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Codeine Abuse, Addiction, And Treatment Options

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 12, 2019

Codeine is a prescription medication commonly paired with other medications to treat a variety of ailments. People who abuse codeine are at high risk for addiction, as with other opioids.

What Is Codeine?

Codeine is an opioid that is combined with other medications for use as a painkiller or cough suppressant, and some migraine medications. As a painkiller, it is used to treat mild to moderate pain and is only intended for short-term use.

Codeine combination medications:

  • Tylenol 3 / Tylenol 4: Acetaminophen and codeine are combined in this prescription painkiller. Available as 30 mg or 60 mg of codeine with 325 mg acetaminophen.
  • Tuzistra XR: Promethazine / Codeine combine to treat cough, runny nose, and other allergy or cold symptoms. This cough syrup is only available by prescription.
  • Fioricet w/codeine: Used to treat migraines, this prescription medication combines butalbital, acetaminophen, caffeine, and codeine.
  • Phrenilin with caffeine and codeine: Prescription migraine medication that combines butalbital and acetaminophen with additional caffeine and codeine.

Codeine usually takes an average of 15 to 30 minutes to take effect and can last four to six hours. Acting as a depressant to the central nervous systems (CNS), codeine changes the way the body and brain respond to pain and decreases the activity in the area of the brain that regulates coughing.

Codeine has historically been considered a “weaker” painkiller. This is a dangerously inaccurate label, as amounts of codeine turn into morphine in the body. The conversion can result is severely impaired breathing and potentially fatal outcomes. As a result, in 2017 the Food and Drug Administration (FDA) declared that codeine was no longer appropriate for patients under the age of 18.

Like other opioids, codeine is considered habit-forming, addictive, and has a high risk of abuse. It is important to only take medications that contain codeine as prescribed, for as short a period of time as possible.

Codeine Abuse

When a person takes codeine in a way that is not prescribed to them, it is considered abuse. Young people have been known to combine liquid codeine with alcohol, soda, and other beverages to get high. These mixed drinks are commonly referred to as Lean, Sizzurp, and Purple Drank.

When individuals abuse codeine in pill form, they typically swallow or crush and snort the pills. Abusing codeine results in feelings of euphoria and relaxation, as well as surges in dopamine. It is believed that all these factors play a key role in developing an addiction.

Abusing codeine, like other opioids, can lead to tolerance. Because opioids are highly addictive, this process can occur in a matter of a few weeks. Tolerance develops when a person needs more codeine to feel the same effects as the previous dose. A person who is abusing their prescription or experiencing tolerance will usually run out of their codeine medication before they are supposed to.

There are some indications that a person is abusing codeine, and these symptoms include:

  • headache
  • stomach pain
  • constipation
  • agitation
  • difficulty urinating
  • decreased sex drive
  • shallow breathing
  • pinpoint pupils
  • allergic skin reaction or rash
  • flushing or itching

In high doses, codeine can make people appear drunk. Lack of coordination, slurring words, and nodding off can occur when a person takes too much codeine.

Codeine Addiction

People who abuse codeine are at high risk for addiction. Once a person develops codeine dependence, they will struggle with symptoms of withdrawal if they attempt to stop taking codeine. Often times, avoiding withdrawal is a key factor in opioid addiction.

In addition to the side effects of codeine abuse, individuals who struggle with codeine addiction may display the following behaviors:

  • faking prescriptions for codeine
  • spending large amounts of money to buy illegal codeine
  • isolating themselves from family and friends
  • doctor shopping (visiting several, different doctors to obtain multiple prescriptions)
  • stealing codeine or money for codeine from others
  • lying to family and friends about drug use
  • unable to stop taking codeine
  • taking other opioids (Vicodin, Percocet) when out of codeine
  • withdrawal symptoms when codeine is unavailable
  • high risk for overdose

Codeine Statistics

  • On average, 46 people die every day from prescription opioid overdose
  • Over 275,000 adolescents in 2015 were abusing painkillers
  • In 2014, nearly 2 million Americans were abusing prescription opioids, like codeine

Codeine Overdose

Individuals who abuse or are addicted to codeine are at high risk for overdose. Overdosing on opioids is dangerous and can be deadly. Codeine is especially risky because it metabolizes to morphine and causes such significant respiratory depression. Depriving the brain of adequate amounts of oxygen for three to five minutes can cause permanent brain damage.

If a person is taking codeine and exhibits the following symptoms they may be experiencing an overdose, and should seek medical attention immediately:

  • clammy skin
  • stomach pain
  • trouble breathing
  • fainting
  • vomiting
  • convulsions
  • seizures
  • heart attack
  • stroke
  • coma
  • death

Codeine Withdrawal

Similar to other opioids, the symptoms of codeine withdrawal range from uncomfortable to seemingly unbearable. While opioid withdrawal is not usually fatal, it can be quite difficult for a person to attempt without assistance.

When a person is going through codeine withdrawal, they are likely to experience:

  • yawning
  • runny nose
  • watery eyes
  • sweating
  • goosebumps
  • agitation
  • anxiety
  • muscle aches
  • cravings
  • restless legs
  • body aches
  • vomiting
  • diarrhea

People report extremely severe flu-like symptoms when experiencing codeine withdrawal. The physical side effects last about a week and the behavioral and emotional effects can last for several months after a person stops taking codeine.

When a person wants to stop taking opioids, it is strongly recommended that the person seeks out a detoxification program that is equipped to address the needs of an opioid-dependent person. These programs provide support, medication, and substance abuse counseling for those enrolled in the program.

Codeine Treatment Programs

Opioid treatment programs (OTPs)are designed to provide substance abuse treatment to individuals who are dealing with codeine abuse or addiction. The facilities provide evidence-based, approved substance abuse treatment methods, as well as comprehensive services to help those struggling with opioid use disorder.

OTPs are regulated by outside agencies to make sure that every attempt is made to help achieve sobriety. This involves thorough treatment planning, medical care, detoxification, education and vocational programs, and aftercare programs.

Contact us today so we can assist in finding a program that meets the needs of you or your loved one.

Food and Drug Administration - FDA Drug Safety Communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older, Codeine label

National Institutes of Health - Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures

Mayo Clinic - Butalbital, Acetaminophen, Caffeine, And Codeine (Oral Route)

American Society of Addiction Medicine - Opioid Addiction 2016 Facts and Figures

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