7th January 2024

Codeine

Codeine is the most typically used weak opioid at step 2 of the WHO analgesic ladder. Other options include Dihydrocodeine and Tramadol.

The body must first metabolise Codeine to Morphine for analgesic effect. Opioid conversions will be discussed later, but Codeine is 1/10 as strong as Morphine. There is little evidence of its use in place of strong opioids; studies show there is better pain control quicker from low-dose morphine than codeine. Where strong opioids are readily available, it is common for step 2 to be bypassed.

If step 2 is utilised, the non-opioid analgesic in step 1 is not stopped. If a weak opioid is not beneficial, uptitration is by stopping the weak opioid and switching to a strong opioid and step 3 of the analgesic ladder.