Codeine is an opioid used for suppressing coughs and relieving pain. However, codeine has been taken off the shelves in some countries, while others now require a prescription for what once was an over-the-counter drug.

In 2017, a British woman was arrested in Egypt after some tramadol tablets, a popular opioid painkiller about as strong as codeine, were found in her luggage. Egypt imposes strict rules on drugs that have opioid analgesics, particularly tramadol and codeine, even though they are legal in Britain. A foreigner needs the permission of the country’s Ministry of Health to bring them into Egypt.

Why are some countries banning codeine? Can codeine syrup lead to codeine addiction?

The Food and Drug Administration approved codeine in 1950. Codeine is a mild-to-moderate opiate pain medicine and cough suppressant. Codeine may be used as a single-ingredient product or combined with aspirin or acetaminophen. The medication is usually dispensed in tablet or syrup form.

As an opiate, codeine acts on the body’s central nervous system (CNS) as a depressant. It has relaxing and sometimes euphoric effects. Its long-term use can also lead to tolerance, dependence, and addiction and may have other adverse effects on the body. In the US it is available by prescription only.

Some formulations of Tylenol contain codeine, a formulation that falls under Schedule III of the Controlled Substances Act and is used to for pain relief and to lower fevers.

As an opiate, codeine is among the National Institute on Drug Abuse’s list of most commonly used addictive drugs. Codeine is a habit-forming drug. Addiction is possible with the prolonged use of the medication, especially without a prescription. However, when taken as prescribed, in the proper dosage and for short-term relief of pain or cough, the risk of developing tolerance is reduced.

The abuse of codeine has also led to it being referred to various street names such as cody, schoolboy, cough syrup, and (with Tylenol) t-threes.

Is Tynelol addictive? Yes, even though it is sold over the counter, people can become addicted to Tynelol.

Since codeine is metabolized into morphine in the liver, it has similar effects as morphine although lesser in potency. It is among the categories of the most common prescription opioids. The others are oxycodone (OxyContin), fentanyl and hydrocodone (Vicodin).

Like other opiates, codeine activates opioid receptors in the body’s organs including the brain’s portions that are responsible for the pain and pleasure sensation. This causes the blockade against the pain signals sent by the brain.

Though codeine is less potent than other opiates, some users experience a “high” that leads them to repeat the experience, eventually developing a tolerance, dependence, or addiction. There’s enough demand that codeine is available on the black market.

The maximum daily dose of codeine is 300 mg, with one tablet, ranging from 15 to 60 mg, prescribed to adults every four hours. Someone with a codeine addiction may take as many as 100 tablets in a day. Another popular form is cough syrup.

Reports of the cough syrup causing addiction among young people in Nigeria, where it is illegal, surfaced in April 2018. According to the report, the drug enforcement agency in northern Nigeria seized 24,000 bottles of codeine in a lorry in Katsina. Hong Kong, Indonesia, and Greece also have banned codeine.

A person who keeps on taking codeine after the prescription has run out, in larger doses, or despite feeling its negative effects may have developed a tolerance for or dependence on the drug. Larger doses have a similar effect on the body as alcohol.

Someone who is abusing codeine may demonstrate:

• • Lack of motor coordination
  • Difficulty in speaking
  • Problems concentrating
  • Drowsiness
  • Dilated pupils

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Codeine poses dangers to health that can be fatal. In 2013, the FDA issued a Drug Safety Communication concerning the effects of codeine on children who had a tonsillectomy and/or adenoidectomy. Based on the document, children who had undergone the procedures should not be prescribed codeine.

Children who have difficulty breathing or display uncharacteristic sleepiness may need medical attention for overdose. Codeine misuse also can lead to organ failure, kidney damage, schizophrenia or trigger mental psychosis.

Codeine is safe when taken as directed, but once addiction sets in it can have potentially serious effects such as:

• Sedation
• Lightheaded
• Drowsy
• Nausea
• Vomiting
• Constipation
• Stomachache
• Flushed
• Dry mouth
• Rashes
• Shortness of breath

As a narcotic, codeine also can cause difficulty in breathing, a weak pulse, a low heart rate, or passing out. Seek medical help immediately if the individual shows any sign of an allergic reaction such as hives or the swelling of the tongue, lips, throat, or face.

Prolonged use of codeine may have adverse effects on an individual’s physical and mental health. When a person takes codeine, even with a prescription, it may cause nightmares and insomnia.

Moreover, once the individual becomes dependent on or addicted to codeine, to stop taking it will result in withdrawal pains. Too much codeine use can result in an overdose, lead to respiratory problems, cardiac arrest, and even death.

Codeine dependence may lead to:

• • Weakness
  • Loss of appetite
  • Fever
  • Twitching
  • Muscle stiffness
  • Agitation
  • Problems urinating

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The long-term usage of opioid also may lower fertility in both men and women, though it is not yet known if this is permanent.

Even though it is less potent than other opioids, codeine is addictive when taken for long periods. Some people use it as a substitute for other opioids since it is fairly easy to buy on the black market.

It is safer to manage pain and cough without codeine. If you experience chronic pain, you may even talk to your physician about non-drug alternative for treatment such as exercises or therapies. To avoid the risks to health and sobriety, ask your doctor or pediatrician about the best alternatives to codeine.

Tolerance and some of  the above symptoms doesn’t necessarily mean you are dependent on codeine. If you also have a strong desire to use codeine, coupled with taking large doses and an inability to stop,  it might be worth checking with your physician for a detailed assessment to avoid further complications.

As with most drugs, it is dangerous to take codeine at the same time as another drug without checking with your doctor for dangerous interactions. Drugs that cause sedation like diazepam, drugs for migraines, antibiotics, drugs for anxiety or depression and even herbal extracts may be safe on their own but deadly when combined with codeine.

For instance, when used with other CNS depressants, codeine may result in increased sedation, low blood pressure, respiratory depression or coma. Taking codeine with an opioid analgesic, whether an agonist or an antagonist such as nalbuphine, butorphanol or pentazocine, may cause a reduction of the drug’s analgesic effect and may cause withdrawal symptoms.

Meanwhile, there is also a danger of severe constipation and urinary retention which may result in a pseudo-intestinal obstruction.

People also abuse cough syrups with prescription levels of codeine, mixing it with soda or alcohol as purple drank, syrup, sizzurp or lean. This combination is popular among young people and some celebrities who want to achieve a sensation of relaxation and euphoria. The resulting “high” may be accompanied by hallucinations, a slower heartbeat, and shallow breathing.

Purple drank can interfere with the functions of the digestive system. An overdose could also result in death.

According to statistics, the global distribution of codeine in 2016 was the highest in India with 16.2 percent, followed by the United Kingdom at 15.8 percent, and the US with 14.4 percent. In Australia, there were more than 15 million packs of over-the-counter codeine and 12 million prescribed codeine sold in 2016, according to the National Drug and Alcohol Research Center.

A study published in 2016 showed 1.08 million US children received codeine in 1996 and 1.03 million children in 2013. The drug was most frequently prescribed by emergency room physicians at 18 percent, and dentists at 14 percent.

Meanwhile, according to the Centers for Disease Control and Prevention, there were more than 350,000 people who died from an opioid overdose, both prescribed and illicit opioid, from 1999 to 2016. In the United States, 115 people die every day due to opioid overdose. That accounts for 42,249 deaths due to opioid overdose alone. There were a total of 63,600 deaths due to a drug overdose in 2016.

Codeine and morphine fall under the category of natural opioids. And while it is difficult to categorize the drug overdose deaths, the CDC estimated that there were more than 17,000 deaths involving prescription opioids in 2016. This translates to 47 people who died each day after having an overdose on a prescription opioid.

Overcoming Your Codeine Addiction

If you think you have developed codeine tolerance, tell your doctor about it. Codeine addiction is more easily treated when you seek immediate help or accept an intervention. Depending on the level of addiction, you may need professional help.

If you are taking codeine, to stop taking it abruptly might cause codeine withdrawal symptoms: sweating, headaches, increased heart rate, restlessness, diarrhea, nausea, vomiting, insomnia, fever and muscle aches. These symptoms make continuing or resuming the addiction more likely. You might even take more than usual and overdose. It is better to consult with your doctor who can gradually reduce the dosage of codeine.

Most drug treatments start with an intake interview or an assessment of the extent of addiction. The doctor might order some laboratory tests and a physical examination to check the overall health of the individual and identify the proper rehab plan.

The detoxification process is next, possibly a medically-assisted detox, outpatient or inpatient depending on the level of the addiction. An inpatient detox plan reduces the variables and facilitates a safe and swift detox.