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Codeine vs. Hydrocodone: Is One More Addictive?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated May 13, 2023 • 8 cited sources
hydrocodone pills in rx bottle

Codeine and hydrocodone are both lab-synthesized pain medications, typically administered by doctors to help patients who are in pain. These drugs are chemically similar to heroin, but their pharmaceutical ties can make them seem safe for everyday use. 

People who might never consider trying heroin could think misusing codeine or hydrocodone is reasonable. Since the drugs are legal and medically used, they seem innocuous.

In reality, both codeine and hydrocodone are dangerous drugs, and repeated misuse of these drugs is capable of causing physical dependence, withdrawal symptoms, opioid use disorder and overdose. 

Research suggests hydrocodone is stronger — and therefore more addictive — than codeine. But neither drug is safe for long-term misuse. 

What Are Codeine & Hydrocodone?

Hydrocodone and codeine are prescription painkillers in the opioid class. Both are made in laboratories, prescribed by doctors and administered by pharmacists. Both are associated with drug misuse.

Experts say hydrocodone has been the second most commonly encountered opioid submitted to forensic labs since 2009.[1] This suggests dealers are either stealing the drug from pharmacists to sell to customers or manufacturing the drug in clandestine labs. 

Codeine sits at the center of the opioid misuse problem, experts say.[2] It’s often the first painkiller patients take, and for some, it starts a lifetime of drug misuse, leading to opioid use disorder and all its associated problems. 

Are These Drugs Dangerous to Misuse?

Prescription opioids are generally considered safe when taken as directed for short periods of time.[3] However, repeated use of hydrocodone and codeine can cause radical changes deep within the brain that may spark an opioid use disorder.

Both hydrocodone and codeine prompt brain cells to release the neurotransmitter dopamine. Users describe a rush of sensation, followed by deep relaxation. 

For patients who are in pain, these changes are very helpful. But sometimes, people become attached to the euphoria or the pain relief the drugs bring, and they develop an unhealthy relationship with their drugs. 

Is One Drug More Addictive Than the Other?

Experts agree that oxycodone is the most addictive of all opioids.[4] But hydrocodone is stronger than codeine, and in a head-to-head comparison, hydrocodone has a higher misuse potential. 

Hydrocodone is much stronger than codeine. Doctors use a conversion factor to help them determine how much opioids to give to a patient. Codeine has a conversion factor of 0.15, while hydrocodone has a conversion factor of 1.[5]

Stronger drugs produce bigger chemical reactions within your brain, potentially altering your receptors and impairing your ability to control drug use. Since hydrocodone is stronger, it’s likely more addictive than oxycodone.

Hydrocodone also comes in extended-release formulations that users can crush and snort.[6] Doing so means getting a massive dose of drugs all at once, altering receptors dramatically. 

Researchers say these formulations tend to be popular with those who misuse drugs, as they know they will feel a transformation with each dose they take. These formulations are considered very addictive as a result. 

Signs of Opioid Misuse

Anyone can develop a problematic relationship with opioids, including people who were introduced to drugs via a prescription.

Doctors look for the following three Cs when assessing their patients for drug misuse:[7]

  • Control: People ask for early refills, search for opioids from friends or neighbors and display withdrawal symptoms. They have lost control of their use of the drug.
  • Cravings: People ask for stronger doses and reject any therapies that don’t involve drugs. Because of their strong cravings for the drug, they are focused on getting and using it.
  • Consequences: People take enough to seem sedated and spend more time using drugs instead of doing things they once enjoyed. Regardless of negative consequences, they continue misusing the drug.

Families may notice that the person they love seems tired, sedated or simply absent. And they may notice empty pill bottles in the person’s room or car. 

Do Codeine & Hydrocodone Cause Withdrawal?

All opioid drugs are capable of causing uncomfortable withdrawal symptoms after long-term use. Due to physical dependence, brain cells become accustomed to functioning in the constant presence of drugs. Flu-like symptoms can appear when someone tries to quit abruptly. 

In advanced cases of drug misuse, people experience withdrawal between their doses. They seek out more of the drug just to keep withdrawal at bay.

Do These Drugs Cause Overdose?

Opioids are central nervous system depressants, capable of slowing breathing rates enough to cause tissue death. An opioid overdose is a life-threatening event that happens in slow motion. Someone may seem sleepy one moment, and without prompt treatment, can experience brain death. 

In 2020, more than 68,000 people died due to opioid overdoses.[8] Both codeine and hydrocodone can cause this problem. And once misuse begins and dosages increase over time as tolerance builds, it’s easy to take too much and overdose.

MAT Programs for Codeine & Hydrocodone

A Medication for Addiction Treatment (MAT) program is a life-saving solution for people who misuse codeine, hydrocodone or any other opioid. In these programs, doctors prescribe medications like Suboxone (buprenorphine/naloxone) to address longstanding chemical imbalances, soothing both cravings and withdrawal symptoms. With withdrawal managed, people are able to focus on the work they are doing in counseling and therapy, helping to build a strong foundation in recovery.

Anyone can enroll in an MAT program, and telemedicine makes treatment convenient. Doctors conduct your appointments via computers, and you pick up your medications in a nearby pharmacy. 

With this kind of care, you’ll get the help you need without violating your privacy. Contact us here at Bicycle Health to find out more. We’re ready to help you get on the path to a better life.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Hydrocodone. Drug Enforcement Administration. October 2019. Accessed April 2023.
  2. Codeine. StatPearls February 2023. Accessed April 2023.
  3. Safe Opioid Use. U.S. National Library of Medicine. August 2018. Accessed April 2023.
  4. Likeability and Abuse Liability of Commonly Prescribed Opioids. Journal of Medical Toxicology December 2012. Accessed April 2023.
  5. Opioid Conversion Table. American Academy of Family Physicians. Accessed April 2023.
  6. Abuse Potential with Oral Route of Administration of a Hydrocodone Extended-Release Tablet Formulated with Abuse-Deterrence Technology in Nondependent, Recreational Users. Pain Medicine January 2017. Accessed April 2023.
  7. Recognizing Opioid Abuse. National Institute on Drug Abuse. Accessed April 2023.
  8. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed April 2023.
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