I think I have managed the side effects better this course. I have avoided colic and diarrhea by judicious us of Buscopan and codeine phosphate. However, yesterday I spent most of the time sleeping and today the mucositis has been sore, requiring regular Bongella and Difflam mouth washes. I have rediscovered my liking for pink blancmange.
The way things pan out I shall be spending Christmas Day with the most severe side effects, so I am not making any plans this year.
There have been calls in the newspapers today for the withdrawal of codeine from over-the-counter prescriptions, especially those aimed at children. The reason for this is that codeine has no action of its own, but depends on its effectiveness on the liver turning it into morphine. Unfortunately, different people have different capacities for this transformation; in some it is very fast and in others very slow.
Despite the scares about it, morphine is our best pain medication and giving it as codeine allows it to be given in very small doses to most people.
The main effects of morphine/codeine are pain relief. When enough is given it will eliminate virtually all pain.
Constipation. It is the best anti-diarrheal and works when loperamide is found wanting
Cough suppression. It certainly works for non-productive cough and is especially useful in terminal lung cancer.
Sedation. It gives a feeling that everything else going on in the world is unimportant. It takes away anxiety and allows relaxation.
Elation. This is very variable and not something I have experienced, though I am willing to agree that some people find this the most attractive thing about the drug.
Nausea. With oral or parenteral morphine it always makes me feel sick so that I must have an anti-emetic with it. When I take it as codeine, this is not a problem.
Addiction. Much could be written about this. I must say I am not tempted.
Habituation. It is said that those who are used to it require bigger and bigger doses for the same effect. Again I haven't noticed this with codeine.