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What is the Difference Between Codeine and Hydrocodone?

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

Medically reviewed by

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

January 17, 2019

Codeine and Hydrocodone are prescription opioid medications commonly prescribed to individuals suffering from moderate to severe pain. These drugs affect the opioid receptors in the brain in very similar ways and both carry a high risk of abuse and addiction if taken for long periods of time.

Codeine and hydrocodone are both legally prescribed medications that are most commonly prescribed to treat or manage pain. In the United States, we are surrounded by a large array of options when it comes to pain management. It seems like all painkillers have their pros and cons, but are some worse than others when it comes to the risk of addiction? The short answer to that is yes, absolutely.

Over-the-counter painkillers, such as Ibuprofen or acetaminophen, come with a relatively short list of precautions and side effects. This is largely because of the way they interact with your body to help reduce pain. Other painkillers, such as opioids like codeine and hydrocodone, are much more potent and only available via prescription. Drugs like these should be taken with caution, as their addictive tendencies can quickly outweigh their pain relieving properties.

How Do Codeine And Hydrocodone Affect Your Body?

Codeine and hydrocodone are both opioids. Opioids are a classification of drugs that have been derived from the opium poppy plant naturally found in the Middle East, Asia, and parts of Europe. Opioids work by binding to opioid receptors located at on neurons that are scattered throughout your brain and nervous system. These opioid receptors are tied to your brain’s ‘reward’ system, which directly affects the emotions and feelings you perceive in return from any given action.

The reward system in your brain is a tool that is intended to drive you to do more things that your body instinctively wants you to do again. Procreation, or the act of associating pleasure with having sex to produce offspring, is a common example of this reward system. Sex creates a feeling of pleasure in humans to encourage us to repeat the act in an attempt to instinctively produce more offspring. When your brain rewards you with feelings such as pleasure and happiness, it is trying to get you to repeat the act.

When opioids like hydrocodone and codeine are introduced to the brain, this reward system is overtaken by the drugs. Opioid receptors will produce feelings of euphoria and pleasure, despite the body lacking an act that can benefit it in the long run. In this case, the reward of feeling euphoric has not technically been ‘earned’ by a positive action. Following its natural instincts, your body will want to receive the reward of these feelings again and will therefore crave more hydrocodone. This destructive cycle is the definition of opioid dependence and addiction, and it is the single largest reason that the opioid epidemic is so destructive.

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Codeine Vs. Hydrocodone: Is One Better Than The Other?

Codeine is almost entirely naturally derived and is a result of cultivating and isolating a specific alkaloid from the opium poppy plant. Hydrocodone, on the other hand, is considered to be a synthetic or semi-synthetic opioid. Being naturally derived does not make codeine any safer than hydrocodone. Both codeine and hydrocodone are absorbed by your brain in the same way, making their risk for addiction and overdose equally as dangerous.

Hydrocodone is most commonly prescribed in the form of an immediate-release tablet that contains a combination of hydrocodone and acetaminophen. Acetaminophen is a painkiller and fever reducer that is available without a prescription when formulated on its own. When combined with hydrocodone however, it is available only in a prescription and commonly sold under the brand name Vicodin.

When prescribed for an extended period of time, Vicodin has a tendency to become less effective on most patients. The reason for this is the natural tolerance your body will build up to the drug, decreasing its pain relieving properties over time. When this tolerance is built and the drug is no longer effective, a physician may prescribe a hydrocodone-only oral tablet. Hydrocodone alone can only be prescribed in an extended-release tablet, designed to treat chronic pain and prescribed as a daily dose routine.

Other commonly prescribed hydrocodone medications include:

  • Norco
  • Lorcet
  • Lortab
  • Dicodid
  • Anexsia
  • Tussionex
  • Hycodan
  • Hycomine

Codeine is only available in immediate-release tablets, and can only be sold with a prescription. Codeine is intended to treat moderate to severe pain, as well as intense coughs. Generally, codeine is intended to be taken on an ‘as needed’ basis, meaning once you can feel the pain return then you will take another dose. Recovery from surgery, severe trauma, intense coughs, and diarrhea are circumstances that would usually call for an ‘as needed’ prescription.

Codeine prescriptions can come in many forms and be marketed under different names. Codeine is also commonly combined with other medications, such as cough syrups and acetaminophen, to treat specific conditions. Some common codeine brand names include:

  • Brontex
  • Robitussin AC
  • Tusnel C
  • Nalex AC
  • Vanacof
  • Tussiden C
  • Mytussin AC
  • Ambenyl
  • Cotab A
  • Codafen

The Opioid Epidemic

Codeine and hydrocodone have one major thing in common: they are both opioids. You may have heard of opioids in the news during segments on our nation’s opioid epidemic. In 2015 alone, it is estimated that opioids killed almost 33,000 people nationwide – a statistic that continues to grow. Health organizations such as the Center for Disease Control (CDC) and World Health Organization (WHO) have taken drastic measures to try to educate the public on the dangers of opioid addiction and overdose.

What makes a drug that is prescribed by physicians so dangerous? The truth is opioids have many positive medical applications when taken and prescribed correctly. Opioids can be used in the treatment of moderate to severe pain, chronic pain, severe coughs, and diarrhea. There are many circumstances where the prescription of an opioid could be the best treatment method, and many individuals have taken the drug without any severe implications or side effects.

Unfortunately, opioids such as codeine and hydrocodone are sometimes over prescribed, taken recreationally, or taken incorrectly. Most importantly, opioids are addictive. Far more addictive than any over-the-counter painkiller could ever be. The reason for this lies entirely in the way that opioids are received in your brain.

The chemical reaction that occurs from the binding of opioids to opioid receptors can alter your brain’s natural balance of chemicals. When this occurs, removing opioids from your system will cause your brain to crave more of the drug in order to regain its new standard of ‘balance’. It is a cycle that is both physically and mentally addictive, and one that is very difficult to overcome without professional help.

Even when taken exactly as prescribed, the risk for opioid dependence and addiction can still be very high. Many factors can influence the probability of addiction, such as history of drug abuse, poor impulse control, dose size and frequency prescribed, and environmental stressors. Because of this, it is important to be completely transparent with your prescribing physician when discussing your history with drugs, impulsivity, and the outcomes you hope to achieve with an opioid prescription.

Codeine? Hydrocodone? Why Aren’t All Opioids The Same?

The term opioid is used to describe a class of drugs, rather than an actual drug type. A good example of this would be labeling animals such as a cat. While cats have many similarities and come from a common ancestor, we all know their appearance, temperaments, predators, and habitats can vary wildly from species to species.

Opioid is a broad categorization used to label a class of drugs that is processed by your brain in a similar way, but that can present a wide variety of side effects, applications, potencies, and purposes. Most opioids are derived from the opium poppy plant, but more and more synthetic versions have popped up over the past decade.

Get Help Today

If you or a loved one is suffering from dependency or abuse on an opioid such as codeine or hydrocodone, professional help is the best step you can take towards recovery. We believe that fighting all aspects of addiction, including mental, physical, and emotional, is the best method to treating drug dependency for a full recovery.

Our addiction treatment specialists are specially trained to answer your questions and help you choose a treatment program that is tailored to your needs. Your call is always confidential, and our specialists are available to talk around the clock. Give us a call today.

Healthline- -Codeine vs. Hydrocodone: Two Ways to Treat Pain -

The Pharmaceutical Journal - Codeine Addiction Is A Serious Problem

World Health Organization - Curbing Prescription Opioid Dependency

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