What is codeine?

History of Use

Codeine was isolated from opium by French chemist Pierre-Jean Robiquet in 1832 and was used in the nineteenth century for pain relief and diabetes control. Near the end of the nineteenth century, codeine was used to replace morphine , another substance found in the opium poppy, because of the highly addictive properties of morphine. Codeine has effects similar to, albeit weaker than, morphine and was not thought to be addictive. Codeine was subsequently used in treatment for withdrawal from morphine.

The first detailed report of codeine addiction is thought to be from 1905, and reports by others followed. In the 1930s, concern over the widespread abuse of codeine in Canada was noted. Codeine abuse in the United States was evaluated more fully in the 1960s, leading to inclusion of codeine as a schedule II controlled substance. Schedule II drugs have a high potential for abuse.

Subsequently, among substance abusers, prescription cough syrups containing codeine began to be mixed with soft drinks and candy (in a combination known as lean syrup, sizzurp, or purple drank). The combination remains a substance of concern.

Effects and Potential Risks

Codeine primarily exerts its medicinal effects by being metabolized by liver enzymes to substances that bind to specific receptors in the central and peripheral nervous systems. One of the most potent of these substances is morphine. The codeine metabolites can effectively block the transmission of pain signals to the brain and can inhibit the cough reflex. The metabolites also contribute to the usefulness of codeine in treating diarrhea by affecting, among other things, the contraction of gastrointestinal tract muscles.

Short-term use of codeine provides pain relief and euphoric effects. Some of the more common side effects of codeine ingestion include itching, constipation, dizziness, sedation, flushing, sweating, nausea, vomiting, and hives.

Long-term use of codeine can lead to tolerance, necessitating higher doses to achieve the same euphoric effect. Endorphin (natural painkiller) production may be slowed or stopped, causing increased sensitivity to pain if codeine is not used. More serious side effects include respiratory depression, central nervous system depression, seizures, and cardiac arrest.

Bibliography

Amer. Soc. of Health-System Pharmacists. "Codeine." MedlinePlus. US Natl. Lib. of Medicine, 15 Sept. 2015. Web. 27 Oct. 2015.

McCoy, Krisha. "Opioid Addiction." Ed. Michael Woods. Health Library. EBSCO, Jan. 2014. Web. 27 Oct. 2015.

Manchikanti, Laxmaiah, et al. “Therapeutic Use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective.” Pain Physician 13 (2010): 401–35. Print.

Parker, James N., and Philip M. Parkers, eds. Codeine: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: Icon, 2003. Print.

Parker, Philip M., ed. Codeine: Webster’s Timeline History, 1888-2007. San Diego: Icon, 2010. Print.