Codeine has been grossly abused in Nigeria

By FAVOUR HALILU

Against regulations from health governmental bodies like NAFDAC and NDLEA, Codeine still remains the 4th most common drug across the country, according to stability and reconciliation group. Most people take the drug for sundry ailments such common tough without being concerned about its adverse effects.

Just recently, British Broadcasting Corporation reinforced their emphasis on the rate of codeine addiction across the country. They stated that more than 10 percent of Nigerians especially in Northern Nigeria. use codeine. Ironically most of the users take it for non-medical purposes, such as recreational.

However this widely used drug has a couple of side effects that have not been much publicized for general information. Greenlife Pharmaceutical’s Dr. Ugwanyi Ugochukwu high lights the effects of codeine and why you shouldn’t use it.

According to him ‘ codeine still poses high health risks especially when misused or abused. Codeine has some effects on the system and these are due to its adverse effects which are related to the mechanism of action of the drug.’

He said some of the adverse effects are mild while some are life threatening. The common side effects include drowsiness, nausea, vomiting, lightheadedness, sedation, abdominal discomfort, itching, constipation, etc.

He further explained that, “Severe effects include hallucinations, seizures, respiratory depression, low blood pressure, and agitation. The use of codeine over the time can lead to tolerance, addiction and dependence.”

Ugwanyi also explained that another major effect of codeine is addiction.

“Codeine addiction is a serious health cum societal issue. It results from the users’ dependence on the drug. Stopping addiction for someone who is already addicted to opiods is not an easy task. This is because an abrupt stoppage from the drug will lead to withdrawal symptoms.

“The brain has been sensitized to the side effects of the codeine and any withdrawal will lead to the reversal of the side effects. Some withdrawal symptoms include headache, diarrhea, dehydration, depression, insomnia, fever, cravings, sweating, muscle aches.’

He also said that “codeine has a high risk of abuse because it creates a euphoric medium (makes the user to feel high) and that triggers a cycle of reward that leads to addiction. Dependence on its own arises when the brain and the body are used to the codeine that in absence of it or if it’s stopped abruptly, the user will experience discontinuation syndrome (withdrawal symptoms).”

While the withdrawal symptoms are somewhat not life-threatening, they could get worse and progress to a life-threatening condition if not properly handled.

Ugwanyi further identified three ways of recovering from codeine addiction. A codeine addict who wishes to stop has many chances of recovery. There are many ways of managing codeine addiction but its better in a rehabilitation centre where a trained clinician will be monitoring the patient.

Some management modalities include:

Tapering the dose of the drug

Due the fact that an abrupt withdrawal leads to some unfavorable conditions which makes the user to crave for more, it’s advisable that the dose of the drug is gradually tapered (Titrated downwards) until the user stops it. As the term “taper” connotes, it is a gradual lessening of the codeine’s presence in the body.

The system is not completely devoid of the drug, meaning that withdrawal symptoms are not likely. When the dose is tapered, the user still feels the euphoric effect of the drug but in a reduced intensity. As the tapering continues, the feeling keeps reducing till it completely wanes out. This approach takes a long time anyway and it should be done under the supervision of a professional.

Pharmacotherapy approach:

This approach makes use of some drugs that are either blocking the effects of codeine in the system or are mimicking its effects but in a milder way. These drugs have been effective in the treatment of codeine addiction.

Buprenorphine; This drug creates an opiod-like euphoric effects but it reduces the individual’s risks of codeine-related side effects, misuse and dependence.

Naltrexone and Naloxone block the euphoric effects of codeine and other opiods.

Methadone prevents withdrawal symptoms and reduces cravings.

Codeine detox approach:

Detox is the process of clearing toxins from body of a patient who is dependent on substance abuse. Medical detoxification is designed to manage the symptoms of withdrawal following cessation and to help patients overcome physical dependency.

Codeine is a centrally acting opiod substance. It’s an opiod agonist and specifically binds to the mu type of opiod receptors found in the central nervous system. Some of these receptors are also found in the gastro-intestinal tract. Codeine is actually a pro-drug which binds to the opioid receptors to become metabolised to morphine which is the active form.

Codeine is a mild opiate analgesic. i.e. a pain killer. It’s used to treat acute and moderate pains. When bound to the receptors, it blocks the transmission of pain signals from the brain to the affected parts. Resultantly, the individual feels less pain, though the source of the pain still exists.

Also, codeine has good antitussive properties. It raises the stimulus threshold of the cough center and as a result, it is used as a cough suppressant. It is found in some cough syrups. In a milder way, codeine has the ability to contract the gastrointestinal muscles and can be used to relieve diarrhea. ‘In short-term use, codeine is somewhat safe but not entirely risk-free.