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Codeine is an opioid narcotic analgesic that is recommended in the treatment of mild to moderate pain and coughs. In short term treatments, codeine may cause a relatively minor physical dependence. However, in long term use or abuse, it can cause a harsher physical dependence as well as psychological dependence which may increase the risk of addiction.
The potency of codeine compared to morphine is about 10% and in pure form, codeine is a Schedule II narcotic, however most codeine products contain less than 90 mg of codeine and are classified as Schedule III drugs except in cough syrups containing less than 200 milligrams of codeine or per 100 milliliters which are Schedule V drugs, according to the DEA.
Codeine products used to treat pain may be combined with other ingredients such as acetaminophen or aspirin to enhance the analgesic effects and reduce harmful risks including abuse. Codeine cough syrups are combined with expectorants and antihistamines and are a favorite pastime for some abusers.
Codeine acts as a central nervous system depressant to reduce pain and cough stimuli, but, it also depresses other functions and can decrease breathing or heart rate which can be significantly dangerous. According to the Food and Drug Administration, “Some people metabolize codeine much faster and more completely than others.” Codeine side effects may include relaxation, drowsiness, dizziness, sedation, constipation, nausea, impaired cognition, and declined motor functions. In higher doses, codeine can produce euphoria.
Physical Symptoms of Codeine Dependence
The more codeine a person takes the greater their tolerance will become as their bodies adapt to its use and tolerance is marked by decreased effectiveness. Codeine dependence increases with tolerance and is recognized when withdrawals occur after discontinuing use.
Physical withdrawal symptoms are usually minor compared to other opioids and produce symptoms of nausea, headache, chills, stomach pains, sweating, or fatigue.
Psychological Symptoms of Codeine Dependence
Psychological dependence is much more complicated and can occur when the brain becomes adapted to the repeat codeine use. All opioids increase dopamine in the brain which helps to regulate behaviors and reinforce those that bear repeating such as eating, or having fun.
Evidence shows that drugs which increase dopamine levels above normal can cause the person to experience cravings for the drug and psychological withdrawals when they are discontinued.
Psychological withdrawals from codeine abuse may include agitation, restlessness, anxiety, and sleep disturbances.
Some behavioral changes from psychological dependence may include:
- Fear of running out of codeine
- Obsessing over next dose
- Denying or hiding the amounts used or frequency of doses
- Using fraudulent means to obtain more codeine
- Social withdrawal or isolation
- Need to use codeine to feel normal
- Loss of interest in activities not involving codeine use