intense feelings of wellbeing and pleasure. This kind of pleasure can lead to both psychological and physical dependence.

How Risky is Taking Codeine?

Some individuals use codeine for legitimate medical purposes, but addiction is a major risk with prolonged use of narcotics (over two to three weeks). After extended use, an individual develops a tolerance for this substance and needs to take more and more of the drug in order to feel its effects. Even moderate doses of some narcotics can result in a fatal overdose. When increasing doses of narcotics, the person may first feel restless and nauseous and then progress to loss of consciousness and abnormal breathing. Other risks include withdrawal symptoms that may last for months. Other individuals become addicted to codeine and begin to use it to manage other problems in their lives, such as emotional pain or stresses due to the euphoric feelings it causes. Many who become addicted to codeine will use it with other substances, such as benzodiazepines or alcohol, to increase the calming sense of well-being these substances cause. This can lead to major health risks such as respiratory depression and coma if taken in high quantities. Other people may take codeine with stimulants like cocaine or methamphetamines in order to reduce the severity of unwanted side effects of the depressant. This combination of uppers and downers can lead to cardiovascular failure and myocardial infarction. As codeine is one of the less concentrated narcotics, individuals who develop an addiction to it may seek out more powerful prescription narcotics, such as OxyContin®, so that they experience even greater feelings of euphoria. If prescription narcotics are not available, an individual may opt to use heroin (a morphine derivative and illegal narcotic) to achieve an even more powerful high.
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