Codeine: Physiological effects

Last modified: Thursday, 25. December 2008 - 10:26 am

Other than analgesia, the most common Physiological effects produced by medicinal quantities of codeine are nausea, vomiting, constipation, and itching of the skin (pruritis). These symptoms would be considered relatively harmless (benign) side effects. They typically disappear in most people after taking the drug for several days, or by reducing the dosage. If someone has diarrhea prior to using codeine, the physiological side effect of constipation then becomes a medicinal effect for that symptom. For most people, the higher the codeine dose, the more likely side effects will be present or the more severe the side effects will be.

Harmful side effects

Overall, codeine’s lower potency results in fewer side effects compared to other drugs in the class. The complication of greatest concern is respiratory depression. Opioids affect the area of the brain that controls breathing. A large enough single dose of any opioid, including codeine, can stop breathing completely, resulting in death. Combining codeine with another central nervous system depressant, such as alcohol or sedatives, is especially risky. Unfortunately, people who abuse codeine often abuse other drugs as well. While drowsiness itself is not a harmful side effect, it can be dangerous when driving or engaging in other activities that require concentration and alertness.

Since most codeine is dispensed as part of a compound preparation, potential side effects of the other drug(s) must also be considered. For instance, someone with stomach ulcers should not take codeine that is combined with a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Another type of risk from a compound preparation relates to codeine abuse. For instance, a person who abuses codeine might routinely take a dose of 100-200 mg of codeine to produce noticeable euphoria. Using Tylenol #3 to obtain this dose would also mean ingesting 1,000-2,000 mg of acetaminophen. Taking that amount of acetaminophen for any extended period presents a risk for liver damage, especially in combination with alcohol.

Long-term health effects

There are very few adverse health effects as far as organ or tissue damage from long-term (years) use of codeine. This is in contrast to most other abused drugs, with alcohol and tobacco being the obvious examples.

The relative lack of any known serious organ or tissue damage produced by codeine use is counterbalanced, however, by its high risk for abuse and addiction. Even though codeine may be the least addictive of the group, opioids are arguably the most addictive drugs known. Drugs with a high risk of addiction also present a high risk for long-term use, which can include either years of continual use or a repeated cycle of use and abstinence. The latter can be especially difficult with codeine given the potentially serious withdrawal symptoms associated with stopping the drug suddenly. Most people with codeine addiction do not seek professional help, and self-treating an addiction usually involves stopping the drug suddenly.

A sudden withdrawal from codeine after a long period of use always results in some withdrawal symptoms. The longer and more serious the abuse, and the more suddenly the drug is stopped, the more difficult and painful the withdrawal symptoms will be. Chronic use of codeine can result in some tolerance to the drug so that higher doses must be taken to obtain the same initial effects. However, the level of tolerance seems to be less in people using codeine legitimately for pain. Long-term use also can lead to physical dependence, a process in which the body adapts to the presence of the drug, resulting in withdrawal symptoms if its use is abruptly stopped. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, runny nose, chills with goose bumps, and involuntary leg movements. The involuntary leg movements associated with opioid withdrawal are what originally lead to the phrase “kicking the habit.” The phrase “quitting cold turkey” originated because the goose bumps on a person’s skin that often occur during withdrawal resemble cold turkey skin.

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