The Risks Of Addiction To Over The Counter Codeine Products

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A number of codeine products are available to purchase over the counter at pharmacies. These products usually combine codeine with other painkillers like aspirin, ibuprofen, and paracetamol.

Codeine products can be useful to treat and ease pain. However, there is a risk of addiction that patients should be aware of. In this article, we explain the dangers of codeine addiction. We also share resources for people who are worried about their codeine use or would like to learn more.

What is codeine?

Codeine is an opioid painkiller. Codeine is considered a weak opioid, whereas morphine and heroin are examples of strong opioids.

Codeine is used to treat mild or moderate pain when other painkillers (like paracetamol) have not relieved the pain. It can be used to treat muscular pain, migraines and dental pain, among others. Common side effects include drowsiness, dry mouth, constipation, nausea and vomiting.

There are a number of over the counter products that contain codeine. These are classed as ‘pharmacy’ medicines and can only be sold by a registered pharmacy and pharmacist. Different combination products include:

  • Codeine and paracetamol - often called co-codamol (e.g Solpadeine Plus)
  • Codeine and ibuprofen (e.g Nurofen Plus)
  • Codeine and aspirin (e.g Co-codaprin)

Co-codamol is commonly used over the counter. Most over the counter co-codamol products contain 8mg of codeine. There are stronger co-codamol products that are only available as prescription medication, they contain either 15mg or 30mg of codeine. Codeine can sometimes be prescribed as a cough syrup.

Painkillers available over the counter that are not potentially addictive are:

 

Codeine addiction

Opioid medicines like codeine, morphine, oxycodone, and heroin all have the potential to cause addiction. Sometimes, opioid addiction is referred to as painkiller addiction because opioids are commonly used as painkillers. If someone is addicted to co-codamol it may be referred to as co-codamol addiction or codeine abuse.

Over the counter codeine products come with the warning not to take codeine continuously for more than three days. Taking it for a short time minimizes the risk of addiction compared to taking it continuously over a long period of time. The risk of addiction is higher with people who have had substance misuse problems in the past.

Some key codeine addiction symptoms or signs include:

  • Feeling a strong desire or compulsion to take codeine
  • Difficulty controlling the use of codeine
  • Gradually neglecting different pleasures and interests because of codeine use
  • Becoming tolerant to codeine and needing to increase the dose to feel the original effects
  • Getting physiological withdrawal symptoms when missing a dose or reducing the dose

 

Withdrawal signs and symptoms may show that someone is physically dependent to codeine. Symptoms of opioid withdrawal include stomach cramps, nausea, diarrhoea, cold and clammy skin, a runny nose, and dilated pupils. After long term use, it is best to gradually reduce the dose to reduce the chances of withdrawal symptoms. If you stop taking codeine abruptly, withdrawal symptoms are more likely.

Another issue is tolerance. Your body can become tolerant to the effects of codeine if you take it for a long time. This means that higher doses may be needed to have the same effect as before. 

This can lead to some people taking high doses which increases the risk of overdose. Overdosing on over the counter codeine products can be very dangerous. The products are combination medicines meaning you could overdose on two different drugs.

Drug addiction can cause social problems like relationship issues and financial issues. It can also affect mental health and lead to, or aggravate, problems such as depression and anxiety.

Getting help for addiction

If you or someone you know has an addiction to over the counter codeine (or any other substance) you should seek help. The NHS has a page on getting help for drug addiction which may be useful.

Speaking to your GP about your worries can be a good starting point. They can discuss the next step with you and what options you have for help. TalkToFrank is useful to help you find addiction services local to you (in England). 

In Scotland, the NHS website has information and a link to the location of Scottish services. Welsh patients can find local services using the Dan24/7 site.

Addiction treatment and rehabilitation aim to support a person to overcome their dependence on substances. Different types of support include therapy (e.g CBT) and detox. Some people with opioid addictions (including over the counter and prescription drugs like codeine) are offered substitute therapy. This involves taking a prescription opioid under medical supervision to help avoid experiencing withdrawals and minimise the risk of overdose. 

Charities with more information and support include:

 

Summary

Over the counter codeine products are available from registered pharmacies and some people find them effective for mild to moderate pain relief. However, codeine is an opioid and has the potential to be addictive. It may not be suitable for people with a history of substance abuse issues. Co-codamol is a common over the counter product that contains codeine and stronger variations are available as prescription painkillers.

You should not take over the counter codeine products for more than 3 days. Long term continuous use of codeine has a higher risk of causing addiction.

There are other products available over the counter to help with pain such as paracetamol, ibuprofen, and aspirin. These do not have the potential for addiction like codeine.

When buying any over the counter codeine products, you should be aware of the risk of addiction. Always read the information leaflet in the medicine box and discuss any problems with your pharmacist or doctor. If you think you or someone you know has drug addiction issues, speak to your GP or visit the NHS website for help.

Content Reviewed: 03/11/2020