Codeine Detox
Codeine is a form of opioid commonly prescribed for short-term pain, both mild and moderate. It is also effective at treating coughing and diarrhoea, and in some cases is used to treat long-term pain when other painkillers have proven to be ineffective.
Opioids are derived from the opium poppy plant, with their primary function based around reducing pain and inducing relaxation. If you have recently had an operation or suffered an injury, you may be prescribed codeine on a short-term basis. [1]
Available in tablet and liquid form, codeine can also be prescribed through injections administered by a trained medical professional. While higher-strength codeine can only be legally obtained with a prescription, it can be combined with other medications resulting in a lower-strength form of codeine that can be purchased over the counter. This includes co-codamol (codeine mixed with paracetamol) and co-codaprin (codeine mixed with aspirin).
It is recommended that individuals attempting to detox from codeine should work with their doctor to slowly reduce the dosage over time, rather than abruptly stopping. This allows the body to adjust to the lower levels of codeine and may help to prevent many of the more severe withdrawal symptoms.
How does codeine affect the body?
While codeine is used for pain management, it does not remove the cause of the pain – instead, it binds to opioid receptors in the central nervous system that is responsible for sending pain messages to the brain. This changes the way the brain reacts to pain and discomfort as the usual signals are now blocked. The pain is still present, but the nervous system does not register it in the same way. [2]
When used to treat excessive coughing, codeine depresses the area of the brain that would usually instigate a cough. In cases of severe diarrhoea it is used to slow down the digestive system.
Codeine promotes feelings of relaxation and drowsiness, as it effectively slows down a number of the body’s key functions. This may provide relief in terms of pain management but it can also lead to a number of unwanted side effects including slow and shallow breathing, poor digestion and nausea.
When taken in high doses it can cause the body to shut down completely, leading to respiratory failure and in severe cases coma or even death.
Is it possible to become addicted to codeine?
Codeine is often viewed as a fairly harmless drug due to its reputation as a cough syrup. However, there is a risk of developing a codeine dependency due to the addictive nature of this opioid-based medication. [3]
The body can build up a tolerance to codeine in a short space of time, resulting in a desire to ingest more in order to experience the desired effects. If you have been prescribed codeine for pain and are finding it less effective over time, do not increase the dosage yourself – instead, speak to your doctor. There is an increased risk of addiction when the treatment plan is not closely monitored by a medical professional.
It’s thought that codeine also serves as a gateway drug, potentially leading to abuse of stronger opioids such as oxycodone and fentanyl.
Codeine can be highly dangerous when taken in high doses. Overdosing on this drug can cause the body to shut down, causing breathing problems and potentially leading to respiratory failure, coma or loss of life.
What are the symptoms of codeine withdrawal?
While slowly tapering off the dosage of codeine over time can reduce the severity of any potential withdrawal symptoms, some may still be present.
Individuals undergoing codeine withdrawal often report that the symptoms are similar to that of the flu, with a runny nose and body chills being some of the most common side effects.
Despite the seemingly benign nature of many of the below symptoms, it is recommended that detox from any type of addictive medication should be performed under the supervision of a trained medical professional.
Conditions such as dehydration can become serious very quickly, and there is a risk that individuals could cause harm to themselves or others if they begin suffering from suicidal thoughts or psychosis during the withdrawal process.
Physical symptoms of codeine withdrawal can include:
- High fever
- Muscle twitches
- Poor appetite
- Body chills
- Runny nose
- High blood pressure
- Gastrointestinal issues
- Stomach cramps
- Dehydration
Psychological symptoms of codeine withdrawal can include:
- Irritability
- Restlessness
- Runny nose
- Mood swings and anxiety
- Paranoia
- Insomnia
- Suicidal thoughts
- Psychosis
As many of these symptoms are merely unpleasant rather than inherently life-threatening, many people do not seek medical guidance when attempting to detox from codeine due to a sense of guilt or shame. However, it is recommended that codeine withdrawal is performed under the care of a trained professional whenever possible.
If an individual chooses to detox from home, they should reach out to family and friends for support during the detoxification process. This can reduce the chance of relapse and prevent them from turning to codeine to escape some of the more unpleasant withdrawal symptoms.
How to detox from codeine safely
There is no shame in becoming dependent on any substance, and codeine is no exception. Opioids are highly addictive, with many people not realising they have a problem until they try to cut down on their dosage.
The first step to recovering from dependence on codeine is to undergo a full detoxification process in order to completely cleanse any trace of the medication from the system. Once this stage is complete, individuals will be able to focus entirely on the psychological aspects of their addiction in the form of individual and/or group therapy. [4]
The safest and most effective form of codeine detoxification involves working with a medical professional to slowly reduce the amount of codeine ingested over a period of time until eventually, the dosage has reduced to zero. This gives the body time to gradually adjust to the new balance of chemicals, potentially reducing the severity of withdrawal symptoms that can often cause the patient to relapse.
It is possible to undergo the detoxification process at home, but it is highly recommended that medical guidance is sought. This can be through an outpatient facility or within a specialised rehabilitation centre where any withdrawal symptoms are closely monitored and support is provided throughout the recovery process.
What to expect when undergoing a codeine detox
Codeine is fast-acting, meaning that it is quickly released and processed into the body. As a result, withdrawal symptoms will appear fairly soon after the last dose.
Physical side effects such as nausea, insomnia and muscle aches can present themselves within a matter of hours, with psychological symptoms including intense cravings and depression appearing a few days later. During the first week of withdrawal, it is common for individuals to become dehydrated, and care must be taken to ensure they receive an adequate amount of fluids.
While the symptoms experienced during the first two weeks may be unpleasant and difficult to deal with, they should subside within a period of one month. However, some people may experience feelings of depression and intense cravings for the drug that continues for a number of months. In these cases, it is vital that professional guidance and counselling is sought.
Medications used for codeine detox
Codeine withdrawal can be an unpleasant process and many people struggle to get through the initial phase of detoxification, particularly when detoxing from home without the support of experienced medical professionals.
In these situations, there is a higher chance of relapse, so it’s important to be aware of the range of medications available that have the potential to alleviate many of the more uncomfortable symptoms of codeine withdrawal. [5]
Over-the-counter medications
A range of over-the-counter medications can be used to manage some of the more unpleasant physical symptoms of codeine withdrawal. These include Ibuprofen to ease headaches and other pain, Imodium to ease gastrointestinal problems and Hydroxyzine to relieve feelings of nausea.
1. Clonidine
Many of the symptoms of codeine withdrawal can be similar to the flu. Clonidine can be used to treat many of the more severe flu-like effects such as perspiration and muscle cramps, providing relief and allowing the patient to continue with the recovery process.
2. Diazepam
If an individual is having trouble sleeping or is suffering from severe stomach cramps during the withdrawal process, diazepam may be prescribed to help alleviate these symptoms.
3. Naltrexone
Codeine withdrawal can vary in severity based on the length of the addiction and the amount of codeine ingested on a regular basis. For more intense addictions where there is a higher chance of relapse, Naltrexone may be used to decrease the pleasurable effects of opioids on the brain.
4. Methadone
Methadone is another medication that can be prescribed during a more intense withdrawal. It can help to reduce cravings and potentially decrease the chances of relapse.
5. Buprenorphine
When used as a substitute for codeine during the detoxification process, Buprenorphine can provide a similar effect with a lower risk of addiction.
The treatment for codeine addiction does not stop once the detoxification process has ended. It is highly recommended that individuals follow up with professional aftercare, including one-on-one counselling and/or group therapy to manage and support the psychological aspects of addiction recovery.
References
[1] https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
[2] https://www.nih.gov/news-events/nih-research-matters/how-opioid-drugs-activate-receptors
[3] https://bmjopen.bmj.com/content/3/6/e002913
[4] https://www.ncbi.nlm.nih.gov/books/NBK310652/
