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Codeine medications are safe to use as directed with a low to moderate risk of dependence. In most cases, they are prescribed to treat short term conditions and should not be used for longer periods or in abusive ways.
While codeine has had a number of historical uses, it is most commonly used today to manage pain and cough when over the counter remedies would be inadequate. By relative dosage comparisons, codeine is less potent than morphine and has been an acceptable medication in small doses for treating these conditions in children.
Cause of Codeine Dependence
Codeine dependence can be caused by a number of factors or a combination of factors after repeat exposure to the drug. Opioids work by attaching to certain opioid receptors in the brain and central nervous system reducing the stimuli of pain and coughs. As the person becomes adapted to the use of codeine they develop a tolerance and require more medication to activate these receptors. With repeat disruption to the brain’s chemistry, it begins to rely on codeine for normal functioning and without it the person will experience withdrawals.
Codeine also activates the “reward circuit” of the brain and increases the neurotransmitter, dopamine, which produces a sense of pleasure and reinforces behaviors that bear repeating such as eating, exercise, and fun. The more dopamine a drug induces, the greater the chance of a psychological dependence.
Effects of Codeine Dependence
Codeine dependence can be recognized when a person suffers withdrawals after they stop using codeine. Withdrawal symptoms may include cravings, runny nose, sweating, chills, stomach pains, muscle cramps, nausea, agitation, anxiety, or in chronic cases, psychosis, and suicidal or harmful ideations.
Effects of codeine dependence may include maladaptive thoughts or behaviors that surround the use of codeine such as a strong desire to take codeine or obsess over next dose, avoidance of people or activities that do not involve the ability to use codeine, or hiding usage amounts. Other disruptive behaviors may damage relationships and cause work, social, or financial problems.
Dangers of Codeine Dependence
Codeine dependence can lead to abuse or the use of other more potent opioid drugs and according to the Drug Abuse Warning Network, in 2011, there were 9,927 emergency visits for non-medical use of codeine products. Codeine dependence can also lead to addiction.
Physical dangers may occur in chronic or long term use including; liver damage, kidney damage, seizures, respiratory depression, irregular heart rate, overdose, and death. Acetaminophen toxicity is another physical danger resulting from excessive abuse of codeine products containing acetaminophen.
Some people may combine other drugs or alcohol to increase or enhance the effects of codeine and this can be fatal.
Long term use of codeine can cause heightened pain sensitivity and the user may develop pain in other areas than those included in initial diagnosis.