Overload

Codeine

Category: Medicines

Type

Involuntary and voluntary

Introduction and description

 

Codeine is the third most prevalent opiate found in opium from Papaver somniferum

In unadulterated poppies, codeine is between about 3%-6% or so of the alkaloid content.

It is usually present in raw opium as free alkaloid in addition to codeine meconate, codeine pectinate, and possibly other naturally occurring codeine salts. Pseudocodeine and some other similar alkaloids are found in trace amounts in opium as well. 

The name codeine is derived from the Greek word kodeia for "poppy head."   It is much more prevalent in the Iranian poppy (Papaver bractreatum), and codeine is extracted from this species in some places for use in pharmaceuticals. 

It is extracted and used pharmaceutically for its analgesic and antitussive effects, often in combination with paracetamol, aspirin, NSAIDs and so on.


 
 

Demand for codeine exceeds the supply of it naturally.  Most morphine produced for pharmaceutical use around the world, for example a little under 50 per cent of opium licitly (lawfully) produced by the latex method, is actually converted into codeine.  In most countries the usage of codeine (both as end-product and precursor) is at least equal or greater than that of morphine on a weight basis and codeine is by far the most commonly-used opioid in the world.

While strains of poppies have been engineered to produce much higher yields of other opioid pharmaceutical precursors like thebaine, no known strain of P. somniferum will produce more codeine than morphine. The poppy straw process of producing licit opioid alkaloids generally yields more codeine.

Side-effects

 

The principal side-effect of codeine, whether it is used as a pain reliever or 'recreationally' is addiction. 

I have chosen to put the experiences of a real sufferer as the means of showing what can happen.  The main problem is actually withdrawal - stopping use. 

The body adjusts to the existence of the codeine and effectively reduces the number of pain relief receptors, in order that the signals signifying that something is wrong continue to reach the brain.  Once you stop the codeine, the pain plus a whole load of other symptoms come back with a vengeance.

If we use an analogy, let us suppose you are standing on your dog's tail.  This hurts any dog, the tail is very sensitive, so he bites you to tell you to get off his tail.  You divert him with a plate of delicious warming chicken and for a while he forgets you are still on his tail.  Then he finishes the stew and the pain is worse because you have been on the tail so long, so he bites you a lot harder.

Pain is the body trying to tell you something is wrong.  You need to address the cause - see Healing yourself.

Withdrawal

Citation:   Jack. "Kicking the Crutch: An Experience with Codeine (ID 31507)". Erowid.org. Jul 31, 2006. erowid.org/exp/31507
I am 24, male, in the US. I get migraines, which I obviously inherited from my mother, and she gets Tylenol 4s with codeine for them. For a short time I got Tylenol 3s for mine, but when I didn't have health insurance I would just take a few of hers …. I remember having four or five Tylenol 4s in my drawer for two years or so. …..
I guess it was the spring of 2001 when I really started abusing the painkillers. I was going out with a girl I loved a lot but who, I found out periodically, was cheating on me. …. Somehow, after taking a Tylenol for a bad headache and realizing that it made me feel *much* better about what was going on, I started taking them for emotional reasons rather than strictly physical ones. My mom … started giving me 30 a month of her prescription for 90.
Anyway, I gradually moved up to 45/month--half my mom's prescription--and I'd … find myself running out before the new script was in, which caused my first withdrawals. The girl and I broke up …. At one point in the spring of 2003 I ran out and determined to endure the ten days until the prescription came in. … I'll describe what happened in those ten days.
First there was the misery, which did sort of pass, though it feels like it wouldn't. No more good feelings about being at work or doing anything at home or watching a movie or talking to a friend; everything is a chore, and I mean a CHORE. That's because, coupled with the misery, there's the lethargy and muscle aches, which make just getting out of a chair very difficult indeed.
…. There's a general irritability; in my case, however, I've found that I get into very few real arguments with anyone when this is going on because I'm so miserable I don't want to endure any conflict at all. Muscle aches can be quite pronounced; I remember throbbing leg muscles that kept me awake at night, … when I woke up in the middle of the night to go to the bathroom and got back in bed, they were howling …. My sleep was also affected pretty badly, sometimes on the getting-to-sleep end but more usually in the morning. I would wake up after just a couple of hours no matter how little I had slept in how long, and laying in bed awake staring at the ceiling can be pretty fucking rough, let me tell you. Which brings me to the final and, in my experience, most lasting symptom of codeine withdrawal: depression.
In my case this was what did me in. I was very, very extremely depressed about things at certain points--especially the long, lonely, sleepless mornings--and it was during one of those mornings around day ten, .. I was really overwhelmed by depression bordering on panic. … it .. lasted all day in full force, debilitating and frightening.
That day happened to be the day my mom got her codeine prescription refilled. The evening came, she gave me my bottle of 45, and I popped two. The depression evaporated; I could face the world confidently again. Yes, I'm an idiot.
One more thing to report about the withdrawal ….. I got what felt like a very bad stomach flu roughly between days 3 and 6. …I don't ever recall having a stomach flu before then, and I haven't had one since. This one gave me diarrhea, as well as nausea which would make a normal person vomit plenty. I hate vomiting and don't ever seem to do it, but this stomach flu brought me very, very close. I remember kneeling over the toilet wishing I could.

Overdose

Justin Bieber has had to be treated for codeine addiction

If you overdose as opposed to withdraw from use, you can experience ..........

  • Constipation
  • Miosis and Visual distortions
  • Hypothermia
  • Respiratory depression -   pulmonary edema, shortness of breath, pleural effusions - hypoxia
  • Itching
  • Heart problems - hypertension or hypotension, bradycardia, tachycardia

 The itching shown in the list above as a side effect is probably a result of over stimulation of the immune system and the release of an excess of histamine.

"On Aug, 22, 2014: 2,039 people reported to have side effects when taking Codeine. Among them, 78 people (3.83%) have Death." [eHealthme]

How it works

Why does codeine cause hallucinations, visions and even out of body experiences?  It may be helpful here to have the Model of spiritual experience open for referral.

It may also be helpful to refer to the generic description of How spiritual experience works.

Normal/first dose

If you turn for a moment to the description of Overwhelming fear and terror you will see that all truly major threats eventually cause Endorphins to be released.  In effect, the ingestion or injection of any opioid is like throwing yourself off a cliff without the emotion of fear that precedes it!!    Codeine just happens to have similar though not identical actions to endorphins.....  initially.

Endorphins generate a feeling of total relaxation and by doing this, we have opened the door to the Composer.  The relief acts in much the same way as the Relaxation techniques.   Thus the first use of codeine can be positive, it can indeed promote a feeling of well being.  But this is dangerous, because it can generate a wish to experience the same again, and again, and again...

Overdose

lil Wayne

If you have overdosed, any one of the side-effects listed above are capable of  producing hallucinations - particularly hypothermia and hypoxia.

What is actually happening is that the body perceives itself to have encountered a major Threat. Codeine is competing with the body's own pain killers and is masking the fact that something is wrong within the body and deserves attention.

But, it is also clear from the observations that many people who obtain the more overwhelming effects from codeine – hallucinations, visions and so on have obtained them because they have taken the drug in truly overdose proportions and have been poisoned  - see Poisoning.  There have been Near death experiences.

Withdrawal

Elvis presley died from an overdose of prescription drugs - As many as
14 different drugs, including codeine

As I have explained, codeine like all opiates is highly addictive.  If taken regularly, our own endorphin receptors are destroyed to counteract the high amount of the endorphin look alike that appears to be flooding round our system.  If you then stop the codeine, you do not have enough receptors to support your own natural endorphin release.

We have seen some of the side effects of withdrawal above - one of which is depression, which can cause hallucinations. The technical name for this is dysphoria – despondency of a level you can not imagine without having been there – so low you are in an abyss of unfathomable horror.  The hallucinations are not nice.

Furthermore, there may be excruciating pain from only tiny wounds, or from whatever prompted you to take the pain killers in the first place.  Extreme pain is an extremely effective mechanism of producing all sorts of spiritual experiences - including out of body.

References and further reading

EROWID - this LINK takes you to the EROWID experience vault for codeine.

EROWID - this LINK takes you to the list of all experiences on EROWID good and bad.

Codeine addicition help - this LINK takes you to a site providing guidelines, help and advice on codeine addiction.

For a detailed explanation of codeine receptor activity see Codeine receptor bindings.

Observations

Rapper Macklemore battled a codeine
addiction before his 'Thrift shop' success

One of the really great problems with codeine is that you often are not aware that you may be taking it. 

Codeine is marketed as both a single-ingredient drug and in combination preparations with numerous other apparently harmless pharmaceuticals such as paracetamol and less benign pharmaceuticals.

So, for example, co-codamol which contains codeine and paracetemol is then marketed as   e.g., Paracod, Panadeine, and Paramol.

There is then the Tylenol-with-codeine series, also classified as co-codamols as they contain both paracetemol and codeine.  But it is even more confusing as whilst Tylenol 1 contains acetaminophen and codeine; Tylenol PM is the trademark for a mixture of acetaminophen (paracetamol) and diphenhydramine [which is an antihistamine].

'lil wayne still sipping syrup'

Codeine may be combined with aspirin; and is known then as  co-codaprin.  It can be combined with  ibuprofen and is then known as Nurofen Plus!  After concerns were raised about the addiction risk posed by the codeine content of these medicines (both Nurofen Plus and competing brands which contain codeine), an addiction warning was placed on the boxes in 2009 to warn users the medicine may cause addiction and must only be used for three days.

Codeine may be mixed with phenacetin (Emprazil With Codeine No. 1, 2, 3, and 4), naproxen, indomethacin, diclofenac, and others, as well as more complex mixtures, including such mixtures as aspirin + paracetamol + codeine ± caffeine ± antihistamines and other agents, such as those mentioned above.

Codeine is also found in cough syrups – many for children – often mixed with other active ingredients, and a linctus e.g., Paveral.  

So the opportunities  of overdose, addiction and abuse are quite high, given that these are all over the counter medications.

A whole range of performers have suffered from codeine addiction, see the observations.  One of the most prominent and visible victims of codeine abuse was Howard Hughes.  It may be interesting to know that one side effect of codeine abuse is obsessive compulsive disorder 

Acta Psychiatr Scand. 1989 Jun;79(6):619-20. - Obsessive-compulsive disorder in people that abuse codeine. Senjo M.  Department of Psychiatry, Kuchan Kosei Hospital, Hokkaido, Japan.  PMID:  2763855

I have only one specific observation for Hughes, but have added his biography so that you can see what happened – he suffered the whole gamut of the most unpleasant of the spiritual experiences – frightening visions,  hallucinations, demons….

Related observations