Opioids Long term codeine use side effects

[thickskin]

TLDR: what are long term side effects of low dose codeine beyond tolerance and dependence

Hi all,

I have quite severe IBS-D and have suffered from it for the past 10 years. I get very painful cramping, diahorea, extreme need to use the bath room and in the worse cramping cases I get cold sweat, difficultly talking, difficultly standing up. Sometimes I get such concentrated acid when I relieve myself that it burns off the skin and causes very small amounts of bleeding on the outside.
Before I started using codeine to treat these symptoms my life quality was very badly impaired. Having a job was difficult because I couldn't predict when I would have 2 hours long cramping sessions where I can't move far from the bathroom. Going out for drinks with friends basically would have to be canceled as soon as I felt cramping start and I would just need to return home instantly in the hope I could get there before it got too painful.

I don't have Crohns and I don't have Coeliac disease. I have tried a range of treatments including a variety of anti-spasmodics, food elimination diets, lite benzos during times of stress. I find fasting and not eating much food does help reduce the symptoms, as does eating very healthy diet. Codeine is the only medication that I have used that can stop the cramping once it starts. It basically allows me to live a normal life (sometimes I am in pain for 30 mins until the codeine kicks in but that's not too bad).

I use between 0-90mg in a day. Sometimes I'll have weeks where I use only 1-2 times a week, sometimes I have to use every day for a long time. If there is a particular stressor that is causing very bad cramping I use up to 120mg (bad stressors can include LSD, excessive eating, bad social anxiety). I have used it for the past 3 years, not finding that I need to increase the dose yet.

I have a doctor who is very understanding of the condition and gives me scripts for 150 30/500 codeine/paracetamol tablets on request (I don't use ever recreationally). Previously I've been to gastroenterologists who have been no help at all and basically ignore the fact that I tried food elimination diets for years before I saw them and were only willing to suggest that route.

Due to a mix-up in doctor's names I went to another doctor at my medical centre who refused to prescribe me this amount of codeine and kept saying 'it's a very bad drug' and that at 23 it would be horrible for me to be dependent for the rest of my life on an opiate. She gave me a referral to a gastric diseases study centre where I have made an appointment.

Basically I want to know what the long term side effects of low dose codeine is. I have tried to look it up but the side effects seem to centre on dependence and tolerance. I asked the doctor a number of times for why she thought it was bad for me to be taking it and she gave the same answer.
It doesn't really tell me the actual side effects I will get. I haven't had to increase my dose over 3 years so tolerance isn't a major concern. I can go weeks without using it if I am not having IBS symptoms so I don't know how much of an issue the dependence is. I want to know what negative effects on my body could be caused by continuous long term use will be. I understand opiates can have an estrogenic effect. I understand that I need to limit the amount of paracetamol that I take in due to stress on the liver. I just don't understand why I can't get a straight answer out of doctors about what the side effects will be. If they don't know then I don't get why they are giving me a strong opinion on the topic. The doc who prescribes for me basically says that it's fine as long as I don't increase my dose.

If I find a new treatment that works as well as the codeine I'll use it an happily give up the codeine. If nothing else works I won't stop taking the codeine ever basically. I want to know what the side effects of this will be and if there are any ways to mitigate them.

Thanks for any help!

ps I currently suffer no noticeable side effects from the codeine. I don't get any effect I can notice at all except relief of cramping and the need to go to the bathroom

 

[sekio]

Sounds like codeine is an acceptable treatment to me. Seeing as you've been using it for over 3 years with no ill effects... don't fix it if it ain't broke is a good motto.

Tolerance and dependence are the two big worries with poppy-based opioids, mainly. Some people are prone to side effects like constipation, itching, stuff like that. (Although in your case the constipation is almost certainly a desired effect.)

With APAP compound medications, there is concern of liver damage if you consume >2g in a sitting or >4g daily.

In higher doses of opioids some people worry about suppression of testosterone production. I don't think you have to worry about that at 90mg codeine, though.

You could also try Immodium / loperamide, or if they still make it, Lomotil (co-phenotrope - what a cool name! - aka diphenoxylate and atropine).

 

[thickskin]

Hi,

Thanks for the reply!

I have indeed tried Loperamide/Immodium. Its better than nothing but its more like making it 10% better whereas the codeine can actually stop all the cramping.

I will consider trying a non-libido anti-depressant if this is suggested by the specialist. Even if it doesn't work it will help convince skeptical doctors from thinking I haven't tried all the alternatives.

 

[Ksa]

90mg of codeine to counter LSD side effects is considered recreational use. You can take 90mg to lower final exam anxiety, obliterate common headaches and to fall asleep easier after a day of drug use, but these are all recreational uses. You don't have to take 500mg with Reactine for it to be recreational use, and even if you do, you won't get much out of it.

It's like taking 30mg dexedrine XR to drive 32 hours straight without stopping for the night...it may seem like a legitimate use to prevent you from falling asleep at the wheel, and it sure is legitimate, but it is nevertheless recreational because you might as well stop to a hotel and sleep there. The fact that you only took 30mg changes nothing.

 

[sekio]

He's not talking about using codeine to counter LSD side effects, it's a daily therapy for IBS. Is that any more recreational than the narcoleptics who are on amphetamine, or the CPPs on opioids?

 

[Lady Codone]

Codeine is pretty benign in terms of long-term toxicity (i.e. it doesn't damage the organs like alcohol or some others). If you manage to avoid the tolerance/addiction/withdrawal factors, you should be good to go. Constipation can happen but that might be okay in your situation, eh?

 

[thickskin]

Ok thanks for all the replies, it's good to know there isn't some terrible health effects that the doctors are keeping from me.

To the poster above I only mentioned LSD as a trigger for particularly bad cramping because it relates to the serotonin component of IBS.

I don't use it recreationally at all. I only use for the symptoms of IBS.

 

[thickskin]

Hi just as update for all the people who had any interest in this thread.

The gastroenterologist said that all the previous doctors had been wrong about the problem the whole time (still have IBS but their treatments basically do the opposite of what I need). I'll keep it short because this isn't an IBS support forum though feel free to PM if you are in a similar situation and would like to know what he said.

Anyway he didn't seem that concerned about the codeine beyond the fact he said it would be problematic for me to be dependent on codeine for the rest of my life especially as I'm 23. I'm hoping with the various techniques he has given me that I'll only need the codeine as a backup.

 

[RobotRipping]

tolerance will become an issue if you have to increase your dose consistently - i'm sure there's a point where tolerance just levels off but you may not find that point with codeine as it's not very strong. At higher doses the histamine release may start to become a problem as well, forcing you to switch to another opioid.

few things to keep in mind are libido will decrease significantly and testosterone levels will be quite low after long term use. Opiates also tend to mess with motivation, create complacency and sometimes cause depression, not necessarily an ideal long term solution but if it works, it works. Physically though, so long as it's pure codeine, you won't face any health issues or damage. I doubt any Dr. is going to completely recommend you take codeine unless they prescribe it to you themselves. Hope it works out for you.

 

[Psychedelic Jay]

If you keep increasing the dose, there will be a point to where codeine is no longer effective. You will trash your kidneys if you are the guy that literally tries to take half grams of it throughout the day.

Codeine is toxic to your kidneys in high dosages. Use a different opiate if you have to go any higher than 400-600mg a day or it is rather pointless.

 

[thickskin]

I've been able to take only 30mg of codeine since starting to take lactulose on the doctor's recommendation. This is pretty good considering I am used to daily use. I have had insomnia though, including in the morning (only ever had it at night before so it's a little odd).