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

This combination comes as a tablet and liquid that are FDA-approved for pain. It is a Schedule III controlled substance.

Codeine with butalbital, aspirin and caffeine
Codeine with butalbital, acetaminophen and caffeine
Codeine with aspirin and carisoprodol
Codeine with guaifenesin
Codeine with promethazine
Codeine with promethazine and phenylephrine

Codeine is also known by a variety of street names, many of which reference its liquid formulations:

  • Captain Cody
  • Cody
  • Lean
  • Schoolboy
  • Sizzurp
  • Purple Drank With glutethimide
  • Doors & Fours
  • Loads
  • 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.

Break The Cycle of Addiction

If you or a loved one are struggling with Codeine addiction, seek help today. Our recovery advocates are standing by to guide you through your options.

Codeine Use Side Effects

Codeine side effects are similar to those of other opioids and include:

  • Sleepiness
  • Lightheadedness or dizziness
  • Shortness of breath
  • Nausea and vomiting
  • Sweating
  • Constipation

Over the long term, opioids like codeine are linked to hormonal abnormalities which can cause problems like:

  • Low sex drive
  • Impotence
  • Erectile dysfunction
  • Menstrual irregularities
  • Infertility

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

When a person is beginning to abuse a medication like codeine, signs start to show up. Some warning signs of codeine abuse include:

  • 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
  • Confusion
  • 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:

  • Oceanian
  • 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
  • Anxiety
  • Trouble sleeping
  • Hot or cold flushes
  • Sweating
  • Muscle cramps
  • Runny eyes and nose
  • Diarrhea

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:

Medical Detox

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.

Residential Rehab

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.

Outpatient Rehab

Outpatient rehab typically follows inpatient rehab and can coach you on the skills you need as you begin to enter your new life without codeine. Teletherapy may also be available.


After rehab is complete, the lifelong process of aftercare begins. Aftercare sets you up for continued success with support groups and relapse prevention training.


Dual Diagnosis

Our dual diagnosis program addresses both your codeine addiction and underlying mental health problem that may have exacerbated your codeine struggle.


What schedule is codeine?
Is codeine an opiate?
How long does codeine stay in your system?
Is codeine over the counter?
How much codeine is too much?

You Might Be Interested In

Medical-Detox-TRV-Cheryy-Hill-1024x512 (1)
24/7 Medically Supervised Opioid Detox

Because of the discomfort and dangers that detox often creates, detox is often safest at a detox or rehab center. This allows for medical monitoring and treatment by professionals during the detox process.

rehab-cost-calculator (1)
How Much Does Opioid Rehab Cost?

Though the thought of paying for treatment for opioid addiction may seem overwhelming, there are many options that help people pay for rehab and reduce the cost of treatment.

Untitled-1 (1)
Inpatient Drug & Alcohol Rehab in NJ

Inpatient rehab increases an individual’s chance of success. When someone stays in an inpatient setting, they are away from the environmental and social cues that accompanied their addiction.

Mixing-Fentanyl-and-Alcohol-rvr.com_-4-1024x512 (1)
Fentanyl Withdrawal Symptoms & Timeline

Fentanyl withdrawal symptoms are uncomfortable and sometimes dangerous, so a medical detox is often recommended for a safe, successful and lasting recovery.

Suboxone-Box-1024x346 (1)
Buprenorphine for Opioid Addiction

Buprenorphine is an FDA approved medication marketed under a variety of brand names and formulations used in the treatment of opioid use disorder (OUD) and, in some cases, for pain management.

Editor – Melissa Carmona
As the content manager at Advanced Recovery Systems, 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. 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

U.S. National Library of Medicine. “Codeine.” November 1, 2019. Accessed September 21, 2020.

U.S. National Library of Medicine. “Butalbital, Acetaminophen, Caffeine, and[…]ne Phosphate Capsule.” June 24, 2020. Accessed September 21, 2020.

U.S. National Library of Medicine. “Acetaminophen and Codeine Tablet.” May 6, 2019. Accessed September 21, 2020.

U.S. National Library of Medicine. “Acetaminophen and Codeine Phosphate Solution.” February 5, 2020. Accessed September 21, 2020.

U.S. National Library of Medicine. “ASCOMP with Codeine.” August 20, 2020. Accessed September 21, 2020.

U.S. National Library of Medicine. “Codeine Guaifenesin.” January 10, 2020. Accessed September 21, 2020.

U.S. National Library of Medicine. “Carisoprodol, Aspirin and Codeine Phosphate Tablet.” September 10, 2019. Accessed September 21, 2020.

U.S. National Library of Medicine. “Promethazine, Phenylephrine, Codeine Syrup.” May 31, 2018. Accessed September 21, 2020.

U.S. National Library of Medicine. “Promethazine and Codeine.” May 18, 2018. Accessed September 21, 2020.

National Institutes of Health. “Street & Commercial Names.” January 17, 2018. Accessed September 21, 2020.

Tettey, Naa-Solo; Siddiqui, Khizar; Llamoca, Hasmin; et al. “Purple Drank, Sizurp, and Lean: Hip-Hop […]lic Health Educators.” International Journal of Psychological Studies, February 26, 2020. Accessed September 21, 2020.

Roberts, Emilee; Byars, Kara. “Codeine References in Rap Music Increase[…]ailability Decreases.” April 2019. Accessed September 21, 2020.

Cherian, Roy; Westbrook, Marisa; Ramo, Danielle; et al. “Representations of Codeine Misuse on Ins[…]am: Content Analysis.” JMIR Public Health and Surveillance, January-March 2018. Accessed September 21, 2020.

VanValkinburgh, Danny; Kerndt, Connor C; Hashmi, Muhammad F. “Inotropes and Vasopressors.” StatPearls, June 9, 2020. Accessed September 21, 2020.

Indian Health Service. “Warning Signs of Substance and Alcohol Use Disorder.” Accessed September 20, 2020.

Anne Arundel County Department of Health. “Naloxone: Frequently Asked Questions.” September 9, 2019. Accessed September 20, 2020.

World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]e in Closed Settings.” 2009. Accessed September 20, 2020.

Gryczynski, Jan; Schwartz, Robert P; Mitchell, Shannon D; et al. “Hair Drug Testing Results and Self-repor[…]isk Illicit Drug Use.” Drug and Alcohol Dependence, May 17, 2014. Accessed September 20, 2020.

ARUP Laboratories. “Drug Plasma Half-Life and Urine Detection Window.” January 2019. Accessed September 20, 2020.

Cansford Laboratories. “Oral Fluid (Saliva) Testing.” Accessed September 20, 2020.

New Jersey Department of Health. “Naloxone (Narcan) Incidents, June 2017 – July 2020.” Accessed September 20, 2020.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.