Codeine Addiction & Treatment: Effects, Signs, & Symptoms
Last Updated: November 27, 2023
Codeine is an opioid that is available on its own as well as in combination with other substances. Although rap, hip-hop and social media may glamorize codeine, this substance is a dangerous drug that can lead to abuse, addiction and overdose. Fortunately, treatment is available to help you overcome a codeine addiction.
What is Codeine?
Codeine is an opioid that is available on its own in tablet form. It is FDA-approved for pain and is a Schedule II controlled substance, meaning that it has a high risk of abuse, dependence and addiction. However, codeine is commonly prescribed as a combination agent with other drugs. These include:
Codeine and acetaminophen
Codeine with butalbital, aspirin and caffeine
This combination is a capsule and Schedule III drug that is FDA-approved for headaches. The drug is sold under the brand names Ascomp-Codeine and Fiorinal/Codeine #3.
Codeine with butalbital, acetaminophen and caffeine
This drug is a capsule and Schedule III drug that is FDA-approved for headaches. It is sold under the brand name Fioricet/Codeine.
Codeine with aspirin and carisoprodol
This combination is a tablet and Schedule III drug that is FDA-approved for musculoskeletal pain.
Codeine with guaifenesin
This drug comes as a liquid and is a Schedule V drug that is FDA-approved for cough. It is sold under a variety of brand names that include Coditussin AC and Guaiatussin AC.
Codeine with promethazine
This combination is sold as a liquid and is a Schedule V drug that is FDA-approved for cough.
Codeine with promethazine and phenylephrine
This combination is a liquid and Schedule V drug that is FDA-approved for cough. The drug is sold under the brand name Promethazine VC/Codeine.
Codeine is also known by a variety of street names, many of which reference its liquid formulations:
- Captain Cody
- Purple Drank With glutethimide
- Doors & Fours
- Pancakes and Syrup
Codeine Abuse in Pop Culture
Pop culture has often glamorized codeine use, with street names for the drugs often appearing in rap and hip-hop songs. This trend has increased since 2014 when the DEA made promethazine/codeine combination drug a controlled substance. This trend has increased since 2014 when the promethazine/codeine combination drug was made a controlled substance. Songs talk about using codeine products during sex, while driving, as a replacement for alcohol, and mixed with other drinks and substances to get high. One study also showed that some Instagram posts glamorize codeine, making researchers worry that codeine abuse is becoming normalized despite its potential for dependence and fatal overdose.
Codeine Use Side Effects
Codeine side effects are similar to those of other opioids and include:
- Lightheadedness or dizziness
- Shortness of breath
- Nausea and vomiting
Over the long term, opioids like codeine are linked to hormonal abnormalities which can cause problems like:
- Low sex drive
- Erectile dysfunction
- Menstrual irregularities
Because codeine is often combined with various other medications, different side effects can be linked to a codeine-containing product, even if the side effect is not from codeine itself. For example, codeine with promethazine and phenylephrine can cause high blood pressure, a side effect not typically associated with codeine but a common side effect of phenylephrine.
Signs of Codeine Abuse
- Changes in pupil size
- Different eating habits
- Changes to a person’s sleep schedule
- Runny nose
- Relationship problems
- Missing deadlines
- Avoiding responsibilities
- Showing financial strain
- Having legal problems
- Changes in friends or hobbies
- Personality and mood changes
Signs of Codeine Overdose
Codeine is an opioid, and opioid overdose is unfortunately common. In 2019 alone, the opioid reversal agent naloxone, sold under the brand name Narcan, was used more than 14,000 times in New Jersey. Codeine overdose has similar symptoms to other opioid overdoses. These include:
- Extreme sleepiness
- Slow or shallow breathing
A codeine overdose is a medical emergency. If you have naloxone available, you should give it right away and seek emergency medical attention. Even if the person begins to rouse, it is important to seek medical help because naloxone can wear off within 30 minutes, putting the person at risk of going back into an overdose.
Some people may be more prone to codeine overdose than others based on genetic differences. People with certain subtypes of a chemical in the body called CYP2D6 may break down codeine too quickly into its active component morphine, increasing the risk of overdose.
People at higher risk include those from certain racial or ethnic groups such as:
- Northern African
- Middle Eastern
- Ashkenazi Jewish
- Puerto Rican
Some combination products that contain codeine have other ingredients that can cause an overdose on their own. For example, codeine products that contain acetaminophen can cause acetaminophen overdose if too much is taken. Symptoms like appetite loss, nausea, vomiting, sweating, pale skin and general malaise can occur due to acetaminophen toxicity in these cases. Acetaminophen overdose is a medical emergency as it can cause liver damage. Naloxone will not reverse an acetaminophen overdose.
Withdrawal from Codeine
If you take codeine regularly, experts recommend against stopping codeine cold turkey because of the risk of withdrawal symptoms. Withdrawal symptoms may start anywhere from 8 to 24 hours after you stop codeine and can last up to 10 days. Symptoms can include:
- Nausea or vomiting
- Trouble sleeping
- Hot or cold flushes
- Muscle cramps
- Runny eyes and nose
Codeine Detox Process
Because codeine withdrawal and abstinence can be difficult and uncomfortable, it is important to slowly taper off codeine. Sometimes, doctors may consider medication-assisted treatment, or MAT, with methadone or buprenorphine. These strategies can help you stop taking codeine while reducing the risk of withdrawal symptoms. A drug detox program can wean you off codeine while under medical supervision to stop taking the drug in the most comfortable way possible. This is especially important if you take codeine with other substances like alcohol, which may complicate withdrawal.
Related Topic: Inpatient vs. Outpatient Rehab
Codeine Treatment Options
Depending on the severity of your struggle with codeine, The Recovery Village Cherry Hill at Cooper has options to help you stop taking the drug. These include:
Our inpatient detox center has a specially trained health care team that can help to comfortably wean you off codeine.
While you undergo codeine detox, our medical team can discuss options including medication-assisted treatment, or MAT, with methadone or buprenorphine to keep you away from codeine long-term.
Once your body is free from codeine, inpatient therapy helps you learn ways to live life without codeine and explore why you became reliant on the drug in the first place.
What schedule is codeine?
Codeine by itself is a Schedule II drug. However, codeine is also available in combination with other drugs and can be scheduled differently as a result.
Is codeine an opiate?
Codeine is an opiate drug that is chemically related to morphine. Codeine breaks down into morphine inside the body.
How long does codeine stay in your system?
Codeine can stay in your body for different lengths of time, depending on what is being tested. The drug can show up in urine for up to 3 days and can be present in saliva for up to 2 days. Lastly, a 1.5-inch section of hair can show if codeine was taken in the past 90 days.
Is codeine over the counter?
Codeine is a controlled substance, so it is a prescription-only drug. It is not available over the counter.
How much codeine is too much?
The amount of codeine that a person can safely take varies based on multiple factors. These include the person’s physiology, their genetic ability to break down codeine and morphine, their kidney function, and if their body is used to codeine or other opioids. A common initial dose for codeine when taken alone is 15 mg every 4 hours as needed.
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