Codeine: Personal and social consequences

Last modified: Thursday, 25. December 2008 - 10:28 am

Illicit drug use provides little or no personal and social benefits, though codeine and other opioids do offer personal and social medical benefits. However these benefits must be weighed against the potential costs of abuse and addiction for individuals and society.

Most codeine prescriptions are written for Schedule III preparations. These medications provide an important middle ground between two drug groups — less effective OTC and nonnarcotic prescription analgesics on one side, and Schedule II analgesics on the other. Distribution and prescriptions are more tightly regulated for Schedule II than for Schedule III drugs. Consequently, for a patient whose pain level is not severe enough to require a Schedule II drug, yet is too severe for or does not respond well to OTC or other prescription analgesics, codeine can provide an effective compromise.

The social consequences of having a broad range of analgesics to treat chronic pain are significant. Conditions associated with chronic pain are the largest contributors to lost work time and productivity. In addition, home and family life may be disrupted for those whose pain is not effectively treated. Therefore, while a doctor must weigh the risks and benefits of treating with codeine on an individual basis, judicious use of codeine and other opioids would seem to present much greater social benefits than costs.

Personal costs — financial, physical, and emotional — can be significant for those individuals who abuse codeine and become addicted. An established addiction can be expensive to maintain, even with a relatively inexpensive medication (through legal purchase) such as codeine. Many people describe a serious opioid addiction as “all consuming”; everything in their life eventually revolves around obtaining more of the drug. With the drug as their focus, they lose friends, alienate family members, and they may be unable to hold a job. With a lower cost and greater availability compared to other opioids, codeine may serve as a starting point for a progression to more powerful, costly, and addictive Schedule II drugs, not to mention illicit drugs.

It might seem logical that anyone who goes to great lengths to obtain codeine is addicted, abusing it recreationally, or selling it for profit, but this is not always the case. While the situation is improving, many people with chronic pain still find it difficult to locate a doctor who will prescribe opioid analgesics. A person with chronic pain may show drug-seeking behavior if they find it difficult to obtain prescriptions for the medication. In fact, a doctor treating such a person might mistake the behavior for psychological addiction rather than somewhat desperate attempts to obtain relief for an ineffectively treated condition.

Codeine plays a relatively minor role in the overall picture of opioid prescription drug abuse. Evidence indicates that proper prescribing of codeine for legitimate medical concerns does not greatly increase the risk of addiction and abuse. Those in the medical community agree that more education is needed on both sides to help prevent the potential for abuse and addiction, so that patients truly in need are not denied access to codeine based on misperceptions and fear. The benefits for individuals and society are great when chronic pain is treated safely and effectively.

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