How To Taper off Codeine

A medically guided codeine taper can help you end codeine use without experiencing uncomfortable withdrawal symptoms. 

When someone with a codeine dependence stops taking codeine, they’ll experience uncomfortable withdrawal symptoms and cravings. These symptoms can be treated through a medical detox program, but many people have also found success through a medically supervised codeine taper. This involves slowly reducing the dose of codeine over time, which lessens or prevents withdrawal symptoms from occurring. This overview covers how a codeine taper works, why it’s effective and how to find treatment for codeine addiction.

What Is Codeine?

Codeine is an opioid medication commonly used to treat pain or suppress a cough. The drug breaks down into morphine within the central nervous system, and effective, timely pain relief occurs just moments later. Codeine is generally only 15% as potent as morphine, which is also less potent than oxycodone, hydrocodone and fentanyl.

When someone regularly uses opioids like codeine, their body can build a tolerance to the drug. When this occurs, they must use larger amounts of the drug to feel the same effects. Tolerance can easily lead to dependence, which is when the body needs the drug to function.

Codeine dependence and tolerance may lead people to stronger but more dangerous opioids to feel the same effects that codeine used to provide. Codeine tapers help wean the person off the drug so they can enter recovery instead.

How to Taper off Opiates

A codeine taper should ideally take place with the help of medical professionals, as attempting to taper codeine alone can increase your risk of complications and relapse.

Codeine tapers call for a steady dose reduction over time to prevent withdrawal symptoms. The amount reduced can vary based on the person. Overall, the longer the individual used codeine, the longer the taper should be. 

Opiate tapers occur at different rates depending on an individual’s needs and can include:

• Slowest taper: Reduction of opiate use by 2–10% every one or two months for several years
• Slow taper: Reduction of opiate use by 5–20% each month 
• Fast taper: Reduction of opiate use by 10–20% each week 
• Fastest taper: Reduction of opiate use by 10–20% daily. This method should only be used by those who have been using short-acting opiates for a short time. 

Why Opioid Tapering or Weaning off Opioids?

A taper can be very helpful when you wean off an opioid and help set you up for success in recovery. There are three key reasons a person may want to use a taper to end codeine use that includes:

1. Avoiding withdrawal: Because the codeine dose is gradually and gently reduced, the risk of withdrawal is minimized. Even patients with severe dependence can avoid or lessen the extent of withdrawal by slowly tapering off codeine.
2. Gradual healing: Tapers allow the body to do what it does best — heal itself physically and mentally and then continue to push onward.
3. Effectiveness: Tapers are designed to work on a schedule outlined by a physician, helping ease your body off codeine and minimize cravings. This puts you in a position to succeed in terms of long-term recovery.

Types of Codeine Opioids Tapering Methods

A few different kinds of tapering methods exist. However, only two tapering strategies — direct and substitute tapering — are recommended. Another tapering type, titration tapering, can be problematic and dangerous.

Direct Tapering

In a direct taper, you slowly decrease your codeine dose until you are off the medication. However, because codeine is often dosed multiple times daily, it can be inconvenient to take small amounts throughout the day repeatedly.

Substitute Tapering

In substitute tapering, codeine is exchanged for a different, longer-acting opioid to ensure a steady amount of opioid in your body to avoid withdrawal symptoms. This strategy is sometimes called medication-assisted treatment (MAT), a substitute tapering recommended by opioid addiction experts. MAT often involves buprenorphine or methadone.

Titration Tapering

Titration tapering is not recommended. In a titration taper, you dissolve codeine in water and try taking progressively smaller amounts to taper yourself off. However, a major safety concern is that codeine does not completely dissolve in water, making it difficult to judge your dose.

Why Consider Tapering vs. Stop Codeine Cold Turkey

If a person attempts to quit codeine cold turkey, they’ll likely go through uncomfortable, unrelenting withdrawal symptoms that can last several weeks. Side effects they may experience include:

• Flu-like symptoms: Excessive sweat, mucus or tears are common during a codeine withdrawal.
• Nausea: Vomiting or dry heaving may amplify flu-like symptoms.
• Insomnia: Sleep may not come easy at the onset of withdrawal.
• Cramps: Abdominal pain, spasms and bouts of constipation or diarrhea are common.
• Muscle aches: Muscles all over the body may exhibit abnormal or painful behavior.
• Psychological symptoms: The person may have intense feelings of anxiety, panic and even depression. These symptoms are often a sign that codeine withdrawal is nearly over.

In contrast, a taper is designed to help you avoid such withdrawal symptoms, making for an easier recovery from codeine.

Common Opioids Withdrawal Symptoms

If a person attempts to quit codeine cold turkey, they’ll likely go through uncomfortable, unrelenting withdrawal symptoms that can potentially last for several weeks. Withdrawal symptoms they may experience include:

• Flu-like symptoms: Excessive sweat, mucus or tears are common during a codeine withdrawal.
• Nausea: Vomiting or dry heaving may amplify flu-like symptoms.
• Insomnia: Sleep may not come easy at the onset of withdrawal.
• Cramps: Abdominal pain, spasms and bouts of constipation or diarrhea are common.
• Muscle aches: Muscles all over the body may exhibit abnormal or painful behavior.
• Psychological symptoms: The person may have intense feelings of anxiety, panic and even depression. These symptoms are often a sign that codeine withdrawal is nearly over.

Side Effects of Opioid Tapering

When your codeine is correctly tapered using a direct or substitute taper, there should be few, if any, side effects. If the taper causes side effects, this is a sign that that taper may be moving too quickly and need to be slowed or paused. If you are tapering codeine and experience side effects, discuss them with your doctor.

Opioids Withdrawal Timeline

Codeine is a short-acting opioid that typically has the following general timeline for withdrawal symptoms:

• Withdrawal symptoms start: within 12 hours of the last codeine dose
• Withdrawal symptoms peak: within 24–48 hours of the last codeine dose
• Withdrawal symptoms resolve: within three to five days of the last codeine dose

Although most withdrawal symptoms will improve after three to five days, a person can sometimes experience protracted withdrawal. In protracted withdrawal, withdrawal symptoms like anxiety, insomnia and low mood linger for a few weeks to months after the last codeine dose. 

Medications Used When Tapering off Opioids

Medications are often prescribed to help taper your codeine as part of a medication-assisted treatment (MAT) plan. In MAT, medications can ease withdrawal symptoms, preventing relapse. 

Methadone

Experts consider methadone a first-choice option for a substitute taper from strong opioids. The opioid is first converted to methadone, which may then be slowly tapered. That said, because codeine is a relatively weak opioid, methadone is unlikely to be prescribed for a codeine taper.

Buprenorphine (Suboxone, Sublocade)

Buprenorphine is an alternative to methadone and is another first-choice opioid for opioid withdrawal symptoms. Buprenorphine comes in many different dosage forms, including oral Suboxone, a combination medication with naloxone, and injectable Sublocade. However, because codeine is a relatively weak opioid, buprenorphine is unlikely to be prescribed for a codeine taper.

Naltrexone (Vivitrol)

Naltrexone is an opioid blocker. Because of this, naltrexone is rarely used during tapering because it can cause worsened withdrawal symptoms. That said, after your taper is complete, your doctor may prescribe naltrexone to help you avoid relapse. Although not a first-choice drug, naltrexone is available for those who need an alternative medication to methadone and buprenorphine.

Narcan (Naloxone)

Like naltrexone, naloxone is an opioid blocker rarely used during tapering. That said, naloxone is a component of Suboxone, which is prescribed for opioid withdrawal symptoms. Your doctor may also prescribe naloxone after your taper is complete to help you avoid an overdose if you slip up and take an opioid.

How Long Does It Take to Taper off Opioids?

No one-size-fits-all estimate exists for how long an opioid taper takes. For many people, an opioid taper can last a few days to a week; however, some people may require a longer taper. The length of a taper heavily depends on:

• The opioid dose you take
• Any other medications you take
• Any co-occurring mental or physical health conditions 

How The Recovery Village Uses Opioid Tapering

The Recovery Village supports codeine tapering and may use MAT regimens like buprenorphine as medically appropriate. In our medical detox facility, we can slowly wean you off codeine while minimizing side effects. This puts you in a position to fully recover as you continue your recovery path through rehab. Don’t wait: contact us today to learn more.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more