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Codeine Withdrawal

Articles


ARTICLE SUMMARY: Codeine withdrawal follows the standard protocol for opiate detox. You can expect symptoms to mimic a very bad flu. Medications can help as doctors can prescribe symptomatic treaments. This is why the safest way to withdraw from codeine is under medical supervision.


ESTIMATED READING TIME: 15 minutes.


TABLE OF CONTENTS


Codeine Out of Your Control?

Have you lost control over codeine and want to quit?

You’ve come to the right place for help.

In this article, we’ll explain what codeine detox includes and what you can expect. Additionally, we’ll provide some tips about how to help yourself or a loved one during withdrawal. Plus, we’ll let you know the difference between dependence and addiction. Finally, we invite your questions, opinions, and experiences with quitting codeine at the end. We love to hear from our readers! And we’ll try to provide you with a personal and prompt response.

Dependence and Tolerance

Codeine belongs in the group of drugs called “opiate painkillers”. This medication is effective in relieving pain due to its analgesic properties. However, as a narcotic codeine is highly addictive. This is because codeine can get you high. Codeine also triggers two phenomenon over time: dependence and tolerance.

Dependence. Did you know that even if you use codeine as administrated by your doctor, there is still a risk of developing physical dependence? Drug dependence is the state during which your body becomes accustomed to function with codeine. Any attempt to significantly lower dosage or stop using it will result in withdrawal symptoms.

Tolerance. If you use codeine for a period of several weeks or months you can easily develop tolerance to it. An increased tolerance to a drug means that your body adapts to the chemical properites and no longer responds to its effects. In other words, the brin becomes de-sensitized to the psychoactive effects of a drug over time. This will require you to increase your daily doses to achieve initial effects. Tolerance occurs at different rates for different people, so it’s difficult to predict.

Dependence vs. Addiction

The main difference between physical dependence and addiction is that addiction is a disease that affects you both physically and psychologically. Someone who suffers from addiction is often mentally obsessed. They are often unable to function normally in life without the effects produced by codeine. The usual signs which give away an addicted person include:

  1. Continued use of the drug despite negative consequences.
  2. The inability to control use.
  3. Cravings or obsessive thinking about the drug.

Why We Go Through Withdrawal

Withdrawal symptoms are an expected outcome of a person’s physical dependence on codeine. If you use codeine over a prolonged period of time your body adapts to the effects of the drug. In this case, the brain counteracts depressant effects by stimulating some functions. Take away the drug, though, and it takes time for the simulant effects to balance out again. Expected effects such as nausea, vomiting, headaches, and mood swings then occur.

If you are trying to give up codeine, even after a long period of heavy use know that help is available. Medical treatment tremendously reduces the intensity of the symptoms during withdrawal.

Common Symptoms

Physical Withdrawal Symptoms

  • Agitation
  • Chills and goose bumps
  • Delusions
  • Insomnia
  • Intense drug cravings
  • Muscle spasms
  • Nausea and vomiting
  • Runny eyes and nose
  • Stomach cramps

Psychological/ Emotional Withdrawal Symptoms

  • Hallucinations
  • Memory impairment
  • Psychosis
  • Racing thoughts
  • Suicidal thoughts

Timeline

Codeine withdrawal symptoms develop with a different intensity depending on the stage of withdrawal. Early-stage withdrawal symptoms are the most severe and flu-like, while late-stage symptoms are more psychological.

Level 1 Minor Withdrawal includes: anxiety, muscle aches, yawning, and sweating. These symptoms occur the first few hours after the last dose.

Level 2 Mild Level Withdrawal includes: restlessness, loss of appetite, chills, increased blood pressure can go through peaks and valleys for 7-10 days after your last dose. Most of these symptoms tend to peak around 3-4 days into detox.

Level 3 Severe Withdrawal include: Hallucinations, homicidal thoughts, lack of memory, psychosis and suicidal thoughts can occur during withdrawal and require immediate medical attention.

The worst symptoms usually last for a week. People in detox reported that their third and fourth days of detox are the hardest. However, you should know that pain and anxiety subside after the first week, therefore don’t give up and stick till the end!

Factors That Influence Intensity

Codeine withdrawal symptoms and their duration are different for each person and depend on various factors, such as genetics, general health, and history of abuse. The factors which influence the course of codeine withdrawal are:

  • Co-existing physical or psychological health conditions (Ex. diabetes, high blood pressure, depression or anxiety disorder).
  • The length of time you’ve been using codeine.
  • The amount of codeine you’ve been taking.
  • Whether you abuse multiple drugs, or not.
  • Your general/overall physical health, age, gender.
  • Your unique body response and metabolism of codeine.

Duration

Codeine withdrawal symptoms are most severe and intense during the first week of acute withdrawal but can last up to a month after last use. We’ll briefly introduce you to how withdrawal symptoms develop with time.

STAGE 1: 12 hours after quitting codeine.

The starting period of a codeine withdrawal experience is marked with irritability and fly like symptoms. Chronic codeine users may begin to feel discomfort and drug cravings even sooner.

STAGE 2: 1-2 days after quitting codeine.

Symptoms mark their peak at this stage, which means that you will feel them with the highest intensity. A codeine withdrawal peak the stage at which the relapse potential is at its greatest. At this point your journey may feel as if suffering from continuous dull pain which will never end. But do not worry, since this is only because during this period your body is making the greatest efforts to re-establish a new balance. Additional symptoms during this stage include: anxiety, appetite loss, depression, diarrhea, headaches, insomnia, muscle spasms, nausea, strong drug cravings and sweating. Heavy users might deal with hallucinations.

STAGE 3: 3-5 days after quitting codeine.

Between the third and fifth day, the symptoms will begin to fade. However, you should not relax completely still because anxiety, nervousness, diarrhea, minor headaches, and irritability might still be present. During this period cravings will continue, but will be milder.

STAGE 4: 6 days and beyond after quitting codeine.

You’ll begin to feel normal and restore balance somewhere around the sixth day after being codeine free. Up until now all the previous symptom should begin to subside or at least start to fade away. As you reach your last stage of the detox journey you may face some difficulties eating regularly. You might find it helpful starting with smaller portions multiple times a day and then gradually increase your meals. It is highly advised to start with some mild exercising activity such as sports. This will help you reduce depression and anxiety as well as raise up your energy levels.

Protracted Symptoms

Opioid detox is sometimes followed by Post Acute Withdrawal Symptoms (PAWS) which can linger for months or years after last use. PAWS are characterised by a general feeling of reduced well-being and strong cravings for codeine. This craving often leads to relapse and a return to codeine use. If you repeatedly relapse following withdrawal, you might benefit from a methadone maintenance treatment or other opioid substitution treatment.

Tapering vs. Cold Turkey

A taper plan or, slow taper, is a way of coming off codeine with minimum side effects. This method offers high success rate for those who were on lower daily doses. But, if you were taking high, daily doses of codeine, you should consider a substitute therapy made in accordance with your doctor’s recommendations.

“Cold turkey” withdrawal is an immediate stop in dosing. Quitting codeine cold turkey has a high relapse potential, especially in the early phase of withdrawal. Regardless of the fact that “cold turkey” is the quickest way to rid the body from codeine, this method is usually never recommended since it creates a shock to your system.

NOTE HERE: Withdrawing on your own at home is rarely recommended. Medical practitioners at detox clinics carefully supervise your condition and are licensed to administer medications to ease withdrawal discomfort. This is why you should NOT consider experimenting quitting codeine, or any other drug without advising your doctor first.

Codeine withdrawal is accompanied by a round of negative emotions and distress up to the point where you get detached from reality (hallucinations and psychosis). Lacking the ability to make rational judgment may expose you to the risk of doing self-harm such as becoming suicidal and/or homicidal. In addition, cravings for codeine are powerful in the early stages of withdrawal. The easiest way to reduce the effects of withdrawal is to begin using again. In order to avoid going back to codeine again, exclude “cold turkey” as an option.

Safely Quitting Codeine

A medically assisted detox is the most recommended, effective way to discontinue a prescription medication such as codeine. Participating in a medically supervised detox program increases your chances of a successful come down. Indeed, detoxification programs are most comprehensively carried out on an inpatient basis, sometimes in a hospitalized setting.

A medically supervised detox is a three step journey:

Step 1: Initial assessment and drug history examination.

This is the period during which detox clinic staff obtain information about your drug use and the way codeine affects your life. An assessment is an essential part of treatment and care for those with a drug dependence and addiction issues. The assessment is usually provided by a healthcare worker such as: a doctor, nurse, psychologist, or other qualificatied professional.

In order for the detoxification and treatment to work, you should be honest and accurate when sharing the information. Confidentiality of the information you give is guaranteed, since the data you provide is strictly confidential.

Step 2: Detoxification and withdrawal management.

Detoxification is the actual removal of codeine from the user’s body. As doctors perform this, people usually experience the pain and discomfort of withdrawal symptoms. This why withdrawal management is essential during a medically performed detox. Medical and psychological care is performed by:

  1. A doctor who is responsible for monitoring a person’s progress and intervene in case of complications.
  2. Nurses, who are responsible for monitoring people in withdrawal, dispensing medications as directed by the doctor and providing information about withdrawal.

Step 3: Transition into treatment.

Some people are more than physically dependent on codeine. For people who are addicted to it, detox alone rarely guarantees long-term sobriety. Therefore, after detox, you may directed to a residential rehab. Addiction treatment facilities are effective at helping people work on the psychological issues behind their addiction. This way, you can get to the bottom of an addiction problem safely and with support.

Medications

Medications can be used during withdrawal that reduce withdrawal symptoms, lessen cravings, and prepare you to become used to living without codeine. Some people may be tapered off these medications after detox, while others may remain on medication for a longer period. Here we list the most commonly prescribed medications during a codeine withdrawal and an explanation of what they do.

Buprenorphine helps reduce the intensity of withdrawal symptoms and cravings.

Methadone helps reduce withdrawal symptoms and cravings from quitting codeine.

Naltrexone blocks codeine’s effects and helps reduce cravings.

Suboxone (buprenorphine and naloxone) reduces withdrawal symptoms and cravings by blocking the effects of codeine.

Who To Turn To For Help

Addiction counselor/psychologist
Addiction doctor (MD specialist)
Addiction treatment center
Drug detox clinic
Family doctor
Psychiatrist

The professionals listed above are trained to address specific codeine withdrawal symptoms, control cravings, and slowly taper down your daily intake as you go through detox. Professionally assisted withdrawal is often provided through substance use disorder treatment centers and detox clinics. They should make your journey safe and as painless as possible.

Stress Management And Coping Skills

Our brains do not function at their best when we are feeling stressed. Our thinking gets muddled and we become overtaken by negative emotions. Unfortunately, this is just what happens during withdrawal. People are scared and fear the outcomes. They especially fear experiencing pain again.

The good news is that there are ways to disrupt the stress cycle. Making a conscious effort to increase the amount of positive emotions is achievable. Here are some suggestions on how you can succeed:

1. Remind yourself about the reasons why you’ve entered detox.

In order to make it through withdrawal, it helps to review the reasons you want to quit. This will give you a peace of mind that you are on the right path, the one that leads to recovery. It’s useful to have your reasons for quitting either written, or associated with an object such as a personal item.

2. Learn new habits.

Part of recovery is learning how to live in the world again without relying on drugs. This process is very difficult to accomplish on one’s own. Recovery is not just about quitting the use of codeine. It is a process that involves learning and discovering ways to address old habits, and apply new information.

3. Build a support system.

You can greatly reduce your risk of relapse and increase your chance of recovery if you have friends, family, or other people in recovery you can turn to when you experience a craving or a stressful event that makes you want to use.

4. Learn to recognize the early warning signs of stress.

If you want to avoid being flooded with emotions you need to know how to recognize the early indicators of a stressful emotion. These indicators are unique for each individual and can include: difficulties sleeping, increased and/or decreased appetite, bodily sensations. When you recognize that stress is escalating, take a deep breath, call a friend, or engage in an activity which brings you peace.

5. Accept that withdrawal includes discomfort.

Accept the painful emotions during withdrawal and let them flow through you. Remind yourself that feelings come and go. Do not identify with your emotions. Trying to suppress your feelings might cause the opposite effect. Therefore let it flow and you’ll see the end coming more quickly.

Ways To Support a Loved One

It is never easy to watch a loved one in pain. This is where your presence and support can make a change. Here’s how you can be helpful during your loved ones codeine withdrawal:

#1. Express your readiness to participate in their treatment. Tell your loved one that you want to help.

#2. If your loved one gets extremely angry or hostile at some point of their detox, back off. Do not engage into a fight or express aggression.

#3. Avoid making demands, accusing, threatening, creating consequences for not finishing detox, or for relapsing. Confrontation often leads to the person doing exactly the opposite of what they are supposed to. Instead acknowledge every success along their withdrawal journey.

#4. Avoid using words that label your loved one as “addict.” This stigmatizes people who face dependence and makes them even more insecure in their ability to recover. Instead, tell them that you believe they are strong and they CAN recover. Always use affirmation.

As a loved one, you have a huge role to play in the recovery of a family member or a friend detoxing from codeine. Your loved one really needs to know you are on this path together.

Your Questions

Many people fear withdrawal during detox. Although detox clinics may not be able to take away all of your fears, the detoxification process is necessary in order to get better and healthy again. Medical supervision will make sure you are safe and comfortable during the process.

You can rediscover who you are without codeine.

It just takes committment and bravery.

Still have questions? Please leave them in the comments section below. We’ll do our best to respond to you personally and promptly.

Reference sources: Drug Abuse: Misuse of Prescription Drugs
NIH: Withdrawal Management
Medicine Plus: Opiate and opioid withdrawal
Medicine Plus: Codeine

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