Codeine is a weak “opioid” painkiller, is used for mild or moderate pain relief, and taking less than 30mg doesn’t really do very much. This means that painkiller tablets with paracetamol (or ibuprofen) and codeine, most probably give you more pain relief from the paracetamol or ibuprofen – rather than the 16 to 20mg of codeine in the tablet.
So why do we have a hang-up (or addiction) with codeine painkillers?
Addiction is both a drug (codeine) and a habit.
Codeine is mostly changed to morphine in the body, which changes the way we feel pain in our head – and morphine also releases a “good mood” chemical in the brain! This is why we feel better after taking a codeine painkiller.
However, there is a big problem with codeine. It provides pain relief for a short time (about 4 hours), and so it is easy to get used to this effect.
This means that you will need more and more codeine to get the same pain relief – because your brain also wants more of the “good mood” effect. .
Taking codeine painkillers also becomes a habit – especially if something triggers the pain.
Sometimes stress creates a trigger for pain which boosts the habit of taking codeine painkillers. Some of these stress triggers may include;
- Working long hours or being unhappy in your job
- Anxiety around work and money problems such as losing your job.
- Getting married or divorced, kids screaming ,family problems
- Emotional issues such as long term health problems or looking after sick family members
And sometimes, we make stress in our heads by the way we think.
The big problem with codeine painkillers is that codeine boosts the habit, and the habit boosts the craving (addiction) for codeine. .
Addiction to codeine painkillers can sometimes make us do strange things. This may include;
- Taking tablets on days with no pain
- Taking tablets every day at the same time.
- Taking more and more tablets to get that “good mood” high.
- Feeling annoyed, or restless, keep us awake at night.
- Feeling more pain – it’s the opposite of what you would expect!
Being addicted to codeine also destroys important parts of our body, and may cause things like;
- Liver damage – Jaundice (yellow skin), nausea, stomach pain
- Stomach or bowel problems – ulcers, vomiting, constipation, cramps or bloody diarrhoea.
- Muscle and Kidney damage – leg swelling, heart problems, breathing problems
Does this sound like you?
If so, you may need help to reduce how much codeine you take – so please see your doctor.
There are better drugs for pain control
Aspirin, Diclofenac (Voltaren), and Ibuprofen (Nurofen) are better painkillers, are not addictive, and work quickly where there is pain, swelling and inflammation. These medicines are called NSAIDs, and some are also available on prescription (Naproxen, Indomethacin, Meloxicam, and Celecoxib).
All medicines have side-effects but NSAIDS can be a problem for people with stomach ulcers, asthma, bleeding problems, blood pressure, heart and kidney problems.
Paracetamol is also not addictive, good for mild or moderate pain, and is very safe to take for most people (adults and children) However, paracetamol is not so good for pain with swelling and inflammation, and it can cause liver damage if taken at high doses for a very long time.
Even though codeine is sometimes combined with paracetamol or ibuprofen or aspirin, this creates another serious health problem for us. When we use more and more codeine, we also use more and more paracetamol, ibuprofen and aspirin – this may cause stomach bleeds, vomiting of blood, kidney failure, low blood pressure and fast heart beat.
Many people have died from taking these combined codeine painkillers – especially when mixed with other medicines for depression and sleep.
When people take too many codeine painkillers with alcohol – they can stop breathing.
So what can we use instead?
It is possible to use paracetamol and NSAIDs together to better manage your pain – without the need for codeine painkillers. You should speak with your doctor or pharmacist about changing some of your pain medicines.
And, a Home Medicines Review can also help. Some people take strong prescription pain killers and mix these with over the counter painkillers – which can sometimes be dangerous.
If you’re worried about taking too many painkillers – talk to your doctor about a Home Medicines Review.
Author – Emmanuel Pippos, Consultant Pharmacist