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The Painkiller That Stays Under the Radar

When asked to name painkillers, most people come up with drugs like OxyContin, Hydrocodone, Vicodin, and Percocet—a hodgepodge of generic and brand names for a group of closely related opioid pain medications.  The one that few people think about is codeine. A couple decades ago, Tylenol with Codeine became more commonly known as Tylenol 3.

Back then, if your doctor saw you in the office for a complaint of pain stemming from a muscle or joint injury or from arthritis, he was most likely to prescribe Tylenol 3. Drugs like Percocets were most often reserved for someone whose pain took them to the hospital. It was commonly prescribed by family doctors, orthopedic surgeons, rheumatologists, and dentists, and people considered it just a step up from regular Tylenol. But the codeine it contains is every bit as addictive as its opioid cousins.

Codeine alone is a Schedule II drug, but packaged with Tylenol it is a Schedule III drug. That means people have a tendency to shrug off the potential for danger from codeine; they considered it to be less effective in managing pain than OxyContin and the other opiate painkillers—and much less dangerous. 

So how bad can Tylenol with codeine be? One graduate of a codeine addiction treatment says, “Take them till you get better, then stop, please…[this advice] is for your own good, honey, and it only gets worse.”  If that sounds a bit ominous, let’s take a look at codeine therapy and addiction.

It remains in the system for only a few hours, so it’s short acting and leaves your system quickly. It is, however, an opium derivative, just like morphine and heroin. Most often it is prescribed for persistent pain issues, and it’s also a common ingredient in cough medicines. Once you’ve ingested it, your body metabolizes it into morphine.  It’s especially dangerous for children, because it has been known to metabolize more quickly in younger systems and even cause death, so nursing mothers must never take it.

Besides relieving pain or the horrible wracking coughing of bronchitis, it also induces a calm feeling of euphoria. Some people like it because they think—mistakenly or not—that it curbs the appetite, and they try to get it as a quick way to drop a few pounds. However, using it for even a short term of five to seven days can cause the user to develop symptoms of addiction.  And, like other opiates, it doesn’t really curb the appetite, but the nausea from it may cause the same effect.

It also carries a bigger risk of liver disease because of the acetaminophen content. While some people taking acetaminophen regularly over a two-week period demonstrate elevated liver enzymes, those numbers will quickly return to normal once the person stops using the medication. However, for someone who drinks alcohol along with the codeine pills, there is a much greater risk for substantial liver disease to occur.

Prescribers also tend to shrug off the seriousness of codeine. It just doesn’t evoke the same excitement as its opioid cousins, and it may go under the radar if pill-seeking addicts go to one doctor for complaint of back pain and then see a dentist for a toothache. That puts an increased amount of opiate medication in the system, which can result in death.

Too much codeine can result in respiratory depression, including low levels of oxygen in the blood as evidenced by bluish tinged lips or fingernails. Itchy skin is a common complaint, as are constipation, dizziness, drowsiness, stomach or intestinal spasms.

Treatment involves abstinent withdrawal management and also cognitive behavioral therapy so that the person will stop seeking the codeine. If you’re looking for codeine addiction treatment, or you know someone who needs help, don’t shrug it off—put them in touch with a residential addiction rehab to explore the best treatment options. 

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