Codeine is one of the better known names in painkilling. In its 200+ year history of medical use, it has often been the most commonly used narcotic painkiller in the world. Today, however, consumers are seeing less and less codeine on the pharmacy shelves, fewer and fewer prescriptions for it written, and even popular mixed painkillers – pills that combine two or more drugs, like aspirin and codeine – are being reformulated to leave codeine out of the picture.

So how did such a pharmaceutical powerhouse get knocked off its perch?

A Brief History of Codeine

Codeine was developed over 200 years ago. Since, it has been among the most popular treatments for pain, coughing, and diarrhea in the developed world. At its height, it was a part of literally thousands of unique pharmaceuticals. Today, it is still included in hundreds.

Codeine is derived from the poppy plant – as are opium, heroine, and morphine. Unlike those others, however, codeine is a prodrug; once it enters the body, it is converted into morphine. Codeine is not as potent as many other narcotics and was always thought to have a smaller potential for addiction for that reason.

Codeine’s Eulogy

Because codeine was in use long before strict FDA-regulated standards for pharmaceuticals were put in place, it was just sort of grandfathered in. That is, for a long long time, codeine continued to be used in the United States without thorough clinical testing. Recently, however, medicine decided to do a careful examination and find out really how effective codeine is and what risks it might pose.

What the studies found was shocking.

Codeine simply is not very effective at treating pain. As a prodrug, codeine is completely unreliable. Each body metabolizes codeine differently, and even within the same person it is extremely inconsistent. Sometimes it may work alright and relieve some pain, and other times it might do nothing!

It also comes with several health risks. It is possible that it may create enough morphine in the body to weaken and depress the lungs or cause toxicity, in which case the organs shut down. Either way, there is the potential for death.

While codeine remains an over-the-counter medication in some countries, it is has been pulled from the shelves in others, like the United States, in order to protect consumers from health risks and addiction.

Why Doctors Prefer Tramadol

You will continue to see codeine used is certain medications because it is actually very effective for relieving coughs. However, for everything else, newer analgesics seem to be preferred.

The most likely candidate to replace codeine as king of the painkillers is Tramadol. This drug is a fully synthetic opioid and, as such, it has several advantages over other opioids. Whereas codeine “works” by binding to the opioid receptors in the brain and throughout the nervous system, Tramadol does more. It inhibits the reuptake of norepinephrine – the hormone that makes humans feel pain – and causes a release of serotonin, which makes humans feel good. It is also less addictive.

For the very extreme pain, morphine will continue to take over codeine’s market share as it is more effective. However, for most common types of pain for which over-the-counters are not enough, Tramadol works blissfully.