Abuse of codeine is plunging young people across the world into the world of addiction. According to CapeTalk’s July 2019 news report, the codeine-based cough syrup in a drink known as “lean” is growing in popularity among teenagers in South Africa.
The issue has the attention of authorities, who told the media outlet that codeine’s widespread availability is contributing to the problem. Some of the teens are even buying the medication at pharmacies.
Codeine’s mind-altering effects at higher doses make it easy to abuse. As a result, “We are seeing a dramatic increase in the number of people under the age of 18 coming in for treatment for problems related to the abuse of codeine,” CapeTalk quoted Professor Charles Parry, director of Alcohol, Tobacco & Other Drug Research Unit of the South African Medical Research Council, as saying.
Here in the U.S., “purple drank,” another name for “lean,” is also popular among teenagers as well. The 2018 Monitoring the Future Report states that 2.8 percent of eighth-graders, 3.3 percent of 10th-graders, and 3.4 percent of 12th-graders, abuse cough and cold medication to get high.
Codeine is one of the main ingredients in “sizzurp.” This codeine-laced concoction contains a cough medicine made of promethazine, an antihistamine, and codeine, soda of some kind, such as Sprite or Mountain Dew, and hard Jolly Rancher candies to enhance the drink’s taste. VeryWell Mind writes that the drink is typically served in a plastic foam cup.
The cough syrup dyes give the drink its purplish color, which is why the recreational drink is also called “purp,” in addition to the aforementioned names, on the streets and in popular rap and/or hip-hop songs. Users should be aware they are risking an overdose on codeine and possibly death as they imbibe the purple drank.
As VeryWell Mind writes, this dangerous cocktail has put people from all walks of life in the hospital, including celebrity singers, rap artists, and professional athletes. Some have even ended up paying for the purple drank indulgence with their lives. The site writes, “Purple drank is like an anesthetic but without life support.”
Common side effects of purple drank include euphoria, nausea, dizziness, memory loss, vision impairment, hallucinations, and seizures.
Codeine is an opiate medication prescribed to manage short-term cases of mild to moderately severe pain. The U.S. Food and Drug Administration (FDA) approved it for use in 1950. It is in the opioid class of drugs that includes heroin, OxyContin, and other opioid painkillers. The high is similar to heroin, and the drug is a central nervous system depressant.
The medication can be taken in liquid form, usually in a prescribed or over-the-counter cough medicine, or as a 30 mg or 60 (milligram). Some diarrheal medicines contain codeine, and users may also take medication that combines codeine with acetaminophen (commonly found in Tylenol), aspirin or ibuprofen, among other non-opioid pain relievers.
Codeine’s makeup determines how the U.S. Drug Enforcement Administration (DEA) classifies it. It can be a Schedule II, III, or V drug. Because of this range in scheduling, codeine can either have “a high abuse potential that can lead to severe or physical dependence” or “a low potential for abuse” when compared to other substances on the list.
Like many opioids, codeine binds to opioid receptors in the brain and central nervous system and stimulates various areas of the body. They are:
The limbic system: Users feel pleasure, relaxation, and contentment as codeine stimulates the brain upon use.
The brainstem: Codeine can block pain signals in the brainstem, and it can slow a person’s breathing. It also can halt a person’s coughing.
The spinal cord: Codeine decreases pain in the spinal cord.
Side effects of codeine use include:
Codeine doesn’t take long to take effect once it is the body. Users can feel its effects anywhere from 10 minutes to half an hour after taking it, and those effects can last about four to six hours, depending on the size of the dose.
Long-term misuse and/or abuse of codeine is habit-forming and dangerous. Taking it for longer periods than prescribed, or in higher doses than recommended, can lead to physical dependence and addiction.
Dependence occurs when the body adapts to codeine and can tolerate higher doses of it to achieve the same feelings that were experienced upon initial use.
Addiction, however, differs from dependence. This condition occurs when there is a compulsive and uncontrollable or hard-to-control impulse to use the drug despite the consequences that result from using it. Addiction can last for months or even years after the person has stopped using codeine.
Codeine addiction indicates a need for professional treatment services that are nuanced and effective in treating it. Some will try to go at this alone, but that’s dangerous, and it can do more harm than good.
If you or someone you know is seeking treatment for codeine addiction, search for a reputable addiction treatment program with addiction care specialists who know how to treat addiction. According to NIDA, there are more than 14,500 specialized drug treatment facilities to choose from in the U.S. alone. Such programs usually start with medical detoxification that helps the body regain stability after chronic substance use is stopped.
During the detox process, recovering codeine users receive medications and other medical help to manage uncomfortable or painful withdrawal symptoms they experience as a result of not using codeine. Withdrawal effects after use have stopped can start within a few hours after the last dose. This process can take up to a week or longer, depending on the person.
The brain and body need time to recover from chronic use, and as they do, users will go through a range of symptoms before all systems have safely reset. Safety is important during this process, as going off a drug after longtime use can harm one’s physical and mental health if the person is not careful. Many people need help during this period as the cravings alone can send one to pick up codeine again after a hiatus, an action that can lead to an overdose.
Having medical professionals on hand to monitor the process and treat any withdrawal symptoms that arise ensures that detox is safe and manageable. It is important to note that detox is just the first step of the road to recovery.
Once detox has ended, the next step is to find a suitable program that can help recovering users address their codeine addiction as well as any other issues, including those concerning one’s mental health. Depending on the severity of the addiction, residential or outpatient treatment or intensive outpatient treatment may be recommended.
Residential programs allow people to receive comprehensive therapy and care to address their addiction from a psychological and mental perspective. Among the many benefits of such a program is that it allows people a home away from home 24-7 for a month or more to focus solely on recovery from their substance abuse challenges. This option includes therapy and a routine daily schedule.
Outpatient treatment allows users to receive treatment for a certain number of hours a week before returning home for the day. Services that are usually offered in outpatient treatment include:
The difference between outpatient treatment and intensive outpatient treatment is the number of required hours. Intensive outpatient treatment requires nine-plus hours of clinical services weekly, whereas outpatient treatment requires one to nine hours a week. All addiction services are focused on giving people in recovery the tools they need to overcome substance abuse and prevent a relapse.
Professional treatment programs are recommended to help people receive a fresh start and have a successful life in recovery.
Codeine is not as strong as morphine, but this powerful drug must be used with care. Chronic users are sure to ingest it in higher-than-normal doses, risking overdose each time they take such a dose. This can lead to death. Codeine slows down breathing, which causes blood pressure to plummet. It also slows down the heart rate, and that can lead to dizziness or fainting.
Too much codeine use can lead to decreased awareness to a total loss of consciousness. Other signs of overdose are:
If you or someone you know has overdosed on codeine, call 911 immediately for emergency medical attention. First-responders who arrive may administer naloxone, an overdose-reversal medication that has helped pull many people from the brink of death after an opioid overdose.
As the National Institute on Drug Abuse (NIDA) explains, “Naloxone can quickly restore normal breathing and save the life of a person who is overdosing on opioids.” Emergency first responders as well as friends, family, and bystanders can use naloxone.
You can also visit a hospital emergency room or an urgent care center if any of these symptoms are present.
Long-term codeine use is not advised. These drugs were not designed for long-term use or abuse. Using codeine in this manner can damage the kidneys and liver. Longtime codeine users can also have physical ailments, such as seizures, muscle problems, memory problems, and continued cravings for codeine long after use has stopped. They also can experience nightmares and insomnia. Death is always a possible outcome.
CapeTalk, (2019, July 30) “SA Teens over-the-Counter Codeine Addiction Spikes.” Zama, Z. Retrieved from http://www.capetalk.co.za/articles/356290/sa-teens-over-the-counter-codeine-addiction-spikes
The Conversation. Charles Parry. Retrieved from https://theconversation.com/profiles/charles-parry-345848
Verywell Mind. (2019, June 28). Serious Health Risks of Purple Drank. Saleh, N. MD MS Retrieved from https://www.verywellmind.com/is-purple-drank-going-down-1123889
NIDA. (2018, December 17) 2018 Monitoring the Future. Retrieved from https://www.drugabuse.gov/drug-topics/trends-statistics/infographics/monitoring-future-2018-survey-results
Drug Enforcement Administration. Diversion Control Division. Controlled Substances Schedule.Retrieved from https://www.deadiversion.usdoj.gov/schedules/
NIDA. (2020, July 22). Drug Addiction Treatment in the United States. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states
NIDA. (2017, March 30). Naloxone for Opioid Overdose: Life-Saving Science. Retrieved from https://www.drugabuse.gov/publications/naloxone-opioid-overdose-life-saving-science
Drug Enforcement Administration. Drug Scheduling.Retrieved from https://www.dea.gov/drug-scheduling
Centers for Disease Control and Prevention. Injury Prevention and Control. Real Stories from Real People: Overcoming Addiction. Retrieved from https://www.cdc.gov/injury/features/opioid-epidemic-stories/index.html
Centers for Disease Control and Prevention. Opioid Overdose. Opioid Basics. Retrieved from https://www.cdc.gov/drugoverdose/opioids/index.html