Codeine Addiction

Once considered a “weaker” opioid, the prescription analgesic codeine has seen a spike in abuse amongst young people due to the many mainstream singers that reference misusing it.

What Is Codeine?

Codeine is an prescription opioid that is combined with other medications to reduce pain. Codeine can extend the effects of certain opioids (like morphine) but works differently than other opioids. It treats mild to moderate pain and should not be combined with alcohol.

Codeine can be used on corticosteroids and other immune suppressants such as non-steroidal anti-inflammatories (NSAIDs), including ibuprofen or aspirin. Codeine is intended for short-term pain relief and shouldn’t be used longer than 3 days without consulting your doctor.

Common Codeine Prescriptions and Combinations

  • Tuzistra XR: This combination of Codeine and Promethazine is a cough suppressant that treats runny nose and other cold symptoms, as well as acts as an antihistamine to relieve allergy-related symptoms. It is available as a prescription cough syrup.
  • Phrenilin w/codeine + caffeine and Fioricet w/codeine: This prescription medication is a combination of acetaminophen, butalbital, codeine, and caffeine. It is used as a treatment for migraines.
  • Tylenol 3 and Tylenol 4: This prescription pain medication is a combination of acetaminophen and codeine.

Codeine Side Effects

Although codeine is generally safe when taken as prescribed by your doctor, some people experience side effects. The higher the dose, the more likely it is to have a negative reaction—especially if you are using codeine without a prescription.

Consumption of street drugs or alcohol along with codeine is more likely to cause a stronger reaction to any of these side effects and increases the user’s risk for overdose or death.

Short-Term Effects of Codeine Use

  • Stomach ache
  • Constipation
  • Increased heart rate
  • Nausea
  • Drowsiness
  • Dry mouth
  • Low blood pressure
  • Impaired vision
  • Seizure

Long-Term Effects of Codeine Use

  • Headache
  • Shallow breathing
  • Challenge urinating
  • Mood swings
  • Dilated pupils
  • Poor concentration
  • Skin rash
  • Problems with coordination
  • Irritability/agitation
  • Low sex drive
  • Itching

Codeine also presents a high risk for abuse, potentially leading to substance abuse disorder and requiring treatment to stop. Speak with your doctor or healthcare provider if you are concerned that your codeine use is causing any of these negative side effects, particularly if you do not have a prescription.

Codeine Abuse and Addiction

Codeine abuse occurs when the drug is used for a purpose other than its intended medicinal use. The effects will vary depending on the user’s method of ingestion.

Many people that abuse codeine will crush the pills and snort them. These pills are also sometimes smoked or injected. Combining codeine cough syrup along with alcohol or sprite has become more common amongst adolescents, as this method has been popularized by various rap artists. This mixture is known as “purple drank” or “lean”.

Am I Addicted to Codeine?

Some signs to look out for to know if someone is addicted to codeine include:

  • Illegal purchasing of codeine
  • Seeing different doctors to get multiple codeine prescriptions
  • Stealing the drug
  • Isolation from family/friends
  • Not admitting to drug use
  • Being unable to stop taking codeine
  • Turning to other opioids when codeine is not available
  • Experiencing withdrawal symptoms when not taking codeine

If you are concerned about your codeine use, the good news is that there are plenty of resources available to you to help you get your life back to normal.

Codeine Withdrawal

If you’ve taken codeine for a while and have decided to stop using it, the effect will start to wear off and symptoms of withdrawal will occur. Most symptoms subside within days or weeks, although some can go on for months.

Some of the withdrawal symptoms you can expect from codeine withdrawal include:

  • Sweating
  • Nausea/vomiting
  • Watery eyes
  • Diarrhea
  • Muscle pain
  • Runny nose
  • Stomach cramps
  • Irritability/agitation
  • Anxiety
  • Cravings for codeine
  • Restlessness

Because these withdrawal symptoms can be intense, healthcare providers recommend seeking support through medical detox. Detoxing safely under medical supervision can alleviate many of these symptoms and ensure your safety while the codeine exists in your system.

Codeine Overdose

A codeine overdose can be fatal, especially when a person takes a large amount of the drug within a small period or has mixed codeine with alcohol or another drug. Many of the overdose symptoms are going to be similar to any other opioid overdose.

Some common symptoms of an opioid overdose, including a codeine overdose, are:

  • Increased, intense drowsiness
  • Confusion
  • Sweating/clammy skin
  • Vomiting
  • Convulsions
  • Going in and out of consciousness
  • Unconsciousness

It is important to seek medical services if someone you know has overdosed on codeine, as it can result in stroke, heart attack, seizures, coma, or even death. If you suspect someone is experiencing a codeine overdose, call 911 immediately and stay with the victim until help arrives. If possible, administer naloxone (Narcan) to help slow down the effects of the overdose.

Codeine Addiction Treatment

Treatment for codeine addiction varies depending on the patient and the nature of their addiction. Effective treatment often involves behavioral therapy and counseling to address the psychological aspects of addiction and help the patient develop healthy coping mechanisms and strategies for avoiding relapse.

Codeine Detoxification

Usually, the first step in treatment for codeine addiction is medical detoxification. During this detox, you will be monitored by medical staff and sometimes prescribed a medication to help your body adjust to the lack of codeine in its system. Medical detox is the safest way to quit using codeine and enables you to avoid any potentially serious side effects.

Codeine Treatment Programs

Many different treatment programs exist for people that want help with their addiction to codeine. Some of these programs are aimed at helping you with side effects that arise, while others aim to help you overcome the addiction itself to help you avoid a relapse.

Inpatient rehab programs for codeine addiction offer a safe and comfortable place for people to focus on recovery without distractions or temptations. This type of program provides a structured environment where people can heal their chemical dependency, develop healthy habits, and learn to manage triggers and cravings.

Similarly, a Partial Hospitalization Program (PHP) is a program designed for individuals who need more care than what can be provided by an outpatient program, but do not need to go away from their homes and/or jobs during the process.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) is designed to improve the recovering addict’s mental health after rehab. Medication and behavioral therapy will help the patient stay away from codeine abuse in the future.

Medication-assisted treatment for codeine addiction usually involves the use of one of the following addiction medications:

Codeine Statistics

Statistics about codeine are typically included in the overall opioid statistics category. This category also includes other opioid analgesics such as hydrocodone (Vicodin®) and oxycodone (Oxycontin®).

The National Institutes of Health (NIH) report the following data regarding opioid abuse and overdose:

  • Nearly 50,000 Americans died in 2019 due to opioid-involved overdoses
  • Between about 21-29% of patients with chronic pain misuse their prescription opioids
  • Each year the opioid epidemic costs the US approximately $78.5 billion dollars, which includes addiction treatment, criminal justice involvement, healthcare, and lost productivity

You and Your Loved One Aren’t Alone

Dealing with a loved one who is struggling with Codeine addiction can be overwhelming. In the midst of their addiction, your loved one may make poor choices—at work, at home, or in the community—that affect you.

Plagued by concern about their behavior and disappointed by a lack of support from a seemingly intractable situation, many family members and friends feel discouraged and exhausted.

Thankfully there is a myriad of resources for you as well, from support groups and meetings to group and individual counseling. Not only is it possible to get treatment for your loved one, but you can also get the much-needed additional support for you through this difficult journey.

Codeine Addiction FAQs

How is codeine abused?

Codeine can be abused in several ways. Codeine tablets are swallowed or dissolved in water, crushed, or snorted. Codeine addicts sometimes mix codeine with juice, soda, or alcohol (aka “lean” or “purple drank”).

How does codeine work?

Codeine is an opiate painkiller that blocks pain signals from traveling through the central nervous system and alerting the brain.

Is codeine less dangerous than other opioids?

No, not really. Up until recently, healthcare professionals often viewed codeine as a less dangerous opioid due to its milder potency. However, a 2016 study published by the National Institutes of Health (NIH) examined the impact of codeine compared to that of a stronger opioid, morphine.

The study concluded that both opioids posed the same risks for developing substance abuse disorder and opioid addiction, and therefore codeine was no less dangerous than similar analgesics.

Reviewed by:Kent S. Hoffman, D.O.

Chief Medical Officer

  • Fact-Checked
  • Editor

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is Co-Founder and Chief Medical Officer of Addiction Guide and ensures the quality of our website’s content and messaging.

Written by:

Content Manager

Jessica Miller is a USF graduate with a Bachelor’s Degree in English. She has written professionally for over a decade, from HR scripts and employee training to business marketing and company branding. In addition to writing, Jessica spent time in the healthcare sector (HR) and as a high school teacher. She has personally experienced the pitfalls of addiction and is delighted to bring her knowledge and writing skills together to support our mission. Jessica lives in St. Petersburg, FL with her husband and two dogs.

7 references
  1. Livingstone, M. J., Groenewald, C. B., Rabbitts, J. A., & Palermo, T. M. (2017). Codeine use among children in the United States: a nationally representative study from 1996 to 2013. Paediatric anesthesia, 27(1), 19–27. Retrieved November 26, 2021, from https://doi.org/10.1111/pan.13033
  2. Opioids. (2021, November 1). National Institute on Drug Abuse. Retrieved November 26, 2021, from https://www.drugabuse.gov/drug-topics/opioids
  3. NHS website. (2021a, November 18). Codeine. Nhs. Uk. Retrieved November 26, 2021, from https://www.nhs.uk/medicines/codeine/
  4. Use of Codeine, Oxycodone, and Other Opioids: Information for Employees | U.S. Equal Employment Opportunity Commission. (2020, August 5). U.S. Equal Employment Opportunity Commission. Retrieved November 26, 2021, from https://www.eeoc.gov/laws/guidance/use-codeine-oxycodone-and-other-opioids-information-employees
  5. Codeine - Alcohol and Drug Foundation. (2021, November 10). Alcohol and Drug Foundation. Retrieved November 26, 2021, from https://adf.org.au/drug-facts/codeine/
  6. National Institute on Drug Abuse. (2021, July 1). Opioid overdose crisis. National Institute on Drug Abuse. Retrieved December 13, 2021, from https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
  7. U.S. National Library of Medicine. (n.d.). "weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: No less risky than morphine. Prescrire international. Retrieved December 13, 2021, from https://pubmed.ncbi.nlm.nih.gov/27042732

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