Codeine is an opioid that is prescribed to manage pain and relieve coughing in adults and children. This drug is commonly combined with other prescription medications, such as acetaminophen and ibuprofen, to provide the patient with additional pain relief, fever reduction, and anti-inflammatory properties.1 As an opioid, it works by binding to and activating opioid receptors in the brain in a manner that diminishes our perception of pain and increases our sense of reward or wellbeing.
Beyond its medicinal uses, codeine is also abused recreationally, which sometimes leads to dependency or addiction. When a person uses codeine beyond the intended timeframe or in doses that exceed prescribed amounts, addiction becomes a greater risk. If you or a loved one are seeking codeine addiction treatment, consider the various options available. But first let’s get a better understanding of what codeine abuse and addiction looks like.
Abuse Signs, Symptoms, and Risks
If you were given a prescription for codeine and started using the drug regularly for pain relief, you may have noticed that your body needed more of the drug over time to feel the same relief you felt initially. This phenomenon is known as tolerance and, as people begin adjusting their doses upwards to overcome it, it can drive the development of both physical and psychological dependence. Psychological dependence might include thinking about the drug as soon as you wake up and focusing on it throughout the day to the exclusion of your usual obligations.2
Although dependence and addiction are not interchangeable terms, they are closely related; physiological dependence is one of several diagnostic components for substance use disorders—often referred to as addictions—and develops in magnitude in parallel with larger addiction issues for many people. If you are suffering from a codeine addiction, one of the symptoms you may experience is an uncontrollable desire to continue using the drug. Also, if you try to stop using it, you may experience the onset of an unpleasant withdrawal syndrome. With codeine and several other prescription opioids, withdrawal symptoms will typically peak in intensity within 1 to 3 days after the last dose and generally go away over the course of a week.3
Other symptoms of codeine withdrawal may include:2,3
- Dysphoric mood.
- Muscle twitching.
- Increased sensitivity to pain.
- Fast breathing.
- Rapid heart rate.
- Increased blood pressure.
- Dilated pupils.
- Yawning excessively.
- Runny nose.
- Tearing eyes.
- Loss of appetite.
- Stomach cramping.
The drug may also increase your risk for respiratory depression and heart attack. Because of this, it is especially dangerous to use codeine along with other central nervous system depressants, such as alcohol and benzodiazepines.2,3
Codeine is not recommended for mothers who are breastfeeding their children, as variations in individual metabolic pathways may lead to high blood levels of morphine (an opioid metabolite) in the child. There has been one case report of a mother who breastfed her baby while she was taking codeine and the child died.4
The Detoxification Process
People addicted to opioids like codeine often first go through detox before continuing on with longer-term rehab. Remember that detox is a process that takes time as your body rids itself of the drug, so if you are scared of what you may experience during this time, you can enter a facility that provides medical assistance and supervision (i.e., medical detox). Depending on your level of physical dependence and your overall addiction severity, you may be given a prescription to help manage the discomfort associated with your withdrawal symptoms. Medications used to treat opioid dependence—like buprenorphine or Suboxone—may be administered to help manage any cravings for codeine.5
Depending on your situation, you may detox in one of the following settings:
- Detox programs operated in inpatient or residential facilities are good options if your addiction to codeine is severe. These inpatient settings are able to provide medical monitoring and around-the-clock care to manage your withdrawal symptoms. Treatment staff will work to keep you as comfortable as possible as they help address any medical or mental health issues that develop during your detox.
- If you are referred to an outpatient facility for detox, you can continue to go to work or school while going in for treatment. If your addiction is less severe, you are in good health, and you have a healthy home environment, this may be a good option for you.
- If you have specific needs related to your physical or mental health, detoxing in a hospital setting can provide you with the most acute type of medical support.
- Certain doctors may be able to provide you with a codeine tapering schedule for your detox. If your addiction is less severe and you are able to visit a doctor’s office routinely, you may be a good candidate for this method of detox.
Rehab Program Options
Once you are fully detoxed and stabilized, you can transition into the next tier of care—usually an inpatient or outpatient substance abuse treatment program. This next phase of treatment will help you dive into the underlying issues fueling your addiction, learn skills on how to prevent relapse, and give you the tools you need to continue a life of sobriety outside of a treatment setting. Some rehab programs are operated out of inpatient medical healthcare facilities, while others may take place in a more residential setting. No matter which program you ultimately select, many rehab programs will consist of a combination of services, such as:
- Life skills training.
- Individual counseling.
- Group counseling.
- Family counseling.
- Gym access.
- Art therapy.
- Equine therapy.
- Drug and alcohol education.
As part of your codeine addiction treatment program, drug and alcohol education sessions occur on both an individual and group basis to help you better understand how addiction changes your brain and how it influences every part of your life. Individual counseling sessions are designed to help you deal with the specific aspects of your addiction and address the underlying issues that may be contributing to your drug abuse. When people participate in group counseling sessions, a number of topics may be discussed, including:
- Processing feelings.
- Grief and loss.
- Coping skills.
- Family conflict.
- Anger management.
- Drug-free pain management.
- Co-occurring or dual diagnosis disorders (i.e., concurrent mental health and substance use disorders).
- Relapse prevention.
- Life skills.
- HIV education.
To choose the best treatment option, remember that addiction and recovery look different for every person. Take your time to find the best fit for you.
- Bhandari, M., Bhandari, A., & Bhandari, A. (2011). Recent Updated on Codeine. Pharmaceutical Methods, 2(1), 3–8.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th). Arlington, VA: American Psychiatric Publishing.
- U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal. MedlinePlus.
- Reece-Stremtan, S., Marinelli, K.A., & Academy of Breastfeeding Medicine. (2015). ABM clinical protocol# 21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3), 135–141.
- Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration. Pp. 4–5, 13–30, 55, 66–74.