Codeine is a commonly used medication intended to relieve mild to moderate pain and to reduce cough. However, codeine can be habit forming; furthermore, misuse of the drug can place the user at risk for addiction and overdose.1 For these reasons, it is essential that consumers understand the risk factors and warning signs associated with this substance.
What Is Codeine?
Codeine is classified as an opiate analgesic and an antitussive. When used for pain control, the substance alters the way that the brain perceives pain signals. When used to relieve coughing symptoms associated with a flu, fever, or the common cold, it works to reduce the activity in the part of the brain that causes the coughing.1
Codeine is a primary ingredient in several combination formulations used to treat a range of pain- and cough-related conditions. Such combination pharmaceuticals include acetaminophen, aspirin, promethazine, and carisoprodol. In these combinations, codeine is commonly administered in oral tablet, capsule, or liquid solution forms.1
The Drug Enforcement Administration (DEA) classifies products containing less than 90 milligrams of codeine per dosage unit (such as in Tylenol with codeine) as a Schedule III substance (meaning there is moderate to low potential for dependence). The DEA classifies substances with less than 200 milligrams of codeine per 100 milliliters, such as Robitussin AC, as a Schedule V substance.2 When not in combination with other pharmaceuticals, codeine sulfate tablets are Schedule II controlled substances with marked abuse liability.3
High doses of codeine can produce euphoric feelings similar to those produced by other opioid drugs, such as heroin. This occurs because of an excessive release of dopamine in the brain, which enhances feelings of pleasure. However, the desire to continuously feel that euphoria, and the actions that result in chasing it, can develop into addiction over time.4
Side Effects of Use and Abuse
Codeine may sometimes lead to life-threatening breathing problems, especially within the first 1–3 days of use. Those with a history of lung disease, asthma, or other related pulmonary issues may be more prone to developing breathing problems when taking codeine.1
Other side effects include:1
- Stomach pain.
- Urination difficulty.
More serious side effects might include:1
- Difficulty breathing or swallowing.
- Changes in heartbeat.
- Rash, itching, or development of hives.
- Changes in vision.
- Muscle stiffness or pain.
- Loss of coordination.
How to Recognize and Treat an Overdose
To date, opioid overdose is the leading cause of accidental deaths in the United States, with more than 52,000 overdose deaths occurring in 2015.5
You can recognize some of the main symptoms of an opioid overdose in someone who has taken large amounts of codeine as:1
- Difficulty breathing.
- Slowed heartbeat.
- Cold and clammy skin.
- Loss of consciousness.
If it seems like the person you’re with—or you—are overdosing, the first thing you should do is call 911. Then, if the medication naloxone is on hand, safely administer it to try to reverse the potentially fatal effects of an opioid overdose. If you are with the person who has overdosed, stay with them and monitor their symptoms until emergency personnel arrives.
Some people mix codeine with other substances, such as alcohol, to create a stronger and more intensified high, but these combinations can increase the risk of dangerous side effects and overdose and should be carefully avoided.
When someone is physically dependent on opioids—whether or not they have overdosed—they may experience withdrawal symptoms that start as early as a few hours after taking the last dose. Because opioid withdrawal symptoms can be particularly distressing and uncomfortable, it is often advisable to enter a detox program where a person can receive medically supervised treatment.
Professional detox programs provide a safe and supportive environment to go through withdrawal. Detox timelines will vary depending on the frequency and intensity of opioid use, as well as other factors, such as the person’s health, any psychiatric conditions, and the presence of any polysubstance dependence. Common opioid withdrawal symptoms include:6
- Intense cravings for the substance.
- Body pains, cramps, and muscle aches.
- Lack of appetite.
- Nausea and vomiting.
- Goosebumps, fever, chills, and sweating.
- Dilated pupils.
- Restlessness, nervousness, and anxiety.
- Depression and irritability.
A supervised detox facility provides medical and clinical support while you eliminate a substance and its toxic influence from your body. The professional medical staff can provide medications to ease the discomfort of your withdrawal symptoms and monitor your progress to ensure your physical safety.
For most people, entering detox represents the first step toward achieving sustained, long-term recovery. Detox alone is rarely sufficient intervention to elicit the behavioral changes necessary for lasting recovery. Ideally, people will be referred to appropriate treatment facilities for continued care after they complete their detox program to learn the coping skills and behavioral techniques that can help them achieve long-term sobriety.7
Treatment and Aftercare
Structured treatment can help you or your loved one overcome codeine addiction, since it provides the necessary support and monitoring needed to manage symptoms related to substance abuse and teach you the skills you need to live life without abusing codeine. Going through a treatment program also gives you the opportunity to practice these skills in a safe community with others in early recovery, which helps build confidence in your ability to be successful once you leave treatment. Getting help for your codeine abuse can take many forms. Some of these treatment options include:
- Inpatient and residential treatment: This type of rehab provides the highest level of care, with 24/7 monitoring and supervision and can take place in public or private facilities or in specialized hospital care units. Treatment typically lasts anywhere from 30 days to several months, and the programs tend to be highly structured, with an emphasis on relapse prevention and developing adequate coping skills for managing stress and cravings.8
- Intensive outpatient and standard outpatient care: Patients with relatively less severe opioid addictions may benefit from intensive outpatient (IOP) or standard outpatient (OP) treatment. These programs provide structured sessions throughout the week, with patients commuting to and from their home each day.9 Because treatment takes place on a part-time schedule, patients may continue to work and attend school. IOP or OP can also be a form of step-down care for people who have successfully completed inpatient treatment.
- Individual counseling: Individual counseling provides patients with a safe, confidential space to explore the underlying or behavioral issues related to their addiction. Counseling can help address an array of stressors, from family and marital problems to employment and financial concerns to co-occurring mental health disorders. Counselors may work one on one with patients or invite families or a spouse in for family sessions.8,9
- Group counseling: Many treatment centers use group counseling for patients to provide education, peer support, and sober activities.7 Group counseling can help patients feel connected to their peers since it encourages openness and honesty in their current struggles and fears.
- 12-step involvement: There are nearly 67,000 Narcotics Anonymous (NA) meetings held in 139 countries.10 NA is a nonprofit, free fellowship for people working toward a sustained recovery. Many people find strength and hope in these groups, since members encourage each other to stay clean and practice a life of abstinence.
Once you have completed an inpatient or outpatient program, it is wise to continue with some sort of aftercare program in the months (and sometimes years) that follow. This form of ongoing treatment is often less intensive than initial rehab efforts but keeps you connected to your recovery community, which provides the ongoing support needed to sustain sobriety.
Examples of common aftercare options include:
- Individual counseling: When you first discharge from your treatment program, you might see your counselor 3 times a week. Then, over time and as your counselor advises, you may see them 2 times a week and eventually once a week. This ongoing accountability and support can be invaluable in the weeks and months after you first transition back into your everyday life.
- Psychiatry appointments: If you have a mental health disorder in addition to your substance abuse problem, maintaining regular appointments with your psychiatrist or other mental health professional is essential to managing your depression, anxiety, or other disorder. If these issues go untreated, it is not uncommon for the unmanaged symptoms you experience as a result to lead to a relapse.
- Peer support groups: Many of those who have long-term sobriety attribute their success, in part, to their commitment to a peer support community, such as NA or another group that focuses on recovery. The camaraderie of people who understand your struggles in an intimate way reduces the chances of feeling isolated and alone in your feelings as you learn to live without codeine. This is one factor that improves your odds of remaining sober.
If you or a loved one is struggling with codeine addiction, help is always available—begin your search for the best treatment today.
- U.S. National Library of Medicine. (2018). Codeine.
- Drug Enforcement Administration. (n.d.). Drug Scheduling.
- U.S. Food and Drug Administration. (n.d.) Highlights of Prescribing Information.
- National Institute on Drug Abuse for Teens. (2017). Cough and Cold Medicine (DXM and Codeine Syrup).
- American Society of Addiction Medicine. (2016). Opioid Addiction 2016 Facts & Figures.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2008). Detoxification and Substance Abuse Treatment.
- Substance Abuse and Mental Health Services Administration. (2016). Treatments for Substance Use Disorders.
- National Institute on Drug Abuse. (2018). Types of Treatment Programs.
- Narcotics Anonymous World Services. (2018). About Us.