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Codeine Addiction (Tylenol 3)

Posted on February 2, 2013 in Prescription Drug Addiction

Codeine AddictionOver 210 million prescriptions for codeine are written every year in the United States, making it the most widely prescribed painkiller in the country. Because so much is available, it is widely abused, especially in the form of cough syrups. Its street name, “Little C,” indicates how American addicts feel about codeine -it’s a nice little high to tie you over and to avoid withdrawal symptoms when you can’t get OxyContin or heroin.

In some parts of the world, where codeine is an over-the-counter drug, significant segments of the population are dependent upon it, and some are taking as many as 70 pills a day.

Codeine, like any narcotic, is highly addictive and produces a withdrawal syndrome that feels like a terrible case of flu coupled with anxiety and mood changes that can seemingly last forever. Addictions to common codeine combinations, such as Tylenol 3 or Fioricet, can permanently damage certain vital organs within a matter of weeks.

What Is Codeine?

Codeine is a painkiller in the opiate family of drugs. Opiates, also known as opioids and narcotics, were originally made from the dried sap of poppy plants. Natural opium is still made completely from poppies and dates back to the earliest human era. Morphine was isolated from opium in 1804, and codeine was isolated in 1834. Codeine is a naturally occurring alkaloid of opium, although today most of it is manufactured synthetically.

Codeine is converted into morphine in the human liver, but since most of it is not metabolized, one dosage is only about 10% as strong as the same amount of pure morphine. Codeine blocks the transmission of pain to the brain by attaching itself to proteins called opioid receptors in the brain and spinal cord.

The chemical name of codeine is 3-methylmorphine.

Pure codeine is classified in the United States along with the most additive drugs legally available for medical uses as a Schedule II Controlled Substance. However, most codeine is sold in combinations of codeine and over-the-counter painkillers like aspirin, acetaminophen and ibuprofen, and these combinations with less than 90 mg of codeine in them are Schedule III Controlled Substances as drugs with only a moderate potential for addiction and a high potential for psychological dependence. Cough medications with less than 200mg of codeine per 100 milliliters are Schedule V Controlled Substances, which means they have accepted medical uses and at least some potential for addiction.

What Are The Medical Uses Of Codeine?

Codeine is most often used as a painkiller and a cough suppressant, but it can be prescribed to treat diarrhea, anxiety, hypertension, severe itching, myocardial infarction (heart muscles damaged after a heart attack), or to stop premature labor contractions. It is considered a short-acting opiate. Its effects begin within ten to 30 minutes of taking it, peak in one to two hours, and can last up to six. The usual dose of codeine for adults is 15 to 60mg every four hours.

Codeine nearly always comes in combination with another drug, most often acetaminophen, aspirin, caffeine, butabital, phenacetin, naproxen, indomethacin, diclofenac, and anti-histamines. These other drugs are painkillers, stimulants, barbiturates, and muscle relaxants that may increase the pain-relieving effect of codeine.

Codeine is most frequently sold as pills or capsules; however, there are products you can inject into the site of the pain. Codeine cough products usually come as syrups.

There are over 50 products with codeine, including:

  1. Actifed with Codeine
  2. Ambenyl® Cough Syrup
  3. APAP
  4. Bromanyl® Cough Syrup
  5. Brontex®
  6. Capital and Codeine®
  7. Cheracol® with Codeine Syrup
  8. Cheratussin®
  9. Codimal® PH Syrup and Pyrilamine Maleate)
  10. Colrex® Compound Acetaminophen
  11. Cycofed® Expectorant
  12. Cycofed® Expectorant Pediatric
  13. Decohistine® DH
  14. Decohistine® Expectorant
  15. Dihistine® DH Elixir
  16. Dihistine® Expectorant
  17. DAC®
  18. Empirin with Codeine
  19. Endal
  20. Floricet
  21. Fiorinal® with Codeine
  22. Gani-Tuss® NR
  23. Guiatuss DAC® Syrup
  24. Guiatussin® DAC Syrup
  25. HaNew Riversin® DAC
  26. KG-Fed® Expectorant Syrup
  27. KG-Fed® Pediatric Expectorant Syrup
  28. KG-Fed® Syrup
  29. M-End
  30. Maxifed
  31. Medent
  32. Mytussin® DAC
  33. Nalex®
  34. Notuss
  35. Novahistine® DH
  36. Novahistine® Expectorant with Codeine
  37. Nucodine
  38. Nucofed®
  39. Nucofed® Expectorant
  40. Nucofed® Pediatric Expectorant Syrup
  41. Nucofed® Syrup
  42. Nucotuss® Expectorant
  43. Nucotuss® Pediatric Expectorant
  44. Pediacof® Cough Syrup
  45. Phenergan® VC with Codeine Syrup
  46. Phenergan® with Codeine Syrup
  47. Phenhist® DH with Codeine Modified Formula
  48. Prometh® VC with Codeine Cough Syrup
  49. Pseudodine
  50. Pyregesic
  51. Robafen AC® Syrup
  52. Robitussin®-DAC
  53. Ryna-C®
  54. Ryna-CX®
  55. Soma with codeine
  56. Sudatuss
  57. Triacin-C® Cough Syrup
  58. Trihist
  59. Tussar® SF Syrup – Codeine
  60. Tusshistine
  61. Tussi-Organidin® NR
  62. Tussi-Organidin®-S NR
  63. Tylagesic
  64. Tylenol 2®
  65. Tylenol 3®
  66. Tylenol 4®
  67. Vanacof
  68. Vopac
  69. Zodryl

The most frequently prescribed codeine product is a trademarked Tylenol series of pills and liquids. Tylenol 1 has 300 mg of Tylenol and 8 mg of codeine; Tylenol 2 has 300 mg of Tylenol and 15 mg of codeine; Tylenol 3 is 300 mg of Tylenol and 30 mg of codeine, and Tylenol 4 is 300 mg of Tylenol and 60 mg of codeine. This series is used to treat minor pain from headaches, dental procedures, post-surgical pain, muscle injuries, menstruation, and other pain too severe to respond to over-the-counter products.

Codeine is not prescribed to people with histories of alcohol or drug abuse, central nervous system depression, breathing problems, Addison’s disease, enlarged prostate, stomach or digestive problems, respiratory depression, kidney or liver diseases, brain tumors, head injuries, asthma, allergies to sulfites, or problems passing urine. Since most codeine products contain other drugs, you may not be able to take them if you have certain other conditions. For example, people with ulcers should not use aspirin products; and butabital, found in a popular codeine treatments for migraines called Fioricet and Fiorinal, should not be taken by people with porphyria.

Side Effects

Common side effects of codeine may be dizziness, lightheadedness, drowsiness, headache, mood changes, nausea, vomiting, constipation, stomach pain, difficulty in urination, difficult or troubled breathing, pale or blue lips, finger nails and skin, shortness of breath, and irregular, fast, slow, or shallow breathing. About one in ten people metabolize codeine better than others, and will experience stronger side effects or even go into a fatal overdose when they use codeine.

The drugs combined with codeine have their own separate side effects. For example, aspirin can cause nausea and upset stomach, and promethazine (an antihistamine) can cause chest discomfort.

Some people are allergic to codeine and have life-threatening reactions (anaphylaxis) the first time they take these drugs. Symptoms can be difficulty breathing and swallowing, irregular heartbeat, rash, itching, hives, seizures, and swelling of hands or mouth. If a patient has never taken a narcotic before, a doctor will usually introduce codeine very gradually to avoid anaphylaxis. Should these symptoms occur, seek medical help immediately.

What Drugs Interact With Codeine?

Hundreds of drugs increase the side effects of codeine or cause health risks and other problems if used in combination with codeine. Any drug that depresses the central nervous system should not be used with codeine, including other narcotic painkillers, antihistamines, barbiturates, sedatives, sleeping pills, and tranquilizers. Certain anti-depressants, muscle relaxants, and anesthetics (even for dental surgery) interact with codeine. Codeine should not be taken with naltexone, buprenorphine, Warfarin, or St. John’s Wort.

Alcohol and codeine is a bad combination because both depress the central nervous system, making an overdose more possible. Alcohol should never be used with acetaminophen because the combination causes liver damage.

Risks Of Codeine

The greatest risk of abusing codeine products is that they are addictive. It can take only three days to become addicted to codeine. Once you are physically dependent on codeine, you have to keep using it just to feel normal and you have to use more to feel pleasure and the euphoric effects you originally liked. If you stop using codeine, you will enter into an unpleasant withdrawal syndrome.

One huge problem with codeine addiction is that people get addicted to combination products, so they face the risk not only of codeine’s dangers but the ones caused by the other drugs. For example, if you take more than 4000mg of acetaminophen in a 24-hour period, you can cause permanent liver or kidney damage. Aspirin can cause permanent stomach damage and bleeding. If you are abusing a codeine/barbiturate combination, you increase your risk of death by overdose because it takes only a little bit too much barbiturate to kill you.

In certain countries like the United Kingdom, codeine is an over-the-counter drug, and some addicts there are taking 70 or more pills a day. At this level, codeine can cause kidney and liver damage, disorientation, seizures, sexual dysfunction, and other problems, and the levels of acetaminophen or aspirin will damage vital organs.

Codeine masks the ability to feel pain, which leaves you vulnerable to not noticing natural warnings from your body. It can also cause such severe constipation that certain foods vital to nutrition become too hard to digest.

Codeine abusers risk the stiffest legal penalties under U.S. federal law if they are caught illegally possessing or trafficking in this drug.

Codeine Overdoses

Narcotic prescription drug overdoses most often occur among the elderly or when people mix these drugs with alcohol.

Symptoms are nausea, drowsiness, unsteadiness, vomiting, changes in vision, difficulty breathing, seizures, cold and clammy skin, low blood pressure, slow breathing, and sleepiness. The person’s heartbeat may slow down to under 60 beats a minute, and he may enter a coma and die. Do not induce vomiting, but take the person to an emergency room facility as soon as possible. Doctors can use antidotes such as naxolene and other means to save the person’s life.

Codeine overdoses are not the same as codeine allergic reactions, although both can be life-threatening.

Codeine Addiction

Iatrogenic addiction to codeine is the kind that occurs when doctors prescribe it legitimately for pain, and the patient likes the drug and goes on to abuse it. For decades, iatrogenic addictions were thought to be rare occurrences that affect 3% to 14% of patients, most of whom have histories of alcoholism or drug dependencies. However, research has shown that people with chronic headaches are more likely to develop iatrogenic addictions, and this group is often prescribed codeine.

The majority of those who become addicted to prescription painkillers are people who experiment with a variety of legal and illegal drugs. Some get their supply by doctor-shopping, i.e, going from one doctor to another with fake pain symptoms. Others steal their drugs from home medicine chests, or buy them over the Internet or through street dealers. Since codeine is an over-the-counter drug in many parts of the world, it is relatively easy to obtain over the Internet. There are even websites that explain how to extract aspirin and acetaminophen from codeine products, how to avoid overdoses, how to achieve the best high, and so forth.

Addicts usually smoke, inject or snort codeine, and some even use it rectally. The street names for codeine are cilly, loopy c, schoolboys, codys, juice, little c. The Tylenol products are called T1, T2, T3, T4 or Dors and fours.

Cough syrups with codeine are popular in the hip hop culture and with teenagers who use it the way they use alcohol to relax and get high. Purple Drank is codeine syrup mixed with a clear soda like Sprite or 7-Up and Jolly Rancher candies. It is sometimes called Texas Tea or sizzup. Some addicted to these cough medications often take on a “syrup lifestyle,” in that most of their time is spent obtaining and using cough medications.

Codeine addictions are even more common in parts of Europe than in the United States. One researcher estimated that 96% of cough syrups in France were being used recreationally, not medically. In 2009, after determining that about 30,000 people in Great Britain were codeine addicts, the British healthcare agency put a warning label on codeine products, noting they should not be used more than three days. The British also began to limit the number of pills in each package.

American codeine addicts are typically addicted to a variety of opiates, including heroin, OxyContin and Hydrocodone. Although they may prefer one drug over another, they use whatever is available to avoid withdrawal syndrome.

Codeine Withdrawal Syndrome

Withdrawal symptoms begin within eight to 12 hours of the last codeine dosage, and peak within 48 to 72 hours. The discomfort can last a week or more, depending on individual factors such as how long you were addicted and how much codeine you were using. The symptoms are something like a bad case of flu: chills, fever, runny nose, sweating, muscle pain, muscle twitching, nausea, insomnia, dehydration, yawning, weakness, abdominal cramps, and diarrhea. Mood changes such as anxiety, crying spells and irritability are common.

If a physician supervises your withdrawal, he may prescribe clonidine, an antihypertensive drug to reduce muscle pain and cramping; anti-anxiety drugs; muscle relaxants; and/or Naltrexone, an opiate antagonist.

People who are taking codeine for pain at medically recommended amounts can often withdraw gradually under a doctor’s supervision by simply tapering off the amounts they use. These people may have built up tolerances to codeine and will experience withdrawal symptoms when they stop using it, but they have not become psychologically dependent on the drug and are not considered addicts.

Codeine Addiction Treatment

If you are psychologically as well as physically addicted to codeine, you should seek out a drug treatment center where you can withdraw from this drug safely under medically supervised conditions. After you are physically clear of codeine, you will need undergo an intense program of counseling and education to avoid relapsing into drug abuse again. The trick in addiction, as Bill W, founder of Alcoholics Anonymous, said, is not stopping but never starting up again.

There may have been profound reasons why you become a drug addict. You may have problems that have never been diagnosed or treated, such as depression, anxiety, bipolar disorder, Attention Deficit Disorder or childhood trauma. Many codeine addicts use the drug as a way to escape everyday reality and to feel mellow all the time, because they have elevated anxiety levels. All these issues can be addressed in one-on-one counseling sessions with your therapist.

A good residential treatment center will help you get into your best physical shape through good nutrition and both indoor and outdoor sports. You will learn about the science of addiction, how certain places and people can trigger relapses and what techniques you can use to avoid using drugs again. You might learn healthy relaxation techniques such as yoga, meditation or art that will take away your need to use drugs to relax. Certain medications can be prescribed to help you avoid relapses, but the emphasis of state-of-the-art addiction treatment is about learning and adapting a new lifestyle. Some people change careers or even the primary relationships in their lives. Codeine addiction treatment should be enjoyable and life-enhancing. As one addiction professional put it, if it isn’t fun, it probably will not work.

After you leave your treatment center, you usually enter an aftercare program near your home of continued counseling and attending support meetings.

Signs You Are Addicted To Codeine

If you can answer yes to one or more of these questions, it is time to consult with your local mental health center or family physician about getting help for your addiction to codeine.

  • Do you have to have codeine products available at all times?
  • Have you tried to quit using codeine in the past and failed?
  • Do you know that codeine is causing certain health problems, such as constipation, and yet you continue to use it?
  • Do your family members or friends criticize you for abusing drugs?
  • Are you unable to go more than three days without using codeine?
  • Are you using codeine without a doctor’s prescription?
  • Are you buying codeine from illegal sources or going to more than one doctor or clinic to get it?
  • If codeine is unavailable, do you keep thinking about it and craving it?
  • Do you get withdrawal symptoms when you cannot take codeine?
  • Have you been abusing codeine for more than a month?
  • Do you have to keep increasing the amount of codeine you use to get the effects you want?
  • Do you experience a feeling of happiness and warmth and then a sense of peace when you use codeine?
  • Does your codeine habit interfere with your roles at school, home or work?
  • Do you keep telling yourself that you will quit next time?

This questionnaire is based on one used by doctors to screen for drug abuse.

Sources:

IMS Health, Prescription Painkillers, see http://www.imshealth.com/portal/site/ims

Hope, Jenny and Tamara Cohen. “Tough New Controls for Everyday Painkillers,” The Daily Mail, September 4, 2009.

“Codeine,” on Medline Plus (Medical information you can trust), posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682065.html

Bellenir, Karen. Drug Abuse Sourcebook. Detroit: Omnigraphics, 2000, pg. 262.

Ibid, page. 171-172. See also “Controlled Substance Schedule,” The Drug Enforcement Agency, at http://www.deadiversion.usdoj.gov/schedules/index.html#list

See McNeil Pharmaceuticals, the manufacturer’s website at http://www.mcneil-consumer.com/

“Acetaminophen and Codeine (Oral Route),” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR603233

“Codeine,” PubMed, The National Institutes of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000565/

“Acetaminophen and Codeine (Oral Route),” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR603233

Rabin, Robin. “Hazards: Codeine’s Safety Questioned,” The New York Times, October 11, 2010.

“Codeine,” PubMed, The National Institutes of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000565/

Ibid, see also “Acetaminophen and Codeine (Oral Route),” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR603233; and “Codeine,” on Medline Plus (Medical information you can trust), posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682065.html

Ibid.

Galanter, Marc (MD) and Herbert Kleber (MD). “Treatment of Acute Intoxication and Withdrawal from Drugs of Abuse,” in The American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fourth Edition. American Psychiatric Publishing, 2008.

Hope, Jenny and Tamara Cohen. “Tough New Controls for Everyday Painkillers,” The Daily Mail, September 4, 2009.

“Codeine,” on Medline Plus (Medical information you can trust), posted at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682065.html

Meir, Barry. “Delicate Balance Between Pain and Addiction,” the New York Times, November 25, 2003.

Ibid.

“Codeine Briefs,” The Drug Enforcement Agency at http://www.usdoj.gov/dea/concern/codeine.html

Bellenir, Karen. Drug Abuse Sourcebook. Detroit: Omnigraphics, 2000.

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