Cracking the Codeine; Can I Get Addicted?
What is Codeine & What’s the Big Deal?
Codeine is an opiate-based painkiller that has been a very popular prescription among physicians for decades. It is often prescribed for mild-to-moderate pain, or in some cases, it is combined with other medications to treat coughing. As such, codeine is an ingredient in many medications for cough and colds, so it’s important to read ingredient labels and ask your doctor if codeine is in any medications you may be prescribed.
Why does It matter, though? What’s the big deal if codeine is in medicines? Well, codeine’s effectiveness is largely dependent on the genetics that govern metabolism. In order to work, the body’s liver must convert the codeine into morphine, but one third of people, which includes children, are poor metabolizers because of their genetics. This means the drug just doesn’t relieve the symptoms it’s supposed to.
More alarming, however, is the eight percent of people who have a hyperactive metabolism. This ultra-rapid metabolism causes the body to convert 5 to 30 times more of the drug, leading to fatal overdoses even from taking the normal dosage of codeine.
This makes 250,000 children each year, just in the United States, who could be taking a drug that doesn’t even work for them and 57,000 children who could face overdose and death. Think about that for a moment. That’s 57,000 children a year, a full eight percent, who could overdose and die from the normal, prescribed dosage of codeine.
Cracking the Code
As previously stated, codeine is dependent on the liver, which converts the drug into morphine in order to do it’s job. This conversion is governed by genetics, so it varies from person to person, through an enzyme called CYP2D6.
CYP2D6 deficiency occurs in roughly 14-20% of people, totaling from Caucasians, Hispanics, African Americans, and Asian Americans. These people have no CYP2D6 activity, as they have inherited a nonfunctional gene from both parents, and are called “poor metabolizers.”
People who have inherited only one nonfunctional gene from their parents are called “intermediate metabolizers.” These people have lower CYP2D6 activity than normal, but it is present.
“Extensive metabolizers” are those who have normal CYP2D6 activity and have inherited at least one functional gene. Most people fall into this category.
Some people, however, have much higher CYP2D6 activity than normal and these people are called “ultrarapid metabolizers.” Much like CYP2D6 deficiency, the chances of being an ultrarapid metabolizer is based in one’s ethnic background and genetics.
Is it Really Dangerous?
In 1997, the American Academy of Pediatrics issued warnings about codeine and renewed their efforts to warn people in 2006. In 2012 and 2013, the Food and Drug Administration sent out a black-box alert intended to warn against the usage of codeine for children after surgery in order to treat sleep apnea. This is because one child suffered life-threatening respiratory arrest and three more died.
Some of the side effects of codeine include light headedness, dizziness, drowsiness, headaches, nausea, mood swings, constipation, vomiting, difficulty urinating, and stomach pain.
Codeine can also cause more serious side effects, such as confusion, sleepiness, difficulty swallowing or breathing, shallow or noisy breathing, rash, irregular or pounding heartbeat, hives, itching, obscured vision, and seizures.
There are much safer alternatives to codeine and they are frequently more effective as well. People often think of codeine as a “safer” alternative to morphine, but that’s sadly just not the case. If your doctor prescribes codeine for you or your child, ask about alternatives.