Codeine Addiction and Abuse - Signs, Symptoms, Treatment

Codeine is a prescription opioid painkiller used to treat moderate pain. Most people will use it the way their doctors have prescribed it, however, some people misuse it. An opioid crisis was announced by the Department of Health and Human Services in 2017 as a result of increasing opioid-related deaths. This is due to pharmaceutical companies aggressively marketing opioids in the 1990s. Painkiller addiction involving codeine can also lead to misuse of more potent opioids.

If you are wondering whether you or a loved one has a substance use disorder you may find it helpful to understand more about codeine abuse and addiction. Recognizing the signs and symptoms of codeine addiction could help you accept when you need to seek support. In this blog post, we discuss these signs and symptoms as well as the addiction treatment process.

What is Codeine?

Codeine is an opioid painkiller that is used to relieve pain, for example after an operation or injury. It is also used for ongoing pain when weaker painkillers do not work, and sometimes to treat diarrhea. It works by blocking pain signals in the central nervous system and reducing stress caused by pain. While more potent opioids such as morphine or fentanyl treat severe pain, codeine use is for moderate pain.

How the US government classifies codeine depends on the quantity of the substance in the specific drug:

  • Schedule III: Products with less than ninety milligrams per dosage. These have moderate to low potential for causing physical and psychological dependence to occur.
  • Schedule V: Products with less than two hundred milligrams per one hundred milliliters such as cough syrups. Out of all scheduled drugs, these have the lowest potential for causing dependence.

When codeine is mixed with other substances in low quantities it may be sold as an over-the-counter medication. A common mix is codeine with acetaminophen, which is sold under the brand name Tylenol 3.

Codeine Addiction and Abuse

Although codeine is classed as one of the least dangerous drugs, codeine use can still lead to an opioid use disorder. This can develop by taking pills or cough syrup. 9.30 million people over twelve years old misused prescription painkillers in the last year according to the 2020 National Survey on Drug Use and Health (NSDUH). Codeine was the third most misused painkiller after hydrocodone and oxycodone.

Your tolerance will build as you take it, so you need more to get the same effects. If you start to take it differently than prescribed, either at higher or more frequent doses, your risks of developing dependence increase due to this heavier and unmonitored use.

Codeine dependency develops because your brain changes in response to the drug. Your brain is good at creating balance when there are changes. So, if you chemically change the balance in your brain, it will adapt to this. Dependence is when this change has occurred, meaning you can no longer function normally without the drug. When you stop taking it you will experience unpleasant withdrawal symptoms due to upsetting the new balance.

Codeine addiction is usually close behind dependency. According to The National Institute on Drug Abuse, addiction is a brain disease that causes you to compulsively seek out and take the drug to which you are addicted. When this happens you have lost control over your codeine use. Formal health care treatment can be vital in managing codeine misuse.

Abusing Prescribed Codeine

When using illicit drugs, any usage is defined as misuse since it is illegal to buy and consume the product. However, misuse of prescription drugs is defined differently as there are legal ways to take them. Codeine misuse occurs when you take it in a way that is not prescribed, such as:

  • More frequent doses
  • Higher doses
  • Someone else's prescription
  • Illicitly bought codeine
  • Administered in a different way e.g., snorting or injecting yourself

People who abuse codeine will often take the drug in a way that is not prescribed. This includes crushing tablets and snorting them or mixing cough syrup with soft drinks to make what is sometimes known as Purple Drank. Common street names for codeine include Lean, Cody, Schoolboy, Sizzurp, and T-threes.

Risk Factors for Addiction

Addiction risk depends on multiple factors that make it difficult to compare why some people have developed an addiction and others have not. Risk factors include:

  • Genetics – up to fifty percent of addiction risk is due to genetics
  • Exposure to drugs in your family or friend circles
  • Family history of addiction – such as parental prescription opioid abuse
  • Childhood neglect or other childhood abuse
  • Previous substance abuse problem – a codeine addiction can develop more easily if you already have an addiction to a different substance; it can also contribute to the development of another addiction
  • Mental health problems – it is common to have co-occurring disorders as some people use drugs or alcohol to self-medicate untreated mental health disorders

You should never judge someone for having developed an addiction. You may not understand the reasons they are using drugs and the specific risk factors that affect them. Judging those with codeine addiction feeds into the stigma which surrounds addiction and which acts as a barrier to treatment.

Signs of Codeine Misuse

Using codeine causes physical and psychological effects. It may be difficult to recognize if you or a loved one is misusing codeine if you or they have a prescription, because you may experience these side effects as part of normal codeine use. Understanding these symptoms can help you recognize if you or they are experiencing more severe symptoms as a result of misuse. They may also help you recognize if a loved one who does not have a codeine prescription is using it. Strong psychological or emotional responses to running out of codeine can also be a sign of codeine addiction.

Physical Symptoms

  • Constipation
  • Nausea
  • Sleepiness
  • Dizziness and vertigo
  • Dry mouth
  • Headaches
  • Itchiness

Psychological Symptoms

  • Euphoria
  • Relaxation
  • Confusion
  • Apathy
  • Drowsiness
  • Anxiety

Severe side effects include muscle stiffness, agitation, hallucinations, and fever. Anyone who is prescribed codeine is advised to contact their doctor if they experience these symptoms.

Long-Term Effects of Opioid Abuse

With long-term codeine use, you risk additional adverse health effects. These include:

  • Severe depression
  • Liver failure
  • Brain damage
  • Heart and lung failure
  • Chronic nausea and vomiting
  • Persistent insomnia

Signs of Codeine Addiction

If someone is misusing codeine, behavioral symptoms of addiction may be an easier way to recognize it. Symptoms of addiction include:

  • Secretiveness
  • Performing poorly at work or school
  • Increasing doses to get the same effect
  • Trying to quit and not managing
  • Obsession with getting the next dose
  • Stealing money to buy codeine or the drug itself
  • Losing interest in hobbies
  • Failing to meet responsibilities
  • Losing control over dosage and frequency of use
  • Withdrawing from family members and friends
  • Neglecting hygiene
  • Partaking in risky behaviors such as driving under the influence, mixing codeine with other drugs, or unprotected sex
  • Going to multiple doctors for prescriptions

Codeine Overdose

When you take codeine, there is the risk of overdosing. If you can recognize the signs of an overdose this can help someone get medical support with time to protect their life. Overdose symptoms include:

  • Cold and clammy skin
  • Lowered blood pressure
  • Abnormal breathing such as irregular or shallow breathing, which can lead to breathing stopping completely
  • Vomiting
  • Pale or blue lips and fingertips
  • Pain in upper stomach

If you see someone experiencing these symptoms you should call 911 immediately. If the person is unconscious you should put them in the recovery position to prevent them from choking if they vomit. Once the emergency team arrives the person may receive naloxone, a medication that quickly reverses the effects of an opioid overdose.

Using codeine combined with other substances increases the risk of overdosing. For example, if you mix it with other depressants such as alcohol, benzodiazepines, or other opioids this could lead to your breathing slowing down and even stopping. Codeine combined with acetaminophen, also known as co-codamol can have fatal side effects such as kidney and liver failure.

Illegal prescription opioid sales also increase the risk of overdose as it is impossible to know whether codeine has been mixed with other substances. Fentanyl is found in an increasing number of pills. This is an extremely powerful opioid that is about fifty times more potent than heroin. Just two milligrams of fentanyl can cause an overdose.

Codeine Addiction Treatment

When you seek formal addiction treatment support, the first thing you will do is undergo detox. Detoxing is when you stop taking the substance on which you are dependent and allow the toxic compounds to leave your body. At this point, you will experience withdrawal symptoms.

Tapering vs Cold Turkey

There are two main types of detox, tapering and cold turkey. Tapering is where you reduce the amount of drug you are taking slowly until you are no longer having any. You may also take a substitute drug. In the case of codeine addiction, this will usually be methadone and/or buprenorphine. These drugs also act on opioid receptors, so you do not experience such intense withdrawal symptoms and cravings.

Cold turkey is where you stop taking the drug altogether without tapering. This is not generally recommended as it does not allow for the management of withdrawal symptoms.

Online, some people suggest alternative methods to help with the detox process such as essential oils, acupuncture, exercise, and yoga. However, since codeine withdrawal can be very unpleasant you should always do these in combination with recognized practices and under the supervision of a medical professional.

Codeine Withdrawal Symptoms

Codeine withdrawal symptoms' severity and length vary depending on the person. Factors that affect this include the length of use, dosage, age, health condition, mental health, social support, level of tolerance, and whether the person tapers or quits cold turkey.

Physical Withdrawal Symptoms

  • Sweating and runny nose
  • Problems sleeping
  • Nausea
  • Abdominal cramps and diarrhea
  • Tremors and muscle spasms

Psychological Withdrawal Symptoms

  • Anxiety
  • Restlessness

Codeine Withdrawal Timeline

Days one to two – Codeine is a relatively short-acting opioid which means that withdrawal symptoms will start quite quickly after your last dose, as soon as eight to twenty-four hours. Common initial symptoms include muscle and bone aches, shakiness, nausea, and flu-like symptoms. Cravings are likely to be most intense at this point.

Days three to five – This is normally the peak of symptoms, however, if you were a mild user you may already see a decrease in symptoms from days three to four. Common symptoms include difficulty sleeping, headaches, appetite loss, shakiness, and lack of motivation.

Day six and onwards – Most people's symptoms will stop by day six. Though some people will continue to experience psychological symptoms such as cravings, mood swings, fatigue, and insomnia. If these symptoms continue well beyond what is normal this is known as protracted withdrawal.

Inpatient vs Outpatient Treatment

You may undergo detox either as an inpatient or outpatient. With the former, you will receive twenty-four-hour medical supervision to make sure you are as comfortable as possible. Medical professionals such as nurses, doctors, and psychologists will be available so that both physical and psychological symptoms can be managed. Inpatient treatment is advised for those who experience severe withdrawal symptoms or who live in a setting that makes quitting very difficult.

While codeine withdrawal is rarely medically dangerous it can be very uncomfortable and some people will find it difficult to stay sober due to this. Medical complications may also arise if you have underlying health problems such as a heart condition. It is important to speak with a medical professional before you quit so that you can discuss what is best for you.

Outpatient addiction treatment programs may suit those that have responsibilities which they cannot take a break from. In outpatient treatment, you will still go to the treatment center during the day, but you will be able to maintain your job and social responsibilities and sleep at home. Usually, you will have more sessions at the beginning of detox to make sure that you are managing, and with time you will go to the center less frequently.


Detox is only the start of the recovery process. Once you have completed it you should continue to receive support and treatment advice. Aftercare will usually include therapy. Therapy such as cognitive behavioral therapy and other talking therapies can help you to come to terms with why you have been using drugs.

It is important to get to the roots of the problem (such as mental health problems or trauma) because if you do not deal with these you are more likely to relapse. Therapy can also help you to navigate other relapse triggers such as stress, environments you used to take in, and people you used to take with.

You may also join support groups such as those that follow the twelve-step approach. Having structure in your life is important to recovery. Twelve-step programs, such as that offered at Vita Recovery, help you to develop structure while also helping with many other aspects of your addiction. You will come to terms with your past, accepting responsibility for your actions.

Join Us Today

Admitting you need substance misuse treatment and seeking it out can be extremely difficult. At Vita Recovery we are here to help you on your addiction treatment journey. We offer flexible programs to suit your individual needs. You may take part in our inpatient program or our intensive outpatient program.

We even offer the option to change your program depending on your progress. We understand that opioid addiction affects all those around the individual who is suffering and therefore we also offer support for family members.

If you would like more treatment or recovery information or if you are ready to get support today, please visit our website or call us at (786) 551-4944. We would love to welcome you to our community. With us, your treatment and retention outcomes have the chance to be bright!

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