Codeine

AC/DC, coties, schoolboy, DFs, cody, captain cody, syrup, sizzurp, purple drank, little C, T1 (2, 3, 4, etc), texas tea

Opioid, depressant, analgesicpain relieving, cough suppressant, sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More

Codeine is an opiate, closely related to morphine, and comes from the opium poppy, but possesses around one fifth of the strength of morphine. It is still a very effective analgesicpain relieving. Most mild pain killers contain small quantities of codeine, e.g. co-codamol. However, the formulations are too weak to be used in the treatment of dependence, and because they contain other drugs such as paracetamol and aspirin, it may be harmful, if taken in sufficient quantity, to feel the opiate effect of codeine ¹.

Codeine is part of the opioid family whose family members include heroin. Codeine, however, is much milder than many of the other opioids. The drug’s intent is to alleviate moderate to severe pain due to outpatient surgery and intense dental work but it easy for someone to develop a codeine addiction due to its calming effects.

Codeine has also been used as a cough suppressant, though less so currently due to the addictive nature of the medication.

Most codeine-based products are synthetically produced, and is often combined with other painkillers such as acetaminophen and aspirin.

Codeine is offered in pill and liquid form. It is not an over-the-counter drug; a patient needs a doctor’s prescription for codeine ².

Codeine is an opiate drug used to treat mild to moderate pain. It is available either from doctors as a prescription only medicine or, directly from a pharmacy combined in lower doses with aspirin, ibuprofen or paracetamol. It is used to treat pain that does not respond to simple painkillers.

Someone who takes the combination painkillers containing codeine at higher than recommended doses in order to get a stronger codeine effect, can easily consume doses of aspirin, ibuprofen or paracetamol that could be fatal.

The key effects and risks of codeine itself include –

• feelings of warmth and well-being, relaxation and sleepiness,
• nausea, constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More, confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation, sweating, itching, mood swings and feelings of laziness ³.

Mild to moderate pain, diarrhoeaWhere you frequently pass watery or loose faeces, cough suppression ⁴.

Codeine is available in tablet form, as a syrup (e.g. as a cough syrup) and as a solution for injection. It is normally swallowed. Some people misusing the medicine prefer to crush up the tablets and snort them, and some may try to inject them ³.

This is a pharmaceutical drug which is sometimes diverted from manufacturers, pharmacies or GP’s prescriptions ⁵.

Tablets of codeine can cost between £1 – £2.50 per tablet obtained from illicit sources ³.

The attraction to codeine is the high it gives, which is similar to other opioids. It is short-acting, which means it acts quickly once it is taken, but the effects tend not to last very long.

Nonetheless, users report the codeine high to be quite intense if a high enough dosage is taken. Part of the reason codeine is one of the most abused opioids may come from the drug’s characteristic to metabolise into morphine ².

Codeine is typically prescribed for its pain relieving properties, and when taken as indicated, can be an effective medicinal treatment for pain management. However, men and women who use codeine chronically or long-term may develop a physical dependence to the drug. Other individuals may attempt to numb emotional or mental pain in addition to physical pain, and thus turn to codeine as an overall pain suppressant.

Men and women who are inclined to abuse drugs may have several factors contributing to the addictive nature. Such influencing causes included biological, psychological, social, and environmental factors. Biological causes would include a genetic influence or a disruption in normal body mechanisms. Psychological factors would include unresolved traumas or distressing situations that been coped with insufficiently. Examples of social causes include influences from peers or having family members who are addicted to codeine. Finally, environmental factors include homelessness or inadequate food or medical treatment ⁷.

Codeine is an opiate drug used to treat mild to moderate pain. On its own codeine is only available on prescription.

Smaller doses of codeine are in some medicines that can be bought without prescription in pharmacies.

Lower dose codeine is usually combined with other medicines such as paracetamol, ibuprofen or aspirin and are used for treating headache, period pain etc. that has not responded to simpler pain-killers.

Codeine-containing medicines carry warnings on the packs about the risk of addiction and advise that the non-prescription medicines should only be used for up to three days at a time without medical advice ³.

Codeine is selective for the mu receptor, but with a much weaker affinity than morphine. The analgesicpain relieving properties of codeine have been speculated to come from its conversion to morphine, although the exact mechanism of analgesicpain relieving action is less well understood than the more potent members of the opiate family.

Codeine is absorbed from the gastrointestinal tract with maximum plasma concentration occurring 60 minutes post administration. Codeine is absorbed quickly from the gastrointestinal tract and its first pass through the liver results in very little loss of the drug. This contrasts with morphine in which over 90% of the drug is metabolised in the first pass through the liver resulting in a considerable loss of potency when administered orally. This is why codeine is a common opiate in the relief of pain, the ease of oral administration.

Dihydrocodeine is an opioid analgesicpain relieving. It is related to codeine and has similar analgesicpain relieving activity. It is a stronger variant with more euphoric effect and consequently greater dependence potential. After oral doses peak concentrations of dihydrocodeine occur after about 1.2 to 1.8 hours; oral bioavailability is only about 20%, probably because of substantial first-pass metabolism in the gut wall or liver.

In its simple form it has a short half-lifethe amount of time required for the amount of something to fall to half its initial value but longer acting controlled release tablets are available. One frequently cited reason it never really achieved the prominence its properties warranted as an opiate treatment option was not least because of a largely inaccurate perception at the Home Office that the tablet form is frequently crushed and injected. The usual formulation is dihydrocodeine tartrate ¹.

Codeine is not itself centrally active, and must first be converted via first pass metabolism into morphine by the cytochrome P450 enzyme CYP2D6 (as such, it is a prodrug for morphine). Codeine is also metabolised into the inactive norcodeine via the CYP3A4 enzyme system. Both resultant forms are conjugated by UGT2B7 into their corresponding 3-glucuronide.

Some percentage of the population produce less CYP2D6 enzymes and so experience a significant reduction of effects from codeine in comparison to that of the average person. However, others produce CYP2D6 enzymes in higher quantities which can result in a hypersensitivity to the drug.

There is an upper limit to the amount of codeine which can be converted by enzymatic metabolism into morphine throughout an individual session. This limit is commonly referred to as the ceiling dose, which is commonly believed to be around 400mg. Consuming higher doses will lead to greater side effects such as itchiness and nausea, but will not necessarily increase the euphoriafeelings of joy and happiness experienced.

The active metabolites of codeine, notably morphine, exert their effects by binding to and activating opioid receptorsnerve endings that sense changes in the body More, mainly the μ-opioid receptor. This occurs because opioids structurally mimic endogenousproduced within or caused by factors within the body. More endorphins'feel-good' chemicals produced by the body itself More which are naturally found within the body and also work upon the μ-opioid receptor set. The way in which opioids structurally mimic these natural endorphins'feel-good' chemicals produced by the body itself More results in their euphoriafeelings of joy and happiness, pain relief, muscle relaxing and anxiolyticDrugs that relieve medically-diagnosed anxiety. More effects. This is because endorphins'feel-good' chemicals produced by the body itself More are responsible for reducing pain, causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or general excitement.

Codeine itself is a weak ligand for the opioid receptorsnerve endings that sense changes in the body More however its main active metabolite – morphine shows much stronger agonistic effects ⁸.

Tablets are swallowed orally. Codeine should not be injected intravenously (like Dihydrocodeine) – users who have attempted crushing tablets to inject report a painful experience. Injectable ampoules are for intra-muscular injection only ⁵.

• dizziness,
• staggering,
• itchiness,
• scratching (often of the nose),
• constricted or pinpointthe pupils are very small. More pupils,
• slow breathing,
• confused mental state,
• complaints of constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More,
• cyanosisbluish tinge to fingers and lips, caused by inadequate blood supply,
• nausea,
• vomiting,
• delirium,
• hallucination,
• seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More ¹¹.

If the codeine has been prescribed as a medicine (alone or mixed with other drugs such as paracetamol or ibuprofen), the purity will be very high and the doses consumed will be predictable. If you are not sure the tablets have come directly from a reputable pharmacy, you cannot be sure what is in them ³.

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption ⁸.

• Depressants (1,4-Butanediol, 2m2b, alcohol, barbiturates, benzodiazepines, GHB/GBL, methaqualone) – This combination can result in dangerous or even fatal levels of respiratory depressionslowing the drive and effectiveness of breathing More. These substances potentiate the muscle relaxation, sedationthe state of being relaxed or sleepy because of a drug More and amnesiainability to remember caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
• Dissociatives – This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
• Stimulants – It is dangerous to combine codeine, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More effect of codeine, which is the main factor most people consider when determining their level of intoxication. Once the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate wears off, the effects of codeine will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only taking a certain amount of codeine ⁸.

Depending on what kind of opiates you take, these symptoms can kick in –

• 6 – 12 hours after your last dose (in the case of short-acting opiates),
• Within 30 hours of your last dose (in the case of long-acting opiates) ¹⁶.
• nervous tremors,
• anxiety,
• yawning,
• sweating,
• runny nose,
• sleep disturbance,
• nausea,
• goose-bumps,
• restlessness,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• abdominal cramps,
• muscle spasms ³,
• cravings,
• dilated pupils,
• vomiting,
• lack of appetite,
• sneezing,
• insomniadifficulty in going to sleep or in getting enough sleep,
• trembling, aching muscles and jointsmarijuana cigarettes More,
• fever,
• chills,
• irritability,
• nervousness,
• depression ¹³,
• mood swings,
• restlessness,
• watery eyes,
• stomach cramps,
• loss of appetite,
• weight loss ⁶.

Determining exactly how long codeine is detectable in the body depends on many variables, including which kind drug test is being used. Codeine – also known as Tylenol with Codeine, Empirin with Codeine, Robitussin A-C, Fiorinal with Codeine, Tylenol #3, Codate, Codephos Syrup – can be detected for a shorter time with some tests, but can be “visible” for up to three months in other tests.

The timetable for detecting codeine in the system is also dependent upon each individual’s metabolism, body mass, age, hydration level, physical activity, health conditions and other factors, making it almost impossible to determine an exact time codeine will show up on a drug test ¹⁵.

The following is an estimated range of times, or detection windows, during which codeine can be detected by various testing methods –

Under the Misuse of Drugs Act 1971 codeine is a Class B controlled substance or a Class A drug when prepared for injection ¹⁸. The possession of controlled substances without a prescription is a criminal offence ¹⁹. However, certain preparations of codeine are exempt from this restriction under Schedule 5 of the Misuse of Drugs Regulations 2001. It is thus legal to possess codeine without a prescription, provided that it is compounded with at least one other active or inactive ingredient and that the dosage of each tablet, capsule, etc does not exceed 100 mg or 2.5% concentration in the case of liquid preparations ⁸.

• Codeine is a substance controlled under Class B of the Misuse of Drugs Act. That means it’s illegal to have, give away or sell.
• Codeine on its own is only available on prescription, unauthorised possession can get you up to five years in jail and an unlimited fine.
• Supplying someone else, including your friends, can get you up to 14 years and an unlimited fine ³.

Small amounts of codeine are in some medicines which can be bought without prescription but only in pharmacies. These medicines include cough syrups, and tablets or capsules where the codeine is combined with other medicines, such as paracetamol, ibuprofen or aspirin, for treating headaches, period pain etc. Codeine containing medicines carry warnings on the packs about the risk of addiction and advise that the non-prescription medicines should only be used for up to three days at a time without medical advice ³.

Codeine is most often mixed with alcohol or marijuana. Due to the fact that alcohol and codeine are both depressants, taking them at the same time can result in dangerous respiratory depressionslowing the drive and effectiveness of breathing More. This can lead to brain damage, coma, and even death. Marijuana tends to be more unpredictable, but psychological effects of both cannabis and codeine can exacerbate each other and cause panic or severe depression ²⁰.

As codeine use is not as stigmatised as other opiates, it is used by many people who would not perceive themselves as addicts. The overdose effects are also atypical, with the traditional slip in unconsciousness rarely encountered. Restlessness, nausea, confusiontrouble focusing, slow or disorganised thinking, poor short-term memory, unsure of time or place, or having difficulty following a conversation and disorientation, as well as chest pain and palpitations, are reported and ultimately, respiratory failure. The gender, Body Mass Index, age, weight and the tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More of the individual are, as ever important, but a key guideline is not to increase the dose by more that fractions of the highest dose you know you are tolerant to and not to use alone. There is debate on the LD50the amount of a material, given all at once, which causes the death of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning potential (acute toxicity) of a material of codeine, but generally for initiates 300 mgs may be prove fatal, although a chronic user could tolerate many times as much. As with all opiates, if it is possible keep some Narcan at hand. Do not mix with other CNSthe Central Nervous System, upon which certain drugs act depressants ¹.

If injected, prepared ampules, needle, syringe ⁵.

The Substance Abuse and Mental Health Administration states that it is not usually recommended for opioid abusers go through medical withdrawal without the use of medications, so make sure the inpatient program you choose offers not only a pharmacological option but the best one for your needs ²¹.

• methadone – best for those with severe dependencies on codeine,
• buprenorphine – best for those with less severe dependencies,
• naltrexone – best for those who are no longer dependent on opioids and who have a strong motivation to stop using these drugs ²¹.

In most rehabilitation centres, patients suffering from codeine addiction will have a customised program of detox and rehabilitation assigned to them.

This programme is important as each addiction differs from the next, and specialised treatment might be needed in a particular person’s case.

Secondly, most opioids are extremely dangerous to detox from without medical supervision.

An addict should especially not quit codeine cold turkey as the withdrawal symptoms can be life threatening.

In some cases, patients will be treated with Suboxone to help alleviate the withdrawals and allow the patient to detox with less distress ²².

• The Texas State Board of Pharmacy found that more than 145 gallons of codeine cough syrup were used for illegal purposes over a 5-year period ¹¹.
• Within five to six weeks a person can become addicted to codeine ²².

In 1832, codeine was isolated from opium, which has a codeine content of 2 to 30/0 (see Papaver somniferum). Codeine is also biosynthesised in the roots of Papaver somniferum 1. cv. Marianne (Tam et al. 1980). It is possible that trace amounts of codeine can also be found in other Papaver species (Papaver bracteatum, Papaver decaisnei; cf. Papaver spp.) (Theuns et al. 1986). Codeine is also an endogenousproduced within or caused by factors within the body. More neurotransmitter in humans (cf. morphine). A dosage of 20 to 50 mg produces “general mental stimulationcan be defined as any changes in a person's energy levels which are interpreted as stimulating and encouraging when it comes to movement and physical activities such as running, walking, cleaning, socializing, dancing, and climbing More, warmth in the head, and an increase in the pulse rate, as also appear after the consumption of alcohol” (Rompp 1950*). Codeine does not appear to be metabolised in the body and is excreted unchanged. Because codeine suppresses the urge to cough, its most important pharmaceutical use is in cough syrups.

The dosage when codeine is used as a cough suppressant is 50 mg three times a day. A dosage of 100 to 200 mg results in sleep and sedationthe state of being relaxed or sleepy because of a drug More. Higher dosages elicit effects comparable to those of morphine. The medical literature contains repeated mentions of “codeine addiction.” Codeine “addicts” are said to ingest up to 2 g of codeine daily (Rompp 1950, 115*). Today, codeine is gaining increasing medicinal importance as a substitution therapy for heroin addicts (Gerlach and Schneider 1994). The pharmaceutical industry synthesizes codeine primarily from thebaine, the main active constituent in Papaver bracteatum Lindl. (cf. Papaver spp.) (Morton 1977, 125*; Theuns et al. 1986). Codeine has acquired a certain significance in the music scene (jazz, rock, psychedelia), primarily as a substitute for heroin or morphine. Buffy Saint-Marie sang about the anguish of her codeine dependence in the song “Cod’ine” (LP It’s My Way! Vanguard Records 1964). Quicksilver Messenger Service later covered the song and made it famous. In the 1990s, the wave band Codeine had several albums out through Sub Pop. Cough syrups496 with a high codeine content were often consumed as inebriants at concerts, festivals, et cetera (usually in combination with alcohol and cannabis) (Bangs 1978, 158).

Since the 1990’s codeine has gained popularity in the rap music scene where a mixture containing codeine promethazine cough syrup is consumed under the name purple drank and several artists have released songs about it ²³, ¹⁴.