Codeine addiction is tragic and unnecessary. Doctors often think of codeine in its various forms (such as Tylenol with codeine, Nurofen Plus, which is codeine plus ibuprofen, co-codaprin, which is codeine plus aspirin, and so on) as a "weak" opioid with low addictive potential. Actually, the only way codeine is a weak opioid is that it offers very little pain relief. Tylenol with codeine is no more effective than Tylenol (paracetamol) by itself. However, codeine in all of its forms is just as addictive as "stronger" opioids such as morphine. Once you start taking a combination of codeine and another NSAID pain reliever, you can easily become addicted to the codeine in the compound. Taking just the NSAID (Tylenol, ibuprofen, or aspirin) would give you just as much pain relief, but you would have withdrawal symptoms from not taking codeine.
What are typical codeine withdrawal symptoms?
- Runny nose.
- Muscle spasms.
Diarrhea is the most common withdrawal symptom, just as constipation is codeine's most common side effect.
Just how badly you experience codeine withdrawal symptoms has a lot to do with the activity of an enzyme in your liver known as CYP2D6. This enzyme "activates" codeine by transforming it into morphine. It's actually the morphine end-product that causes most of the pain relief and the various side effects, not the codeine itself. There is a long list of drugs and medications (including Prozac, Paxil, Wellbutrin, Paxil, Lexapro, St. John's wort, many antihistamines, and marijuana) that "tie up" the enzyme so that it cannot activate codeine. If you use them while you are on codeine, you can experience withdrawal symptoms despite the fact that you are taking codeine still, or you may just not get the expected pain relief.
It isn't just what's going on in your liver that affects how susceptible you are to codeine addiction. Generally, you are more likely to get hooked on codeine:
- The younger you are when you get your first dose,
- The more you have an impulsive personality, and
- The longer you use codeine.
This means that your doctor:
- Shouldn't give you codeine if you are under 18 years old.
- Shouldn't give you codeine if you have ADD, ADHD, or an impulse control disorder like borderline personality disorder, and
- Shouldn't give you long-term refills for any codeine product.
Probably your doctor shouldn't give you codeine at all. It doesn't really work very well, and the potential for addiction in many cases outweighs the potential for pain relief. About 6 to 10 percent of people of European descent have a gene that alters the function of the CYP2D6 enzyme so that the drug never works very well (the liver cannot transform it into morphine efficiently), while many people of North African and Middle Eastern descent have another gene that causes the enzyme to work so quickly that they naturally crave more and more codeine.
What can you do if you are already addicted?
- First of all, talk to your doctor or pharmacist, about whether you should be taking other medications, and at least temporarily discontinue St. John's wort and marijuana. You need to make the process of discontinuing the medication simpler.
- Secondly, don't replace codeine with another opiate such as oxycodone or hydrocodone. They are even more addictive.
- Enlist help to deal with your addiction. In the United States, this would be a group like Narconon, which you can call at 1-800-775-8750. This support group can put you in touch with recovered addicts who understand your situation well.
- Let your doctor know you are getting off codeine so you can get help in dealing with the gastrointestinal side effects, especially diarrhea. You may need other, non-addictive medications temporarily to help you deal with the side effects of codeine withdrawal as you kick the habit.
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