Codeine Addiction

Because codeine can be prescribed by a doctor, many people think it’s harmless. However, codeine misuse or long-term use can lead to a dependence and addiction.

Codeine, a prescription opioid pain-reliever, is at the heart of the opioid crisis in the United States. Codeine is typically safe to take as long as it’s prescribed for short-term use and not in large doses. While many people benefit from using codeine to manage pain, it is frequently misused and can become addictive.

In the 2019 National Survey on Drug Use and Health, an estimated 1.6 million people age 12 or older had opioid use disorder. Only 22% got their drugs from a doctor. In all, 10.1 million Americans engaged in misused opioids in 2019; the majority were prescription pain relievers.

It’s important to be aware of the codeine’s potential dangers. If a codeine addiction develops, The Recovery Village can help you or a loved one manage the codeine use disorder and move toward an addiction-free life.

What Is Codeine?

Doctors prescribe codeine to help manage pain and suppress coughing. Codeine is technically considered an opiate, not an opioid, although the two terms are sometimes used interchangeably. Opiates are naturally derived from the poppy plant, while opioids are semi-synthetic or fully synthetic substances that provide people with the same effects as opiates.

Codeine can appear and be taken in tablet, capsule, or liquid form and can be swallowed or injected. People with a prescription for codeine or medication that includes codeine should take it as directed.

Low doses of the drug are available for over-the-counter purchase in some parts of the United States. The opioid is an ingredient in some variations of Tylenol. Codeine also is a major ingredient in various cough syrups, including:

• Robitussin AC
• Phenergan Codeine
• Fioricet with codeine

Codeine Side Effects

Codeine affects the way the brain and nervous system respond to pain and coughing. Codeine changes into morphine when it enters a person’s brain and binds to the central nervous system’s opioid receptors, leading to pain relief.

Like many opioids and opiates, the feel-good effects of the drug are what often lead to addiction — people who take codeine can experience a euphoric high similar to heroin.

Examples of codeine side effects can include:

• Feeling dizzy or drowsy
• Nausea, vomiting, or stomach pain
• Constipation
• Sweating
• Itching
• Urination problems
• Seizures
• Feeling extreme happiness or sadness
• Slow heart rate, weak pulse, fainting, or shallow breathing
• Confusion, agitation, hallucinations, or unusual thoughts or behaviors

Codeine Regulations

For many years, codeine-based medications were available over the counter, but many countries have made changes to their laws to curb codeine misuse and addiction.

In the United States, codeine is regulated under the Controlled Substances Act, which is the federal drug policy that classifies different drugs and allows the Drug Enforcement Administration (DEA) to manage their accessibility to the public.

Codeine can exist in many forms and as part of many types of medications, and each classification can bring different regulations. A Schedule I controlled substance has no accepted medical use and a high potential for abuse. Examples include heroin, MDMA and peyote. In contrast, Schedule II through V controlled substances have a lower potential for abuse and accepted medical usage. Codeine is:

• A Schedule II controlled substance, when packaged by itself in a solid oral formulation
• A Schedule III medication when combined with other active ingredients, in oral formulation, and not more than 90 mg of codeine per dosage unit.
• A Schedule V controlled substance when combined with other active ingredients and not more than 200 mg codeine per 100 mL or per 100 grams. Cough syrups with codeine are Schedule V.

Some states have stricter classifications for codeine products. For example,  Minnesota has reclassified codeine cough syrup products as Schedule III.

Codeine Street Names

There are many codeine nicknames that people should be aware of when determining if a friend or a family member suffers from codeine addiction. Some of the most common street names for the drug include:

• Captain cody
• Cody
• Little c
• Schoolboy
• Dors
• Fours
• Texas tea
• Purple drank
• Sizzurp

Codeine and Alcohol

People should never mix codeine, or any narcotic medication, with alcohol. This combination can cause fatal side effects. Additionally, people who take codeine should avoid driving a vehicle or operating machinery due to potential effects, such as impaired thinking or reaction.

Is Codeine Addictive?

Since codeine can be obtained through a doctor’s prescription, some people might believe that it’s a harmless drug and can be taken regularly with no consequences. This is not true: codeine can be addictive if misused or taken for long periods.

As a prescription medication, many people begin taking codeine in small doses with little risk of addiction. They may only receive a short-term prescription and finish that prescription without becoming addicted. In higher doses, codeine is much more potent and highly addictive. Taking codeine in any way other than prescribed, including recreationally, is also codeine abuse and has a greater risk of addiction.

However, you can take codeine exactly as directed and still become addicted. As with any opioid, a tolerance can develop over time, where the body becomes used to the drug’s presence and needs more to get the same effects. If someone takes codeine consistently over a long period or in high doses, their body can also develop a physical dependence, where they experience withdrawal symptoms if they stop using codeine.

Codeine Withdrawal

When codeine withdrawal symptoms appear, this is a sign that someone is addicted to codeine and should seek treatment. Withdrawal symptoms can include:

• Agitation
• Insomnia
• Runny nose
• Sweating
• Yawning
• Increased tearing
• Muscle aches
• Anxiety

Late symptoms of withdrawal are usually more uncomfortable, including:

• Goosebumps
• Nausea and vomiting
• Diarrhea
• Dilated pupils
• Abdominal pain

Codeine Addiction Treatment

Codeine addiction treatment varies in length of time. The length of treatment is dependent on the severity of the person’s substance use disorder. If someone is suffering from a minor dependence on the drug, certain levels of care might not be necessary during rehabilitation. However, some people are severely addicted and in danger of injury or death. These severe cases require a more intensive treatment plan to properly begin recovery.

The Recovery Village has an experienced team ready to answer any questions people might have about codeine addiction, how addictive codeine is, and whether they are addicted based on the side effects they may be experiencing. If a substance use disorder has formed, rehab treatment can help you enter recovery.

Codeine Addiction Facts and Addiction Rate

In the past few years, more people have become addicted to codeine and similar opioids. According to the American Society of Addiction Medicine, 276,000 adolescents were recreational users of pain-relief medication in 2015, and 122,000 have an addiction to prescription pain relief medicines like codeine. Additionally, the prescription rates for opioids among adolescents and young adults almost doubled from 1994–2007. The publication also reports that women are more likely to be prescribed pain-relief medicines like codeine because they are more likely to suffer from chronic pain. Around 48,000 women died from prescription pain-relief overdoses between 1999 and 2010.

In 2017, the Centers for Disease Control and Prevention reported that over 70,000 Americans died from drug overdose, including prescription opioids.

Editor – Melissa Carmona

Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP

Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more