Codeine Abuse & Addiction

Written by Melissa Carmona

& Medically Reviewed by Dr. Jessica Pyhtila, PharmD

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Last Updated - 04/05/2023

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Updated 04/05/2023

Article Overview:

  • Although considered a weak opioid, codeine carries a risk of abuse, addiction and dependence.
  • Some codeine side effects may include drowsiness, lightheadedness, dizziness and sedation. 
  • Taking larger doses than prescribed, taking codeine more often than prescribed, taking codeine recreationally and crushing it are all signs of codeine abuse. 
  • Codeine addiction is a treatable condition that begins with detox.

What Is Codeine?

Codeine is a prescription opioid medication usually used to treat coughs and sometimes pain. Codeine fights pain by interacting with mu-opioid receptors on brain cells (neurons). The drug can prevent cough by acting on the medulla in the brain, which would produce cough. Because codeine is an opioid, the risk of addiction comes with its use.

Codeine is part of a class of drugs called narcotic analgesics, which treat pain by acting on the central nervous system. It can be used to treat mild to moderate pain. It’s considered less potent than a lot of other opiates, so people tend to falsely believe they won’t become addicted, but that’s not the case.

Codeine Formulations

Codeine often comes as a cough syrup mixed with other ingredients but can also come in other formulations. The Drug Enforcement Administration (DEA) has schedules for controlled prescription medications based on their relative risk.

Codeine comes in different forms. The DEA places codeine formulations into schedules based on how abusable it is:

  • Codeine tablets: Schedule II. Codeine is not very potent compared to other opioids, so it is not prescribed very often.
  • Acetaminophen and codeine tablet (Tylenol #2, Tylenol #3, or Tylenol #4): Schedule III. Codeine and acetaminophen tablets are used for treating pain and are commonly prescribed. Acetaminophen is added to help prevent abuse because taking too much acetaminophen causes gastrointestinal (GI) symptoms like an upset stomach. It can also cause liver damage and acetaminophen overdose symptoms.
  • Acetaminophen and codeine syrup: Schedule V. This syrup formulation is scheduled lower than tablets because liquid drugs are harder to abuse. A person can only fit so much liquid in their stomach.
  • Guaifenesin and codeine syrup: Schedule V. Guaifenesin is a mucolytic (medication that breaks up mucus). However, it does not prevent abuse like acetaminophen. The lower scheduling for this formulation is because the concentration is low.
  • Promethazine and codeine syrup: Schedule V. Promethazine is another medication that prevents coughing. The concentration of codeine in promethazine is low, resulting in lower scheduling.

Understanding Codeine Abuse

When you’re prescribed codeine in any form, it comes with a warning. Codeine has the potential for addiction, abuse and misuse that can result in overdose or death. Like other opioids, codeine can depress your respiratory system to the point where you stop breathing. If you take codeine while pregnant, you’re also warned that it can lead to neonatal opioid withdrawal syndrome.

To avoid the risk of addiction that comes with codeine use, people are warned to take it only as instructed by their doctor. This means not taking larger doses than what’s instructed or taking it more often than you’re prescribed. It’s also imperative that people never take codeine without a prescription because that is automatically considered abuse.

Why Is Codeine Addictive?

Codeine is an opiate, and while it may be weaker or seem less risky than other opiates, it still has the potential for abuse. Codeine can be more problematic than people realize; people see it as less potent and assume it’s harmless. That’s simply untrue.

When you take a drug like codeine that affects the central nervous system, it triggers the brain’s reward center, making you want to repeat the experience. That’s what leads to the potential for abuse and addiction to codeine and other opioids.

Since codeine is less potent than other opioids but still addictive, people will take this drug and then move on to stronger opioids once they’ve developed a tolerance and addiction. In many ways, codeine can be seen as a weaker gateway to other opiates. People may also combine codeine with other central nervous system depressants like alcohol or benzodiazepines, increasing the effects and the risk of overdose.

Codeine Addiction Facts

Prescription medications for cough and cold that contain psychoactive or mind-altering properties are often used at higher doses than recommended and commonly abused. When these drugs contain elements like expectorants or antihistamines, they’re abused at even higher rates.

Some other facts about codeine addiction include:

  • In a recent study by The Recovery Village, 31% of current and former opioid users reported using codeine at some point.
  • Some people genetically break down codeine into morphine faster than expected due to an enzyme called CYP2D6, leading to an increased risk of overdose.
  • Codeine has no effect in up to 10% of people.
  • Codeine can depress breathing and other essential bodily functions.
  • When someone takes codeine, it is naturally converted to morphine, which is how the mind-altering and euphoric effects are felt.
  • Social media glamorizes codeine abuse, especially when the drug is combined with soda to make “lean.”
  • Opioid abuse is a significant problem in Colorado, and state lawmakers have been working to combat the opioid epidemic happening in metro areas like Colorado Springs, Boulder, Denver and throughout the state.

Codeine Side Effects & Symptoms

As a prescription painkiller, codeine can be used for legitimate therapeutic reasons, but even when it is used as directed by a doctor, it can have certain side effects.

Some of the side effects of codeine may include drowsiness, lightheadedness, dizziness and sedation. Other potential codeine side effects of codeine can occur with a prescription or when misuse, including:

  • Nausea
  • Vomiting
  • Sweating
  • Stomach pain
  • Dry mouth
  • Constipation
  • Flushing of the skin
  • Itchiness
  • Rash

Side Effects of Codeine Abuse

The side effects of codeine abuse are usually the first indicators that someone is on the path toward developing an addiction to this drug.

Some of the signs of codeine abuse include:

  • Taking larger doses than prescribed or taking codeine more often than prescribed by your doctor
  • Taking codeine recreationally in any way
  • Purchasing coding illegally or taking it without a prescription
  • Crushing codeine to snort it or use it in unintended ways

Two of the biggest and most dangerous side effects of codeine long-term use are addiction and physical dependence. The longer you use codeine, whether by prescription or otherwise, the more likely you are to become addicted and/or dependent.

Codeine High Symptoms

Most codeine high symptoms are similar to other opioids. Codeine is a sedative; taking a particularly large dose may lead to a sense of well-being and euphoria, which can then fade to drowsiness. As a person continues using it, they may stop feeling the codeine high symptoms, and instead, they keep taking it just to fuel their addiction and avoid withdrawal.

Signs of a Codeine Overdose

The risk of a codeine overdose is real and can happen more easily than you might think. A codeine overdose can occur because you take too much of the drug, take it in a way other than what’s directed (like snorting it) or when you mix it with other substances like other opioids or alcohol.

Some of the signs of a codeine overdose include:

  • Breathing problems, including breathing that seems shallow or labored
  • A bluish tint to fingernails and lips
  • Skin that feels cold and clammy to the touch
  • Confusion
  • Dizziness
  • Drowsiness
  • Fatigue
  • Pinpoint pupils
  • Low blood pressure
  • Loss of consciousness

The signs of a codeine overdose should never be ignored, as they can ultimately lead to coma or death. A codeine overdose is a medical emergency and can be fatal. If you suspect someone is overdosing on codeine, administer naloxone (Narcan) if available and call 911. You will not get in trouble for helping to save someone’s life.

Codeine Addiction Signs

People frequently want to learn more about codeine addiction symptoms because they feel like their drug use has spiraled out of control or see warning signs in someone they care about.

The following are some of the signs of codeine addiction:

  • Taking it without a prescription or taking it in ways other than prescribed by your doctor
  • Doctor shopping to get multiple prescriptions
  • Stealing from friends or family to get codeine
  • Purchasing codeine illegally
  • Withdrawing from friends, family and responsibilities
  • Declining performance at school or work
  • Spending significant amounts of time thinking about or focused on codeine
  • Continuing to take codeine even when there are negative consequences
  • Trying to stop using codeine and being unable to
  • Feeling like your codeine use is out of your control

Codeine addiction symptoms are similar to addiction symptoms for other opioids and drugs. Essentially, if someone seems to change how they behave, acts secretive or lies, or does things they wouldn’t ordinarily do to obtain or use codeine, these can all be signs of an addiction to codeine.

Signs of Codeine Dependence

With codeine and drugs like it, there is a distinction between dependence and addiction. Addiction is a psychological disease where you lose control over your drug use because of changes in your brain. Meanwhile, dependence is a scenario where your body is physically dependent on a substance in order to function normally. Being physically dependent on codeine may or may not indicate an addiction.

One of the first signs of codeine dependence is a building tolerance. Many people build a tolerance to codeine and other opioids very quickly, so they have to take higher doses to get the same effect, whether they’re seeking legitimate pain relief or they want to abuse the drug and get high.

Another one of the primary codeine dependence symptoms occurs when you try to stop using the drug suddenly. If you experience withdrawal symptoms after stopping codeine use, you have a physical dependence on the drug.

Codeine Withdrawal Symptoms

The severity of codeine withdrawal symptoms depends a lot on how long someone has used it and how much they take. As you develop a tolerance to codeine, you become physically dependent. If you stop taking it suddenly, you are likely to experience codeine withdrawal symptoms.

Some codeine withdrawal symptoms include:

  • Runny nose
  • Headaches
  • Nausea and vomiting
  • Fever
  • Achiness
  • Abdominal cramps
  • Weakness
  • Chills
  • Diarrhea
  • Fear or anxiety
  • Agitation
  • Sweating

Codeine Withdrawal Timeline

The timeline for codeine withdrawal can vary from person to person. Below is a general overview of what the codeine withdrawal timeline can look like:

  • During the first phase of the codeine withdrawal timeline, which usually starts within 24 hours after last taking the drug, symptoms can include cramping, vomiting, insomnia, diarrhea and depression. This is also called the acute withdrawal phase.
  • During phase two, which can last for up to 10 days, symptoms of codeine withdrawal can continue but often begin to taper off.
  • During phase three of the codeine withdrawal timeline, which can last up to 6 months, people may experience a reduced sense of well-being and cravings for the drug.

Coping with Codeine Withdrawal

There are some things you can do on your own to cope with codeine withdrawal, such as drinking water to stay hydrated, finding things you enjoy doing, and making sure you’re getting proper nutrients. However, symptoms can be severe, so a professional detox treatment program is the best decision for many.

Dealing with codeine withdrawal at home can include a tapering off schedule or going cold turkey. When you taper off codeine, your dosage is gradually reduced so that you experience fewer withdrawal symptoms. In a cold turkey approach, you stop suddenly, meaning the withdrawal symptoms can be more severe.

Codeine withdrawal help is available in the form of both inpatient and outpatient detox programs, such as what’s offered at Colorado’s The Recovery Village at Palmer Lake.

Codeine Detox in Colorado

If you try to quit cold turkey or go through codeine detox at home, intense cravings can make the experience harder and derail your attempts to stop. Codeine detox treatment can help you detox successfully, particularly if you do an inpatient program.

Detox from codeine at an inpatient facility can include medical interventions to alleviate some of the physical and psychological symptoms you’re experiencing. You’re more likely to be successful with your codeine detoxification if you have professional support.

Once you have safely gone through codeine detoxification, you can begin treatment. The Recovery Village at Palmer Lake specializes in helping people detox from codeine and other opioids through evidence-based treatments that increase their chances for a successful recovery.

If you or a loved one is struggling with codeine addiction, reach out to The Recovery Village at Palmer Lake today. We have representatives standing by to discuss treatment options with you.

Sources “Codeine.” October 30, 2020. Accessed May 31, 2021.

Drug Enforcement Administration. “Controlled Substances.” May 10, 2021. Accessed May 31, 2021.

American Academy of Family Physicians. “Opioid Conversion Table.” Accessed May 31, 2021.

National Institute on Drug Abuse. “Cough and Cold Medicine Abuse.” May 2014. Accessed May 31, 2021.

Cherian,Roy; Westbrook, Marisa; Ramo, Danielle; Sarkar, Urmimala. “Representations of Codeine Misuse on Ins[…]am: Content Analysis.” JMIR Public Health and Surveillance, January-March 2018. Accessed May 31, 2021.

U.S. National Library of Medicine. “Opioid Overdose.” December 24, 2020. Accessed May 31, 2021.

World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]e in Closed Settings.” 2009. Accessed May 31, 2021.


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