Derived from the opium poppy plant, codeine is an opioid narcotic pain reliever. Opioids activate the brain’s pleasure center, block pain receptors, and reduce anxiety.
Over time, a user can build up a tolerance to codeine and other opioid narcotics, causing the individual to need to take more of the drug each time in order to create the same effects. This tolerance and increasing dosage may lead the brain to begin to depend on the drug’s presence, disrupting the natural reward circuitry and brain’s chemical messengers. A physical dependence can develop, and the user may start to experience withdrawal symptoms in between doses or as the drug leaves the bloodstream. This may lead to cravings and a psychological dependency.
Codeine is commonly abused for the rush of euphoria it can produce when taken in higher doses. The National Survey on Drug Use and Health (NSDUH) reported that in the month prior to the 2013 survey, 4.5 million people in America over the age of 12 abused painkillers, including codeine. Any use of a prescription medication for non-medical purposes is considered abuse. The Drug Abuse Warning Network (DAWN) also reported that opioid pain relievers were the cause of 46.1 percent of all emergency department (ED) visits related to the non-medical use of pharmaceuticals.
Prescription drug abuse is considered an epidemic in this country, and the White House reports that one-third of Americans over the age of 12 who abused drugs for the first time in 2009, started with the non-medical use of a prescription drug. Oftentimes, an opioid addiction or dependency is best managed with specialized treatment provided in a treatment facility. The first step is generally a physical stabilization process that begins with purging the drugs from the system, or detox.
The initial goal of detox is to regain a healthy physical balance. Codeine, and other opioid narcotics, can produce intense withdrawal symptoms that may need to be managed in a controlled and medically supervised environment in order to ensure safety and success. The brain is chemically changed by addiction and codeine usage, and it will need some time to heal. During this time, the user may experience both physical and psychological side effects, as the brain attempts to restore its natural balance without the chemical interference of drugs.
During codeine withdrawal, initially the individual may feel anxious and agitated, have trouble sleeping, and experience muscle aches, excessive tearing, inappropriate yawning, sweating, and a runny nose.These symptoms will usually begin after codeine is metabolized and leaves the bloodstream, generally within 24 hours, and peak within a few days. Late withdrawal symptoms may include abdominal cramping along with vomiting and diarrhea, chills, dilated pupils, intense drug cravings, and potentially depression, trouble concentrating, impaired cognition, and irritability.
The severity and duration of withdrawal will vary from person to person. Some may only exhibit a few symptoms, for example, while others may have more. This may depend partially on genetics, personal physiology, the length of time one abused codeine, the amount taken regularly, the level of dependency, and the method of abuse. Doctors do not recommend stopping codeine products suddenly on your own, as this method will induce withdrawal symptoms. Instead, many detox protocols call for a gradual tapering-off process wherein the dosage is lowered slowly over a set amount of time until the individual is drug-free. This should be designed and managed by a health care professional.
Medically Assisted Detox
Opioid dependency and withdrawal symptoms may sometimes be managed by the use of medications during detox. The U.S. Food and Drug Administration (FDA) approves buprenorphine products for the treatment of opioid dependence, and Subutex and Suboxone were the first to be approved that can be prescribed by doctors under the Drug Addiction Treatment Act (DATA) of 2000. Both come in sublingual filmstrips that are dissolved under the tongue.
Buprenorphine is a partial opioid agonist that activates opioid receptors throughout the brain and body, much like codeine and other opioids do. Full agonists like codeine are much more potent and have a stronger effect, while partial agonists are less likely to create a high sensation. Buprenorphine also plateaus after a certain point, meaning that at a set level, the drug will cease to increase its effects, thus limiting its potential for abuse.
Subutex contains primarily buprenorphine and can be used to blunt opioid withdrawal symptoms during detox. Suboxone contains naloxone in addition to the buprenorphine, which is a partial opioid antagonist, meaning that it effectively blocks opioid receptor sites from receiving additional opioids and may prevent relapse or additional opioid abuse. Suboxone may induce withdrawal symptoms if injected as well, thus further diminishing its abuse potential. Buprenorphine products are still opioids, however, and there is the potential for diversion and abuse. Their use should be closely monitored during detox and recovery by a consulting medical professional.
Another opioid antagonist is naltrexone, which is marketed as Depade or ReVia tablets or in a once-a-month injection form, Vivitrol. These medications are also used during opioid addiction treatment, although generally not until withdrawal symptoms have subsided as they may make them worse. Instead, these products are used to promote long-term sobriety.
Another opioid agonist used during detox and dispensed through federally regulated outpatient clinics is methadone. Designed to be taken orally, methadone is slow-acting with a long half-life, meaning that it stays in the system longer, thus staving off withdrawal symptoms and drug cravings. It may be habit-forming and should be regularly assessed and supervised.
Antidepressants and mood stabilizers
Antidepressants and mood stabilizers may also be used during detox to address some of the psychological aspects of opioid withdrawal as well.
Poly-Drug Abuse and Relapse
Mixing other substances with codeine can have dangerous side effects. Alcohol, for instance, is a central nervous system depressant, and mixing alcohol with an opioid can increase the risks for life-threatening breathing problems and a potential overdose. Additionally, codeine is often found in combination medications containing other drugs, such as acetaminophen, for example. Acetaminophen is notoriously hard on the liver, and mixing these codeine combination medications with other substances can also be hazardous to one’s health.
Injection drug users are also more likely to suffer a potentially fatal overdose and increase the risks for developing an addiction. The Centers for Disease Control and Prevention (CDC) reports that 120 people die in America every day, making drug overdose the leading cause of injury death in 2012. Approximately 16,235 Americans died as the result of an opioid analgesic overdose in 2013, according to the CDC. Relapse prevention is an important aspect of detox and recovery as giving in to drug cravings after a period of abstinence can also lead to a potentially dangerous overdose. A return to using codeine at the amounts ingested prior to detox can lead to a fatal toxic buildup that the body is no longer tolerant to, sometimes resulting in tragic outcomes.
Tips During Detox
There are many things you can do in order to make detox from codeine as smooth as possible such as:
- Eat a nutritious diet full of vitamins, minerals, and protein, and avoid caffeine, processed foods, and refined sugars.
- Exercise regularly to produce natural endorphins and boost self-image.
- Make sure to get enough sleep as lack of sleep can hinder the immune system and the recovery process.
- Educate yourself on addiction, codeine dependency, and the recovery process so you know what to expect and are not surprised throughout the process.
- Try yoga, meditation, or other holistic methods that are proven to reduce stress and enhance energy levels, focus, and general well-being.
- Avoid locations where you used to abuse drugs.
- Attend counseling and therapy sessions to learn coping mechanisms and new, healthier ways to manage potential triggers.
- Join a support group or 12-Step program.
- Keep busy in order to occupy your mind.
- Be patient as well as hopeful and positive; recovery is within your reach.
- Consider residential treatment for a period of time in order to hit the reset button and recover in peace and solitude away from daily stressors.
It is also imperative to understand that you are not alone. The NSDUH estimated that in 2013, approximately 21.6 million adults in the United States over the age of 12 met the criteria for substance abuse or dependence. Addiction is a chronic and relapsing brain disease, involving brain circuitry related to the motivation and reward centers.
Substance abuse, dependence, and addiction have emotional and physical components that need to be addressed in order to recover fully. Psychological and emotional stabilization are as important as physical stabilization during and following detox. Detox is an important first step and should be followed up with psychotherapy, counseling, educational opportunities, support groups, and life skills training. Cognitive Behavioral Therapy can help you turn negative and self-destructive patterns and thoughts into healthier positive ones. Family education and counseling sessions can improve your personal relationships and rekindle important bonds.
Black Bear Lodge can provide a safe haven for you to recover in privacy and surrounded by all the glory nature has to offer. Our admissions coordinators can help you get started. Call 706-914-2327 today.