[big sis]

My doctor gave me cocodamol (paracetamol and codeine) for a back problem a couple of weeks ago and I've had a wonderful, darrhoea-free time ever since. I even went on a 5-day trip and had no worries at all - took 1 imodium a day to be on the safe side, but absolutely no problems, where I'd usually be anxious and uncomfortable. Unfortunately, in the UK codeine is regarded as addictive, and its only possible to get a useful dose on prescription. I've noticed people on this forum mention using it - is it more freely available elsewhere? And what is the evidence for its addictive nature?

 

[Kathleen M.]

It isn't all that easy to get anywhere. Most places that will sell it without a prescription are black market and you don't really know if there is any quality control for the drug at all. Most people taking it here have a prescription.The problem other than addiction is long term use of narcotics can for a few people make the abdominal nerves much more sensitive to pain and then the pain is much harder to treat as they try to get you off the narcotics.Everything derived from opium that gets into the central nervous system has some addiction potential. But until you are hooked we don't know if you are one who gets addicted easily or not. If you or your family has a history of addiction you are probably at higher risk. There is even a couple of cases of people using Imodium to fuel their opiate addiction, but that is quite rare and most people can't handle the constipation from taking 100-200 Imodium at a time.I don't know the rates of addiction to codeine, but every single drug treatment program in any country I've ever heard of all seem to list codeine as one of the drugs they get people off of, so it isn't just the UK thinks it and no other country does. I think the rates are lower as it isn't as strong, but they also tend to mix it with other things to lower the amount you need. But some of those can be dangerous at high concentrations, so that can be a risk to being addicted if you need more and more (and can't move on to stronger drugs).

 

[big sis]

It isn't all that easy to get anywhere. Most places that will sell it without a prescription are black market and you don't really know if there is any quality control for the drug at all. Most people taking it here have a prescription.The problem other than addiction is long term use of narcotics can for a few people make the abdominal nerves much more sensitive to pain and then the pain is much harder to treat as they try to get you off the narcotics.Everything derived from opium that gets into the central nervous system has some addiction potential. But until you are hooked we don't know if you are one who gets addicted easily or not. If you or your family has a history of addiction you are probably at higher risk. There is even a couple of cases of people using Imodium to fuel their opiate addiction, but that is quite rare and most people can't handle the constipation from taking 100-200 Imodium at a time.I don't know the rates of addiction to codeine, but every single drug treatment program in any country I've ever heard of all seem to list codeine as one of the drugs they get people off of, so it isn't just the UK thinks it and no other country does. I think the rates are lower as it isn't as strong, but they also tend to mix it with other things to lower the amount you need. But some of those can be dangerous at high concentrations, so that can be a risk to being addicted if you need more and more (and can't move on to stronger drugs).

Thanks Kathleen, that's very helpful. A pity though! Guess I'll enjoy the temporary freedom from IBS while I can - am beginning to tail off the cocodamol now, as my back is getting better.

 

[Cheshire Kat]

HiYa big sis! Love your username, that's what my dad called my favorite aunt, Big Sis.I accidentally discovered that opiates 'resolved' my symptoms too (D, gas, bloating, ab pain). Hubby had recently had back surgery (twice in a row) and while he was recovering we got a goodie of a snowstorm. I had to do the shoveling, nearly crippled myself, tried a hot bath and 1/4 tab of his oxycodone that night and poof -no symptoms. I'd seen folks mention it before over the years, but I'd leaned towards thinking they were users looking for an excuse, or that excessive pain was their major symptom. Well, I know better now. It works very, very well.I've had MC (microscopic colitis) for almost 11 years now. Abdominal pain had not been much of an issue till 2008, then I had six months straight of crying screaming non-stop agony. Prior to that I'd never sought any kind of pain relief -didn't need any. I'd never even liked the idea of PKs, not even when it was prescribed after abdominal surgery. Took some, threw the rest out.I've seen/read very few IBS/IBD sufferers that get a regular script for their D. Although opiates are well known by the medical establishments to, among other things, help control D (the ancient Greeks knew its properties), they are first and foremost prescribed for moderate to severe pain, not to control chronic D. So, a script for D is most likely to be rare and/or a one time deal.Availability isn't good. Opiates are the current favorite target of the DEA here in the US, and elsewhere by the localized judicial/medical systems. Even with good cause, doctors are reluctant to prescribe it, and I can't say that I blame them. Too many scripts, or scripts for off-label use, can raise red flags with the DEA, and patient abuse of the drug can cause them to lose their license, and even their liberty. Read up on what's called (in the US anyway) standard of care, and you'll understand the precarious position a prescriber is in. They, understandably, do not want to stand out from the norm.My GP is willing to 'bend the rules' once in a while for me. He knows me, knows my long term condition, we have a good working relationship. Yet he'd never agree to prescribing it as a maintenance drug, nor would I ask him to. Two GIs I sought help from in 08/09 wouldn't even consider prescribing opiates, not for the pain, and no way for the D. My new current GI has not ruled it out as part of a long term treatment, but I'll find out for true when/if I reach that line again.As to its effectiveness, its great. But its not a cure. One nasty factor is that opiates can mask the warning signs of a serious degenerative and/or unrelated condition. Long term use commonly requires escalating doses to achieve the same results. The withdrawal is most unpleasant, the rebound is vicious and can last two weeks or so.As to abuse, I've read that when prescribed and used appropriately for bona fide chronic pain conditions under pain management guidance that abuse is <1%.As to the narcotic bowel syndrome, can't say. I've never seen reliable stats. What I have seen is ER visits are way up for opiate abuse. The irony is that its not for the opiate, its for the overdose of Tylenol commonly mixed in with it.

 

[big sis]

I accidentally discovered that opiates 'resolved' my symptoms too (D, gas, bloating, ab pain). Hubby had recently had back surgery (twice in a row) and while he was recovering we got a goodie of a snowstorm. I had to do the shoveling, nearly crippled myself, tried a hot bath and 1/4 tab of his oxycodone that night and poof -no symptoms. I'd seen folks mention it before over the years, but I'd leaned towards thinking they were users looking for an excuse, or that excessive pain was their major symptom. Well, I know better now. It works very, very well.I've seen/read very few IBS/IBD sufferers that get a regular script for their D. Although opiates are well known by the medical establishments to, among other things, help control D (the ancient Greeks knew its properties), they are first and foremost prescribed for moderate to severe pain, not to control chronic D. So, a script for D is most likely to be rare and/or a one time deal.My GP is willing to 'bend the rules' once in a while for me. He knows me, knows my long term condition, we have a good working relationship. Yet he'd never agree to prescribing it as a maintenance drug, nor would I ask him to. Two GIs I sought help from in 08/09 wouldn't even consider prescribing opiates, not for the pain, and no way for the D. My new current GI has not ruled it out as part of a long term treatment, but I'll find out for true when/if I reach that line again.As to its effectiveness, its great. But its not a cure. One nasty factor is that opiates can mask the warning signs of a serious degenerative and/or unrelated condition. Long term use commonly requires escalating doses to achieve the same results. The withdrawal is most unpleasant, the rebound is vicious and can last two weeks or so.As to abuse, I've read that when prescribed and used appropriately for bona fide chronic pain conditions under pain management guidance that abuse is <1%.As to the narcotic bowel syndrome, can't say. I've never seen reliable stats. What I have seen is ER visits are way up for opiate abuse. The irony is that its not for the opiate, its for the overdose of Tylenol commonly mixed in with it.

Yes, I think I have to accept that codeine probably isn't the way to go unless I exhaust other possibilities, but it's frustrating, when a low dose sorts everything out so effectively - and much better than Imodium, which leaves me feeling bloated and uncomfortable. I may at least explore with the doctor whether I might use codeine for holidays and other difficult situations -it was so nice this week to get in the car and go out into the countryside without any worries as to whether I'd be able to find a toilet if necessary - in fact just to be normal again! Another doctor offered it to me for a holiday last year: said no on that occasion, but next time might just grab it!

 

[clareuk]

I had to see a specialist a few years ago about the daily diarrhea problems I was having. The doctor practically threw the stuff at me. Codeine phosphate, 15mg tablets and told me to take 3 or 4 a day. I did try to start with but they didn't stop the diarrhea with me, just shifted the problems time to the evenings rather than the mornings. I had already read about the dangers of getting addicted to codeine so I stopped taking them and carried on with immodiums which worked much better. The specialist assured me that the codeine would definitely stop the diarrhea but it didn't for me but I did notice that it really did help the lower back ache I get after a bad day of diarrhea. I was perscribed co-codamol by a dentist when I had a nasty abysess and infection and was in a lot of pain and they also worked brilliantly for period pain (it is the only thing I have found that helps). Feminax used to be the same mix and when that ran out I found out you can buy a codeine / paracetamol mix at boots behind the counter. Although they do say you shouldn't use it more than a few times a month. Which i don't. That might help you.

 

[Cheshire Kat]

Yes, I think I have to accept that codeine probably isn't the way to go unless I exhaust other possibilities, but it's frustrating, when a low dose sorts everything out so effectively - and much better than Imodium, which leaves me feeling bloated and uncomfortable. I may at least explore with the doctor whether I might use codeine for holidays and other difficult situations -it was so nice this week to get in the car and go out into the countryside without any worries as to whether I'd be able to find a toilet if necessary - in fact just to be normal again! Another doctor offered it to me for a holiday last year: said no on that occasion, but next time might just grab it!

Oh, do I ever understand you. When I first had a script from my doc. along with a new corticosteroid treatment I simply could not believe the difference. Or that such a difference was even possible! I nearly couldn't recall what freedom, or normal, was anymore, like it was some distant foggy memory of a former life. Yet suddenly I was free...totally free. Mentally, physically, it was like -What disease? ah, I had a grand time.I nearly went mad when I understood my dilemma. An absolutely perfect 100% 'control' for ALL of my symptoms...and I can't have it.But remember, I'm in the US, and our DEA has created an environment of fear for patients and practitioners alike concerning opiates. I both pity and resent my physicians for practicing, not good medicine, but rather safe medicine -safe for them. But don't give up too quickly. Perhaps, as Claireuk posted, the UK has a more mature and balanced outlook on its uses. I hope for you that its so, and that you can find, keep, and use the relief it offers.

 

[big sis]

Oh, do I ever understand you. When I first had a script from my doc. along with a new corticosteroid treatment I simply could not believe the difference. Or that such a difference was even possible! I nearly couldn't recall what freedom, or normal, was anymore, like it was some distant foggy memory of a former life. Yet suddenly I was free...totally free. Mentally, physically, it was like -What disease? ah, I had a grand time.I nearly went mad when I understood my dilemma. An absolutely perfect 100% 'control' for ALL of my symptoms...and I can't have it.But remember, I'm in the US, and our DEA has created an environment of fear for patients and practitioners alike concerning opiates. I both pity and resent my physicians for practicing, not good medicine, but rather safe medicine -safe for them. But don't give up too quickly. Perhaps, as Claireuk posted, the UK has a more mature and balanced outlook on its uses. I hope for you that its so, and that you can find, keep, and use the relief it offers.

Thanks for that. I think doctors here do have a fair amount of autonomy - maybe because not ruled by insurance companies or so much fear of being sued - and common sense can be used! I wouldn't choose to take something with a risk of addiction on a longterm basis, but it might be a useful temporary help from time to time.

 

[cherrypie09]

I have IBS-D and last year was prescribed Codeine phosphate 30mg tablets to take as a constipating tablet, I could take up to 8 per day, but unfortunately they did not help with the D so I stopped taking them. I did find that when I have to take co-codamol for things that they constipate me better.