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CODEINE: Going from addiction to redemption

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By Sola Ogundipe

A parent was overheard last week: “Doctor, I suspect my son is a codeine addict. What do I do?” The doctor’s answer was unexpected. “It’s not enough to be suspicious, confront him and confirm. Don’t be afraid to be confrontational even if dealing with a drug (codeine) addict can be scary and unpredictable.

“Having good communication and being willing to talk about the drug use directly can be helpful. You don’t have to be aggressive or have an argument, but focus on listening, asking questions and trying to have as productive a conversation as possible.”

The codeine cough syrup crisis in Nigeria is an eye opener. Hundreds of thousands of youths are battling the addiction. Struggling with codeine addiction can take huge toll on the entire family. How can you help without making matters worse?

People commonly experiment with codeine because of the misconception that it’s relatively harmless. This creates a particularly disarming attitude toward codeine, which can lead to addiction or abuse of more potent opiates.

The first step is to understand what codeine is. Codeine is a drug designed to relieve mild to moderate pain and coughing. It is most commonly abused for its calming effects. Codeine may be extracted directly from opium, but most codeine is produced from morphine—another opium derivative. Both have narcotic effects hence their distribution is controlled.

Codeine is commonly prescribed as a painkiller because it is relatively mild when compared with many other opioid painkillers, and its side effects are less severe. Although it’s not as addictive as other opiates, codeine is still dangerous and habit-forming. Codeine acts on the brain and spinal cord.

*Experts say codeine syrup is used in treatment of cough, but when abused could lead to full-fledged addiction that is potentially deadly.

Next is to recognise the symptoms of codeine abuse. Recognising the outward signs of codeine abuse can help determine if a loved one has a substance use problem.

Because codeine is an easily obtained legal substance, it can be difficult to tell the difference between use, abuse and addiction. However, there are a few telltale signs that something may be amiss, such as increasing doses and ignoring personal responsibilities.

Some signs of codeine abuse include: drowsiness, slurred speech, short attention span, impaired judgment, dilated pupils, lack of coordination and apathetic behaviour among others.

According to, codeine addiction can actually be difficult to detect. Many individuals start out using codeine under medical guidance and are unaware they are developing substance dependence.

Risk of addiction to codeine increases with long-term usage. The course of a codeine addiction may vary from person to person, but tolerance to the effects of codeine may occur relatively quickly after taking it, and can drive an individual to take ever-increasing doses to overcome it.

Anyone struggling with codeine may become fixated on obtaining more of the drug, even without having any medical need for it. A codeine addict may continue to use it even when there is no requirement for the medication and may actually go extreme lengths to acquire the drug. Withdrawal is a hallmark of physical dependence and addiction. Codeine addicts will experience withdrawal symptoms when no longer able to use the drug anymore.

As a depressant, codeine slows a person’s breathing rate. At large doses, this may cause a person to stop breathing entirely and can be potentially fatal. Other dangerous results of an overdose on codeine include seizures and coma.

Chronic codeine abuse, over time, may give rise to many detrimental, potentially life-threatening side effects. These side effects vary from person to person, and could be any combination of sleep disorders, constipation and other bowel dysfunctions and depression, irregular heart rhythms, permanent brain damage and coma.

Prolonged and frequent codeine abuse can lead to maladaptive behaviours and health problems. Some of the long-term effects of codeine abuse include depression, anxiety, fatigue, impaired memory, liver damage, kidney damage, muscle spasms and death.

Once a codeine user becomes tolerant of the drug, he or she will require more of it to achieve the previous high. In cases of prolonged use, the drug is needed just to feel normal. Addiction may exacerbate an abuser’s fear of coping with day-to-day tasks without codeine.

Clinicians and addiction specialists can diagnose codeine addiction by following a specific set of criteria. Having a tolerance to codeine and experiencing cravings are some examples of these criteria.

The most effective way to persuade someone to get help for their codeine addiction is to stage an intervention. Because of the legality and accessibility of codeine, some people have a hard time recognizing they have a problem. The purpose of the intervention is to bring these issues to light before it’s too late. If you’re unsure how to approach an intervention, consider hiring an intervention specialist.

Codeine withdrawal isn’t typically life-threatening, which is why some people choose to quit cold-turkey. However, the discomfort of withdrawal often leads to a relapse. Without proper treatment, many people trying to give up codeine turn back to the drug in an attempt to ease their physical and emotional pain.

Regardless of how you first got hooked on codeine, you can get out of the drug’s snare. Abusing codeine over a long period of time will only make the drug’s effects worse as tolerance to it builds—eventually, the high will wear off and you’ll need more of the drug just to maintain a normal balance.

Detox is the first step when it comes to overcoming a codeine addiction. Codeine users should detox in a medical environment to safely manage withdrawal symptoms. Many inpatient rehabs and outpatient treatment programmes offer medical detox services for codeine users.

According to the Consumer Protection Council Act, 2004, the Consumer Protection Council (CPC) notes the strong regulatory action by the National Agency for Food and Drug Administration and Control (NAFDAC) with respect to production and distribution of codeine.

While welcoming all meaningful efforts to address the rising and alarming, abusive consumption of controlled substances, the CPC, issued an Advisory that publicly called for a ban and prohibition on the prescription of cough medication containing codeine. It observed that NAFDAC has heightened the proposed regulatory measure by an outright ban.

“Protecting citizens’ addiction and the harm done by abuse of controlled substances must remain a priority always, to the exclusion and sometimes at the expense of commercial considerations. The Council will deploy its entire apparatus and resources to support NAFDAC, Ministry of Health, the National Drug Law Enforcement Agency and other relevant agencies to enforce this ban and prevent access to codeine and similar addictive substances,” the CPC noted.


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