Codeine

Codeine is an addictive narcotic painkiller, also known as methylmorphine:

• Naturally processed Codeine is an alkaloid derivative of opium.

• Manufactured both in natural and synthetic forms as a narcotic analgesic (or, painkiller).

• Indicated to manage from mild to severe pain.

• Codeine has a ‘ceiling effect’, meaning decreased effect with increased dosage.

• Less addictive than other opiates, with milder withdrawal symptoms.

• 200 mg of Codeine (oral) gives the analgesia effect of 30 mg of morphine (oral). (i)

• Regulated in the U.S. under the Controlled Substances Act (CSA), and internationally under the Single Convention on Narcotic Drugs, as a Schedule II narcotic.

• Some serotonin reuptake inhibitors (antidepressants), such as Prosac and other psychiatric medications, may reduce or quell the effects of Codeine.

• Taking antihistamine promethazine (Phenergan) and cimetidine (Tagamet) should be avoided when taking Codeine.

• Codeine administration exists orally (PO), intramuscularly (IM), subcutaneously (SC), and rectally (PR).

• Intravenous injection (IV) may cause an acute, multi-system, hypersensitive, allergic reaction (anaphylaxis).

• Typical single doses of not more than 60 mg (not more than 4 doses, or 240 mg, daily).

• Due to medical shortages caused by the War On Drugs, the United States National Institutes of Health began to synthesize Codeine from petroleum and coal tar in 1973.

• Codeine-only prescriptions include Codeine Contin and Perduretas.

• Codeine can be sold over the counter in Canada only when combine with two or more ingredients, popularizing the aspirin-codeine-caffeine (AC&C) compound.

• Combinations of other drugs compounded with Codeine for greater pain-relief effect include Nurofen Plus, Fioricet, Soma Compound/Codeine, etc.

• Formulated with aspirin or acetaminophen (to produce paracetamol, or Tylenol) as a Schedule III controlled substance or Schedule V regulated substance.

• Half-life of 2.5–3 hours

• Metabolized in vivo, 5-10% of Codeine converts to morphine in the liver.

• Mood may inversely affect Codeine’s efficacy and euphoria: indifference may lead to a head rush (postural hypotension) and anticipation of euphoria may lead to disappointment.

• Codeine with anti-nausea medication promethazine in the form of “purple” syrup (Phenergan VC with Codeine) is quickly becoming one of the most highly abused Codeine preparations. 

• Street names for recreational use include “cilly" (pronounced ‘silly’) or "loopy c", due to the euphoric effect Codeine causes; school boy, little c, juice (in cough syrup form), codys (in tablet form); T1s, T2s, T3s, or T4s (referring to US grain dosing with Tylenol); and (as Codeine-infused cough syrup, and when mixed in soft drinks), purple, yellow, red, barre, hulk, syrup, sizzerp, drank, purple drank, or Texas tea.

• Because Codeine can be habit forming, it must be taken under the physician's orders, according to instructions.

• Unless used infrequently, potential to cause moderate or low physical or psychological dependence.

• Use with sedatives or alcoholic beverages increases risk of adverse side effects, dizziness, and unconsciousness.

• Increased dosage or period of use, more than prescribed, can lead to dependency.

• Of the 6.4 million Americans misusing prescription drugs, more than 73% misused prescription pain relievers (2006, National Household Survey).