Is codeine a gateway drug to heroin?

[janef001]

I'm always watching documentaries in the States of how prescription painkillers like hydrocodone, oxycodone etc.. lead people to harder drugs as they build a tolerance and the painkillers are too expensive. In fact most people who take heroin started on painkillers.

It makes me wonder if the possibility is the same with codeine since it's in the same opioid family.

The doctor is correct. We process painkillers very differently when in pain.

The issue is when pain tapers off and you don't have very skilled pain management so you end up taking opiates for paracetamol level pain.

The trick is to take appropriate painkillers. And with staffing and support how it is you get PP's DH with a huge number of pills and no management.

Surely that’s not necessarily the case with the US epidemic? Give people highly addictive opioids and many, if not all, will become addicted. These are nightly physically addictive drugs (oxy in particular) and people took them under the advice of doctors for their pain thinking they were doing the right thing. The reason we don’t have people moving onto heroin from prescribed medication in the U.K. is because prescriptions are cheap and available. There are a lot of people I’m sure who if their opioids were removed tomorrow would probably turn to the black market.

I had to take codine for six weeks after having a rather slow recovery from a c-section. Whilst the withdrawal wasn't great I never thought about trying heroine! :)

This might help.

www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

Through the sales representatives, Purdue used a patient starter coupon program for OxyContin that provided patients with a free limited-time prescription for a 7- to 30-day supply. By 2001, when the program was ended, approximately 34 000 coupons had been redeemed nationally

Very similar to actual drug dealers. Have a freebie, you'll end up coming back for more.

You are right. And not forgetting the agony of being an addict, and not having the money for a fix. It's horrific what people will stoop to, and horrific for the families and friends to see someone destroyed by it in that way.
I have old friends who are now dead, either through overdoses or turning to alcohol when they do get clean.
Horrible. And all were good decent people with good decent family.

Opiates are good but I think they're not controlled enough. They're often sold by people who don't take them for a profit to addicts. I have chronic pain and won't touch them.

Codine is delicious though. Just saying.

A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain.

In much of its promotional campaign—in literature and audiotapes for physicians, brochures and videotapes for patients, and its “Partners Against Pain” Web site—Purdue claimed that the risk of addiction from OxyContin was extremely small.43–49
Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”

Misrepresenting the risk of addiction proved costly for Purdue. On May 10, 2007, Purdue Frederick Company Inc, an affiliate of Purdue Pharma, along with 3 company executives, pled guilty to criminal charges of misbranding OxyContin by claiming that it was less addictive and less subject to abuse and diversion than other opioids, and will pay $634 million in fines.61

Although research demonstrated that OxyContin was comparable in efficacy and safety to other available opioids,11,63 marketing catapulted OxyContin to blockbuster drug status. Sales escalated from $44 million (316 000 prescriptions dispensed) in 1996 to a 2001 and 2002 combined sales of nearly $3 billion (over 14 million prescriptions).19

You can't buy codeine over the counter that is higher than 8mg I think? And that's as cocodamol.

I was prescribed 240mg codeine a day for broken ribs. Hated the stuff, preferred the pain, and I have a very addictive personality! I was looking forward to feeling off my face 🤣

I will take codeine now and again OTC to help with a cough I've had for years or for headaches that paracetamol doesn't touch. GP also prescribed it for tonsillitis.

I took 6-8 coedine tablets a day for about a year and a half and managed to easily come off three seperate times. I had physical withdrawal, shaking and cold sweats etc so I can see why people stay on it and struggle. I also found the coedine stopped working for me... So again people might seek stronger solutions.

I think broadly our support for pain in the western world is shocking. We have no way of treating chronic pain or helping people understand it. Pushing pills is hugely ineffectual but the NHS isn't set up to offer anything else.

It's really not that simple. I've used dihydrocodeine for years on and off for chronic pain. Never got a high off it and never had any withdrawal symptoms when I've stopped taking it in times of remission. It just works really well for me. Morphine, on the other hand, made me sick as a dog when I had it for gallbladder pain in hospital.

My husband, however, gets a high off dihydrocodeine so knows it's not good for him to take it for pain relief as it could easily lead to addiction.

Yes, it is. Legal drugs have caused a heroin epidemic and killed millions, illegal drugs like MDMA have cured PTSD. The whole industry is corrupt and exploitative.

12.8 mg.

Codeine is nothing like the drugs they have there it's 1/10 the strength of liquid morphine oxycodone is 1.5 times stronger than oral liquid morphine hydro cosine is the same strength as liquid morphine there's a show on Disney plus which shows how it all started over there with the Oxys , they had some weird label from the fda which showed they weren't addictive so the market was flooded with them but they were obviously highly addictive and when they were more restricted after years people turned to herion because they couldn't get them any more , they also have other tablets over there such as diloted which are 5 times stronger than morphine and a big flood of fentanyl in fake pills .

I’m not too sure about the jump from codeine to heroin but I know for sure that the UK is heading towards it’s own opioid crisis due to irresponsible dispensing and the easy OTC availability of codeine. Prescription strength codeine starts at 30mg. Nurofen Plus and Solpadeine Max are 12.8mg per tablet and you’re meant to take 2 at a time. That works out to just slightly less than the prescription dose.

Someone I love dearly is addicted to codeine and it has destroyed his life. He’s been taking OTC codeine in massive doses for over 10 years. A few pharmacists close to him even give him a discount because he buys it so often. The problem is the OTC stuff is mixed with either paracetamol or ibuprofen so he is not just overdosing on codeine, he is also overdosing on paracetamol and ibuprofen. He is currently taking three 32 pill packs a day. That’s 96 pills. 19,200 mg of ibuprofen and 1228.8 mg of codeine. His body is shutting down. He is in his 30’s and has a beautiful family. He started using it to help with anxiety because he was failed by mental health services here.

I’ve spent so much time researching this and spoken to so many pharmacists who have said this is actually a very common problem in this country. The same thing happened in Australia (because of Nurofen Plus) and they’ve now made codeine prescription only. The same needs to happen here but it won’t because of greedy big pharma. It’s fucking devastating.

That's really awful Running - sadly also reading this evening elsewhere on MN a poster who is trying codeine withdrawal while pregnant. Troubling.
Dopesick was a real eyeopener. The US opioid industry is pure evil & the FDA were totally in their pocket.

@Goodskin46 - I don’t think that’s fair to say they are handed out like smarties, just because your husband didn’t need them doesn’t mean that somewhere else someone wouldn’t be in agony without them and unable to access good pain relief quickly. I was given dihydrocodeine for an episiotomy, I didn’t need them, just had some paracetamol for a couple of days. My friend was in absolute agony with hers. I don’t think I have a different pain threshold to hers, just our bodies reacted differently to the procedure. If your husband had taken the 30 and then tried going back for more it wouldn’t have been so easy.

@MrsTerryPratchett

"An effective drug met a hole inside me. And that's where addictions live."

Beautifully put.

Not in my experience, but I hated how codeine made me feel and was worried about getting addicted so I started to wean myself off it as soon as I could, even if that meant some extra pain. I was surprised though at the really fairly glib way in which the doctor prescribed me a box of 200. Would have been easy to think these were no big deal even if you took the maximum dose every day for months.

Incidentally I didn't find it a terribly effective painkiller either, which makes me wonder if I'm one of those people who doesn't metabolise it properly.

In fact most people who take heroin started on painkillers.

Almost all addicts drank milk as babies, maybe all of them. Correlation is not causation.

There is a really interesting series on Netflix called 'the pharmacist' . It starts with a murder and leads to a Dr who is prescribing oxycontin to anyone who turns up at her office.

It ends with the bankruptcy of a drug company.

We have a different set up in the UK, I can't imagine a Dr here opening late at night and a queue out the door for prescriptions.

We don't advertise prescription meds to the general public.

I have Arthritis in every joint, occasionally in my eyes and a few other health issues. I take Tramadol daily but I am careful to not overuse because I cannot afford, in terms of pain, to be addicted.

I take other meds and use a TENS machine, hot and/or cold therapy, I'm always in pain but not agony.

I'm not saying it doesn't happen, but I think in the UK we are more careful.

I don't think anyone wants to return tot he days of valium in the 1970s.

I always have a box of nurofen plus on standby as I take it when I either have a really bad headache or severe migraine, or if I've done my back in (I sometimes get lower back pain and sciatica). I also found it helped me when I had covid last year. However, I try to take just one dose and time it carefully to give me the most benefit over a period of time. Eg when I had covid I felt grottiest in the early evening so I would take it at about 5, 6pm and it would get me through until bedtime.
I can really feel the codeine kicking in which is why I love NP, and why I ration when I take it!
Incidentally, a pharmacist once told me that the codeine content of NP is only at placebo level, which I found hard to believe.

@Runningupthathill22 that is awful. If he has no plans to stop anytime soon, there is a way to extract just the codeine from the pills using cold water. At least that could mitigate some of the damage being caused by the other ingredients, if it isn't too late already 😔 Paracetamol really is one of the most dangerous drugs out there, but is so easily available that most people don't realise just how toxic it is.