Codeine is an opioid medication that may be prescribed to treat mild to moderately severe pain and to reduce coughing.1 Codeine can have a potential for misuse or even codeine addiction, in part because of its euphoric or pleasurable effects, in addition to its ability to manage pain.2
If you use codeine, or you know someone who does, you should understand what you are taking and be aware of its potential for misuse. This article will cover:
- Warnings and precautions for codeine.
- Possible signs of codeine addiction.
- The effects of codeine addiction.
- Codeine withdrawal.
- Codeine overdose.
- The dangers of mixing codeine with alcohol or other drugs.
- How to find a codeine addiction treatment center.
What is Codeine?
Codeine is one of the most commonly used opioid pain medications.3 Along with morphine, it is one of several naturally occurring opiate alkaloid substances found in the opium poppy plant.4 Codeine is approved by the U.S. Food and Drug Administration (FDA) and is commonly prescribed to treat mild to moderately severe pain. It is also used in some prescription cough medicine preparations and off-label to manage restless leg syndrome and diarrhea.1, 3
Codeine is available as a single-ingredient medication, but it is also sometimes found in combination medications that contain acetaminophen or aspirin.1 People can take codeine in tablet, capsule, and liquid forms.5 People sometimes misuse codeine by mixing it with soda and flavorings.5
Several codeine formulations are categorized as Schedule II substances by the Controlled Substances Act, which means they have a high potential for misuse and may cause psychological or physiological dependence.4
However, products that contain less than 90mg of codeine per dosage unit (such as Tylenol with codeine) are Schedule III substances, meaning they have a low to moderate potential for misuse and dependence.7
Products such as cough preparations that contain less than 200 milligrams of codeine per 100 milliliters, such as Robitussin AC, are Schedule V substances, meaning they have a relatively lower potential for misuse.7
According to the 2020 National Survey on Drug Use and Health (which does not provide specific statistics on the codeine addiction rate), out of 3.3% of the population who misused prescription pain relievers in the past year, 0.9% misused codeine painkillers.8
Warnings and Precautions for Codeine
People who use codeine or products that contain codeine should be aware of the potential risks and precautions of using the drug. Codeine can be misused, lead to dependence, or to codeine drug addiction.9
Due to the compounded risks of certain opioid side effects, codeine should not be used in people who:9
- Have significant respiratory depression.
- Have acute or severe bronchial asthma (if they cannot be monitored during use).
- Have a known or suspected gastrointestinal obstruction, including paralytic ileus.
Is Codeine Addictive?
Yes, codeine can be addictive.9, 10 Opioids like codeine can produce a rewarding euphoria in addition to pain relief, which can reinforce their misuse.2
Opioids work by activating opioid receptors that are located in your brain and throughout your body.11 Activating opioid receptors in this manner results in a modification of pain, but it is also associated with an increase in dopamine activity.11 Dopamine activity is thought to influence the reward associated with such drug use. In connection with opioid use, increased levels of dopamine can reinforce the desire to use the drug and repeat the experience.11
Repeated misuse of codeine can increase the risk of developing significant physiological dependence and, eventually, addiction.2 Addiction is a chronic brain disease characterized by compulsive substance use despite the negative consequences.2, 11
Signs of Codeine Addiction
Codeine addiction may be diagnosed as an opioid use disorder (OUD). Doctors and qualified health professionals use criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose OUD.12
To receive a diagnosis of OUD, a person must meet at least 2 of the following opioid addiction signs within the past 12 months, which include:12
- Using opioids in higher doses or more often than you intended.
- Being unable to cut back or stop your opioid use.
- Spending a lot of time obtaining, using, and recovering from the effects of opioids.
- Experiencing cravings.
- Being unable to meet obligations at work, home, or school due to opioid use.
- Continuing to use opioids despite having social or interpersonal problems that are caused or worsened by opioid use.
- Using opioids despite knowing that you have an ongoing physical or mental health problem that is probably due to opioid use.
- Giving up activities you once enjoyed so you can use opioids.
- Using opioids in situations where it is hazardous to do so (such as while driving or operating machinery).
- Experiencing tolerance, which means you need more opioids to achieve previous effects.
- Developing withdrawal symptoms when you stop using opioids.
What are the Effects of Codeine Use?
As with other opioids, you can experience various side effects from using codeine.
Common unwanted short-term side effects include:9
- Shortness of breath.
Potential long-term health effects can include:
- A cumulatively increased risk of overdose.5
- Increased risk of addiction development.5
- Hypogonadism (decreased production of sex hormones), which can cause symptoms such as decreased libido, fatigue, or sexual dysfunction.3
- Chronic constipation and related GI complications including an increased risk of bowel obstruction.9
- Adrenal insufficiency (when your adrenal glands stop making enough of certain hormones).9
Withdrawal can occur in people who become dependent on codeine. Though opioid withdrawal is not the exact same thing as opioid addiction, it is a common element of many opioid addictions.11 When physiological dependence develops, you may experience unpleasant withdrawal symptoms when you suddenly quit or cut down your use.12
Common withdrawal symptoms include:
- Dysphoria (a sense of unease/unhappiness).12
- Teary eyes.12
- Runny nose.12
- Muscle and/or bone pain.11
- Difficulty sleeping.11
- Diarrhea and vomiting.11
- Cold flashes with goosebumps.11
- Uncontrollable leg movements.11
- Severe cravings.11
Though opioid withdrawal is not generally medically dangerous, the symptoms can be very uncomfortable and distressing.13 In some cases, there may be some additional risks associated with withdrawal from opioids, such as:
- Severe gastrointestinal symptoms that can cause dehydration.13
- Worsening of underlying cardiac illness.13
- A worsening of anxiety disorders and panic.13
- Uncontrolled pain.13
- Risk of suicide.9
The onset, severity, and full duration of acute opioid withdrawal symptoms can depend on the specific type of opioid being used.12 When physical dependence builds to a short-acting drug such as codeine, withdrawal symptoms may begin as soon as 6 to 12 hours after your last use, peak in severity at 1 to 3 days, and gradually resolve over 5 to 7 days.12
The Substance Abuse and Mental Health Services Administration (SAMHSA) states that hospitalization or another form of supervised 24-hour care will be the preferred setting for medical detox and opioid withdrawal management due to the risk of suffering and safety concerns.13
Overdose means that a person has taken enough codeine or used it in combination with substances like alcohol or sedatives to the point where critical life functions (breathing, heart rate, and body temperature) stop functioning, which can lead to death.15
Potential signs of opioid overdose include:16
- Small, pinpoint pupils.
- Loss of consciousness.
- Slow, shallow breathing.
- Choking or gurgling sounds.
- Limp body.
- Pale, blue, or cold skin.
Never leave a person who you think has overdosed alone. If you suspect an overdose, you should follow these steps:16
- Call 911 right away.
- Administer naloxone if available.
- Ensure that the person stays awake and keeps breathing.
- Place them on their side in order to prevent choking.
- Stay with the person until emergency personnel arrives.
According to the Centers for Disease Control and Prevention, an average of 38 people died each day in 2019 due to overdose on prescription opioids.17
Codeine Mixed with Alcohol or Other Drugs
Polysubstance use means using two or more substances at the same time or within a short time–it can occur intentionally or unintentionally.18 Polysubstance use, especially using depressants like alcohol, other opioids, or benzodiazepines, can be hazardous with prescription opioids like codeine due to the increased risk of overdose, dangerously slowed breathing, associated damage to your brain and other organs, and death.18
Older adults, especially those who take multiple prescriptions, may be at additional risk because they may experience changes in the way their bodies metabolize the drug or otherwise be more sensitive to codeine’s effects.9
Codeine Addiction Treatment Programs
Codeine addiction is treatable, and help is available from professionals who know how to treat codeine or other opioid addiction. Codeine addiction treatment should be personalized based on your unique needs, which can include any medical, psychological, social, vocational, and legal problems you may have.19
Common types of programs for rehab can include:
- Detoxification, which is often the first step in the recovery process. It involves a set of interventions designed to help you safely and comfortably withdraw from the substance and become medically stable, preparing you for further treatment.20
- Inpatient addiction treatment, which means you live onsite at a treatment facility, receive 24/7 care and support and participate in different therapies.20
- Outpatient addiction treatment, which means you live at home and travel on a set schedule to a treatment facility where you’ll receive support and participate in therapy for several hours throughout the week.20
Medications can be an important part of opioid addiction recovery. Common medications used during detox and/or maintenance at a codeine addiction treatment program can include:
- Methadone, which manages withdrawal symptoms and reduces cravings.14 It can be used as a part of a long-term maintenance program.21
- Buprenorphine, which also reduces withdrawal symptoms and cravings; because it is a partial opioid agonist, it may have a relatively greater margin of safety regarding respiratory depression and a reduced likelihood of misuse.22 It can also be used during long-term maintenance.20
- Clonidine, which can relieve many opioid withdrawal symptoms.14
- Lofexidine, which is a non-opioid medication that can minimize withdrawal symptoms.23
Medications are often combined with behavioral therapies in a comprehensive addiction treatment program.19 Therapies can include:
- Contingency management (CM), which uses principles of positive reinforcement to promote behavioral change. You may receive vouchers to exchange for tangible goods if you achieve the desired outcome, such as a negative drug test.24
- Family or couples therapy, which can help people work through issues that are the result of or impacted by substance use or addiction.22
- Cognitive-behavioral therapy (CBT), which helps people make healthier choices and teaches ways to implement changes to the thoughts and behaviors that contributed to the addiction.22
If you are struggling with codeine or another substance misuse, American Addiction Centers (AAC) is ready to help you find the treatment you need. Our compassionate team of admissions navigators is available 24/7 at to listen and explain treatment options. Call today to get support and check your insurance for one of our top-rated facilities across the U.S.