All narcotic medications have significant effects on an individual’s subjective experience of pain, and codeine can definitely be used for pain relief; however, it is more often used as a cough suppressant in formulations of cough medicine and as a sleep enhancer. It is most commonly prescribed in a liquid or pill form. Like all narcotic medications, anyone who uses the substance regularly for more than several weeks may develop some level of physical dependence on it.
According to the book Pain Management: A Guide for Clinicians, the mechanism of action associated with codeine is similar to the mechanism of action associated with other opiate drugs. This class of drugs has an affinity for specialized neurons in the brain that are the receptor sites for endogenous neurotransmitters, which are very similar in structure to opiate drugs. These neurotransmitters, such as endorphins, are involved in the subjective experience of pain; when these neurotransmitters are activated, they reduce one’s experience of pain in the same way that narcotic drugs do. They are also involved in the experience of stress, fatigue, anxiety, etc. When these endorphins and other neurotransmitters are repeatedly activated, they act in conjunction with other neurotransmitters, such as dopamine, to produce pleasurable feelings like euphoria and reinforcing effects.
The effects of all of the drugs in the classification of opiate or narcotic drugs are achieved by generally suppressing certain aspects of the central nervous system’s activity (brain and spinal cord). Thus, these drugs are often referred to as central nervous system depressants. This designation does not mean that these drugs cause individuals to become sad and depressed, although in some cases this may occur; rather, the firing rates of the neurons in the central nervous system are suppressed as a result of use of these drugs. Codeine has an added benefit of being particularly prone to bind to neurons in areas of the brain stem that are involved in controlling the coughing reflex, thus making it an effective cough suppressant.
All of these substances also result in a reduction of anxiety, stress, exertion, etc., as a result of their sedative effects. Thus, these substances (both endogenous neurotransmitters, such as endorphins and enkephalins, and opiate drugs) have the potential to induce or motivate an individual to repeat the actions associated with their effects. Some individuals may become “exercise junkies.” They get feelings of reinforcement and euphoria from exercise associated with the release of endorphins in the brain to reduce the subjective experience of stress and exertion. Other individuals get similar reinforcements from taking opiate drugs.
However, the development of a substance use disorder is a far more complicated issue than the simple mechanism of action of any drug. Individuals prone to developing substance use disorders typically have other risk factors, such as certain genetic factors, environmental experiences, and other tendencies, that all interact together to increase the risk to develop the disorder. The mechanism of action of any drug or other substance alone cannot sufficiently explain the development of a substance use disorder in any person or group of people.
Tolerance occurs when one’s system habituates to the effects of the drug, and the person finds that they need higher amounts of the drug to achieve the effects that were once achieved at lower doses. Tolerance is relatively common for individuals who use all kinds of different drugs, either for medicinal reasons or as a result of abuse. Withdrawal symptoms are less common but do occur in conjunction with repeated use of a number of different medications.Withdrawal symptoms occur when an individual’s system has been exposed to the drug for a significant period of time and it adjusts its functioning to account for the drug’s presence. When the levels of the drug in the person’s system decline, the system is thrown out of balance, and the individual experiences a number of negative effects that will vary depending on the type of drug or medication being used.
Individuals who have developed physical dependence on codeine will undergo some level of withdrawal symptoms that are often uncomfortable, but not considered to be potentially physically dangerous. However, any individual undergoing withdrawal symptoms may become emotionally distraught and be at risk for engaging in poor judgment or having accidents. As a result, it is always a good idea to consult with an addiction medicine physician or addiction psychiatrist when attempting to discontinue any drug of abuse. If one is prescribed codeine and has been using it for more than several weeks, it’s important to consult with the prescribing physician before stopping use of the drug.
According to Drugs The Straight Facts: Codeine, the symptoms an individual experiences when undergoing withdrawal from codeine can be quite varied.
The withdrawal syndrome from any substance can be quite variable and affected by a number of factors. These include: