Codeine and opioid painkiller addiction

Codeine is an opioid painkiller

In Australia, codeine is one of the most widely used prescription opioid painkillers.1 Just as with other opioids – misuse can lead to addiction, with similar signs, symptoms and risks.1-3

Only available with a prescription, codeine has the same addictive qualities as other opioid painkillers such as tramadol, oxycodone, fentanyl and morphine.2,3 In fact, codeine actually converts to morphine in the body and people can process codeine at different rates, depending on their metabolism.2

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“Any medicine containing
codeine can lead to opioid
addiction

when misused”

Pain or headache tablets, and even some cough medicines, sometimes contain codeine in combination with other pain killing medicines such as paracetamol or ibuprofen. They may be sold under brand names or unbranded pharmacy names that are familiar and that you trust; however, any medicine containing codeine can lead to opioid painkiller addiction when misused.2,3

Which medicines contain codeine?

Codeine comes in different forms such as:
  • Tablets
  • Capsules
  • Suppositories
  • Soluble powders and tablets
  • Liquids

It’s important to know if a medicine you have been prescribed contains codeine. The list below includes just a few of the more familiar brands, but don’t forget similar combinations can be sold under pharmacy-own brand names.

What’s in your codeine combination painkiller?
Medicine such as paracetamol, ibuprofen or aspirin

May provide relief from:
  • •  Mild-to-moderate pain
  • •  Cold & flu symptoms
Codeine

Generally added for extra pain relief, but may also be added to help relieve:
  • •  Dry, irritating cough
  • •  Diarrhoea
Common codeine combinations
Aspalgin® (aspirin and codeine)
Nurofen® Plus (ibuprofen and codeine)
Panadeine®, Panamax Co® (paracetamol and codeine)
Codral® Cold & Flu (paracetamol, phenylephrine hydrochloride, codeine)
Mersyndol®, Panalgesic® (paracetamol, codeine and doxylamine)
Adapted from Alcohol and Drug Information Factsheet. Codeine facts. Australian Drug Foundation, May 2016.

If you are taking a codeine combination medicine, it’s very important to take it as directed, and to see your doctor for advice if your symptoms persist.

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Should I be concerned about codeine addiction?

Codeine may be present in medicines for minor conditions, such as cold and flu, but it has the same effect on the brain’s chemistry as other opioid painkillers – so, caution needs to be taken.2 Misuse can still lead to addiction.

Signs that you may be developing addiction include:
  • An icon of several pills stacwhy am iked on top of each other.

    Using more codeine to get the same effect

  • An icon representing repeated taking of tablets.

    Unable to stop or reduce codeine use

  • An icon of a person’s face viewed side on.

    Use of codeine is affecting your life – you may be losing interest in regular activities, are often late or absent from work or school, or having relationship problems

What other health issues can result from misuse of codeine medicines?

Opioid painkiller addiction is not the only risk to be aware of when taking codeine combination medicines more frequently than recommended. Taken in high doses, other drugs contained in the tablets, such as paracetamol and ibuprofen can also cause harm. Regular or high doses of ibuprofen, for example, can cause serious harm to the stomach and kidneys, and high amounts of paracetamol can be toxic to the liver.

In addition, high doses of codeine can cause dangerous respiratory depression and even death, especially if combined with alcohol or other sedatives. Because of their capacity to cause respiratory depression, opioids like codeine are responsible for a high proportion of overdose-related deaths around the world each year.1

Serious side effects of misusing codeine combinations include:
  • Stomach and kidney damage
  • Liver toxicity
  • Bleeding in the stomach
  • Stomach ulcers
  • Anaemia

What should I do if I suspect I may be addicted to codeine?

It is important to understand that addiction to opioid painkillers, including codeine combinations, can happen to anyone and doesn’t deserve blame.

If you think you may be addicted to codeine, you should seek help from your doctor. Doctors have a better understanding of addiction as a long-term disease, and have a number of options to help people manage their condition.

Want to find out if you may be at risk of opioid painkiller addiction?

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If you experience any side effects related to codeine that concern you, or you think you might have an addiction to codeine, it’s important to speak with a doctor.

References: 1. Nielsen S, Codeine: The facts. National Drug & Alcohol Research Centre 2017. Available from https://www.tga.gov.au/sites/default/files/presentations-codeine-scheduling-workshops-perth-30-november-2017-sn.pdf. Accessed October 2018. 2. WHO Information Sheet on Opioid Overdose. Available from http://www.who.int/substance_abuse/information-sheet/en/. Accessed October 2018. 3. Gowing L, et al. National Guidelines for Medication-Assisted Treatment of Opioid Dependence. National Expert Advisory Committee on Illicit Drugs (NEACID), Australian Government Department of Health and Ageing. 2014.
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