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Codeine Addiction & Abuse: Signs, Dangers & Treatment

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Sep 14, 2023 • 10 cited sources

Codeine is a prescription painkiller in the opioid class. Doctors typically use it to address mild or moderate pain. Codeine is available as a solo product, but it’s often mixed with other ingredients (like aspirin) to combat pain on multiple fronts.[1]

Like all opioids, codeine attaches to receptors in the brain, triggering the release of powerful euphoric chemicals. Some people initially use codeine for pain relief but then progress to chronic use of the drug to recapture euphoria and manage withdrawal symptoms. 

Codeine is an opioid, and with repeated use, it can work less effectively. Some people change the way they take the drug (such as crushing and snorting it) or switch to stronger opioids (like heroin) to avoid painful withdrawal symptoms. For people like this, codeine is a gateway to significant and powerful struggles with drug misuse. 

Medication for Addiction Treatment (MAT) programs use medications and therapies to combat opioid-related damage. Enrolling in these programs could help you quit all opioid misuse for good.

How Addictive Is Codeine?

Experts say codeine is at the center of America’s opioid addiction problem.[2] It’s the most commonly taken opioid, and for many people, it serves as an introduction to stronger drugs. 

Codeine enters the bloodstream quickly, and it crosses into brain cells within minutes. Once there, it latches to opioid receptors and triggers chemical reactions. Codeine stays active in the body for hours, but euphoria wears off more quickly. Some people take repeated doses to keep the high going.

Other opioids (like fentanyl) are stronger than codeine, and they’re often associated with higher rates of opioid use disorder (OUD). But since codeine offers the first taste of opioids for many people, it’s considered very dangerous. 

Who Misuses Codeine?

Opioid use disorders don’t discriminate. Anyone can misuse these medications, including those with a valid prescription. 

Doctors often use codeine to help their patients recover from dental procedures, muscle strains or acute pain. And in many parts of the world, codeine is available without a prescription.[3] Vast numbers of people use these products, and many are misusing them. 

Why Is Codeine Dangerous?

Years ago, doctors considered codeine relatively harmless. People used the drug to address almost every type of pain, and they gave it to uncomfortable children too. 

As the risks of opioids became clear, prescribing habits changed. In fact, officials at the U.S. Food and Drug Administration became so concerned about codeine that they required a Black Box Warning on the label of each product.[4]

That label says codeine can cause misuse, abuse, addiction, overdose and death. It also tells parents that these drugs are too risky to give children, even if they’re in pain. 

Known codeine side effects include the following:[5]

  • Slow respiration
  • Low blood pressure
  • Slow gastric movement, leading to constipation
  • Drowsiness
  • Dizziness
  • Shortness of breath
  • Nausea
  • Vomiting 

People taking the drug as prescribed by a doctor can experience some or all of these problems. Those who misuse the drug could face even more significant issues.

Your body becomes accustomed to codeine, and in time, you will need larger doses. Without them, you may feel sick between each dose. Sometimes, people switch to stronger opioids due to this tolerance. 

While you might crave codeine for the chemical changes it delivers, the drug can also suppress your nervous system, leading to profound sedation and death. Anyone who takes codeine for long periods or uses too much could face this problem. 

Signs & Symptoms of Codeine Addiction

Addiction is a mental health issue caused by drug misuse. Anyone who takes codeine for long periods could develop opioid use disorder, characterized by compulsive use despite the consequences. 

Someone with codeine addiction (or OUD) might display the following symptoms:

  • Taking the drug more often than recommended
  • Skipping work or social obligations to make time for drug use 
  • Using codeine in unsafe situations, such as while driving
  • Continued use despite known consequences, like a job loss or family fight
  • Spending money on codeine instead of rent or food

Someone with codeine addiction may feel psychologically unable to quit the drug — and they may want to do so. Chemical changes caused by codeine make quitting very difficult. This isn’t as simple as being a willpower problem. Instead, it’s an issue caused by drug-related changes to brain cells. 

Symptoms of Codeine Withdrawal 

After long-term use, your body becomes accustomed to the continual presence of codeine. If you quit using it abruptly, you may develop a series of uncomfortable symptoms. Opioid withdrawal is a life-threatening consequence of codeine physical dependence.[6]

Codeine withdrawal symptoms include the following:

  • Anxiety
  • Diarrhea 
  • Goosebumps 
  • Insomnia
  • Nausea
  • Muscle aches 
  • Runny nose 
  • Vomiting
  • Watery eyes

Without treatment, these symptoms can lead to severe dehydration, harming your organs. People struggling with withdrawal may also relapse to opioid misuse, and they could overdose on the first dose they take, particularly since they may take the same dose they previously took, even though their tolerance has lowered.

Can You Overdose on Codeine?

All opioids are central nervous system depressants, capable of slowing breathing rates. Take too much, and these drugs can stop you from breathing altogether. An opioid overdose is life-threatening. 

In 2020, 4.9 deaths per 100,000 people were caused by commonly prescribed opioids like codeine. In that same period, 17.8 people in 100,000 died from overdoses to synthetic opioids like fentanyl.[7] Stronger drugs come with a higher overdose risk. But no opioid, including codeine, is completely safe. 

Many people who overdose while using codeine take other drugs at the same time. In one study, close to 84% of codeine-related deaths also involved other drugs.[8] But taking codeine alone can also cause a fatal overdose. 

Signs of a Codeine Overdose

People who overdose may exhibit the following signs:[9]

  • Blue-tinged fingernails and lips 
  • Slow or shallow breathing
  • Cold skin
  • Confusion or stupor 
  • Loss of consciousness 
  • Low blood pressure 
  • Tiny pupils 

You can overdose while taking a dose that seems safe. You can also overdose on drugs you obtain from a pharmacy. 

Using MAT for Codeine Addiction Treatment 

Medication for Addiction Treatment (MAT) programs are designed to alter the chemical imbalances that make quitting codeine so difficult. 

Medications like Suboxone (buprenorphine/naloxone) are weak opioid agonists that link to the same receptors used by codeine. These medications won’t make you feel high, but they can help to block severe drug cravings and withdrawal symptoms. Using them can give you a clear head, so you can build a healthy life without drugs.

The goal of MAT is to help re-establish the ability to live a self-directed life.[10] If you’re struggling to quit codeine, these therapies could offer the help you need.

Bicycle Health uses telemedicine techniques to deliver MAT where you are right now. Talk with a doctor via a video chat, and pick up your medications at your pharmacy. You’ll then stay in touch with your doctor and a caring team of professionals, and start living the life you always wanted. 

Contact us to find out if this program is right for you. You don’t have to wait another day to get started on your journey 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. Codeine Information. U.S. Food and Drug Administration. January 2018. Accessed March 2023.
  2. Codeine. StatPearls February 2023. Accessed March 2023.
  3. Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013-2019: A Retrospective Observational Study. Drug Safety January 2022. Accessed March 2023.
  4. FDA Drug Safety Communication: FDA Requires Labeling Changes for Prescription Opioid Cough and Cold Medicines to Limit Their Use to Adults 18 and Older. U.S. Food and Drug Administration. January 2018. Accessed March 2023.
  5. Codeine Prescribing Information. U.S. Food and Drug Administration. April 2013. Accessed March 2023.
  6. Opioid Withdrawal. StatPearls January 2023. Accessed March 2023.
  7. Overdose Death Rates Involving Opioids, by Type, United States, 1999-2020. Centers for Disease Control and Prevention. May 2022. Accessed March 2023.
  8. Trends and Characteristics of Accidental and Intentional Codeine Overdose Deaths in Australia. Medical Journal of Australia October 2015. Accessed March 2023.
  9. Codeine Overdose. U.S. National Library of Medicine. July 2021. Accessed March 2023.
  10. Medications for Substance Use Disorders. Substance Abuse and Mental Health Services Administration. February 2023. Accessed March 2023.

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