Codeine 101and acetaminophen than from combininghydrocodoneand ibuprofen. Such
findings probably indicate simply that various kinds of pain relievers work
adequately for various discomforts, with codeine often being as good as the
other drugs.
Some regular codeine users take it to reduce anxiety, and some simply find
the substance’s effects pleasant. A clinical test of codeine found no antide-
pressant action, but people who use codeine for a long time tend to be de-
pressed and may be taking that drug to medicate themselves for depression—
so if they have access to antidepressants they may have less interest in co-
deine. Codeine cough syrups may include stimulants and other ingredients
that persons find pleasant, increasing the syrups’ appeal.
Drawbacks.Codeine can promote sleepiness, abdominal cramps, constipa-
tion, urinary retention, nausea, and breathing impairment. A case report tells
of a massive dose followed by several days of hallucinations and paranoia in
a person already prone to psychiatric problems. After taking a dose, people
should avoid operating dangerous machinery until they know the drug is not
hindering their ability to do so. When 70 professional army drivers in Finland
were tested in a driving simulator after taking 50 mg of codeine, they ran off
the roadway more frequently than when they were under the influence of
alcohol. Elderly persons who take codeine have an increased likelihood of hip
fracture, presumably because the substance makes them woozy and more
likely to fall. Codeine has been known to cause pancreatitis, particularly if the
victim’s gallbladder has been surgically removed, but this effect is considered
unusual. Medical personnel refrain from administering the drug through in-
travenous injection because that route can lower blood pressure and blood
oxygen to fatal levels.
In two studies researchers found that people taking codeine felt few sen-
sations from the drug and had normal performance on assorted tests of phys-
ical and mental functioning. Those findings, however, may be related to
dosages given by experimenters; higher dosages might well produce different
results.
Abuse factors.Codeine abuse can be troublesome enough that persons need
treatment to break the addiction. Some cases have required hospitalization.
Nonetheless, prevalence of codeine addiction was disputed in 1989 by two
authorities who carefully examined past reports of addiction: Little scientific
research had been done on the topic, and most had involved persons already
addicted to morphine. As morphine addicts will use codeine as a stopgap to
hold off a withdrawal syndrome when their main drug is unavailable, their
responses to codeine are not necessarily representative of a general popula-
tion’s reactions. In addition, codeine cough syrups may contain a substantial
percentage of alcohol, so heavy use of such a product can involve a further
confounding factor of alcoholism. The 1989 authorities concluded that verifi-
able accounts of people being addicted primarily to codeine (rather than
mainly to some other drug, with codeine on the side) were unusual.
Dependence with codeine can develop; withdrawal symptoms are like those
of morphine withdrawal, but milder. A study of rheumatism patients receiv-
ing codeine found that quite a few needed higher doses to control pain as