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Codeine vs. Vicodin: Is One More Addictive?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 13, 2023 • 6 cited sources

With codeine and Vicodin, one is not necessarily more addictive than the other, though some features of Vicodin lend itself to having a higher addiction potential.

Codeine and Vicodin are prescription painkillers. They latch to the same brain receptors, trigger the same chemical release and are capable of causing changes that lead to opioid use disorder (OUD).

In studies of people who misuse drugs, people rank Vicodin the most attractive of all opioids.[1] Research like this suggests that Vicodin has a higher addiction potential than codeine. 

But research comes with limitations. While a friend or neighbor’s brain might respond strongly to Vicodin, you might feel that response about codeine. And no opioid is truly safe. Any drug in this classification is capable of causing an addiction with repeated use. 

Codeine & Vicodin: The Basics

Researchers say oxycodone is the most widely misused prescription opioid drug, and most people who misuse it give it high likeability scores and feel incapable of quitting it once they start.[2] Codeine and Vicodin are less researched and notorious. But they are still very dangerous and should be approached with caution. 

What Is Codeine?

Codeine is a generic drug sometimes combined with acetaminophen or blended into cough syrups. In some countries, it’s sold over the counter to people with coughs or mild pain.

For many people, codeine serves as an introduction to opioid drugs. It’s mild, and due to its many formulations, it’s frequently prescribed for issues like dental pain or sore muscles. 

What Is Vicodin?

Vicodin is a brand-name formulation that combines hydrocodone (an opioid) with acetaminophen. Doctors use Vicodin to address moderate pain, which you might experience due to a broken bone or torn tendon.

Vicodin is incredibly dangerous to misuse, as each dose contains acetaminophen. Too much of that ingredient could harm your kidneys, while too much hydrocodone could cause an overdose. 

Is One Drug More Addictive?

Both codeine and hydrocodone (the active ingredient in Vicodin) are opioids. Take them, and they release dopamine deep within the brain. Euphoria results, and for some people, that change is the first step toward an opioid use disorder. 

While both codeine and Vicodin are addictive, research suggests that one is more dangerous than the other.[3] The following factors contribute to that:

  • Strength: Hydromorphone is much stronger than codeine. A codeine morphine dose equivalent is 200 mg, while the hydrocodone dose equivalent is 30 mg. 
  • Speed: A codeine dose can last 4 to 6 hours, while hydrocodone can last for 3 to 6 hours. The quicker it wears off, the sooner you might take another dose to keep a high going or to stave off withdrawal symptoms. 

Due to these two factors, Vicodin may be more addictive than codeine. 

Signs of Opioid Misuse

Symptoms of problematic use are similar between codeine and Vicodin. Signs to watch for include the following:

  • Using more of the drug than your doctor has prescribed 
  • Chewing, snorting or injecting your doses instead of swallowing pills orally 
  • Feeling sick between drug doses 
  • Using drugs despite consequences, like a job loss or relationship issues

Some people with OUD discuss their drug use regularly, asking people to search their medicine cabinets for doses they can use. But it’s not uncommon for people to keep an OUD hidden for months or even years. 

Opioid Withdrawal Symptoms

Brain cells become accustomed to opioids. Try to quit using opioids abruptly, and you can experience a series of symptoms experts call potentially life-threatening.[4]

During opioid withdrawal, people often experience severe vomiting combined with relentless diarrhea. These two problems combined cause dehydration, which can make your organs shut down one by one.

Along with the physical symptoms, you might experience severe drug cravings. You know one hit can make the problems fade, and your brain might call for drugs repeatedly. 

Relapse is highly likely if you attempt to detox from opioids on your own. With medical assistance and support, success during opioid detox is much more likely.

Overdose Dangers for Both Vicodin & Codeine

Drugs like Vicodin and codeine are central nervous system depressants, capable of slowing breathing and heart rates. Take too much of these drugs, and you can overwhelm your system and lose your life. 

In 2021, more than 80,000 people died due to opioid overdoses.[5] Very strong drugs like fentanyl are often associated with overdoses, but any medication in this class can cause death if you take too much. 

Vicodin or codeine that is bought on the street may be laced with fentanyl. You may take a pill that you think you’re familiar with, only to end up with a much more potent drug that leads to overdose.

People experiencing an opioid overdose seem cold, clammy, slow and sedate. They may not awaken when you tap or shake them. Without quick intervention, people in these episodes can die. Don’t delay in reaching out for help in these situations.

OUD Treatment Options

Researchers define opioid use disorder as a chronic and relapsing disease.[6] Medication for Addiction Treatment (MAT) programs offer very real and life-saving help.

In an MAT program, doctors use medications to help minimizing withdrawal symptoms while you stop misusing drugs. This increases the likelihood that you will stay in treatment. Those same medications can reduce long-term cravings for drugs, allowing you to focus on building a healthy and sober life. 

Bicycle Health uses telemedicine to bring qualified doctors to you, no matter where you live. Conduct all of your appointments online, and pick up your medications at your home-town pharmacy. 

Whether you have been misusing Vicodin, codeine or any other opioid, MAT can help you to stop. Without a focus on opioid misuse, you can build the foundation of a better future. Contact us to find out how this works and see if it’s right for you.

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. Development and Validation of an Opioid Attractiveness Scale: A Novel Measure of the Attractiveness of Opioid Products to Potential Abusers. Harm Reduction Journal. February 2006. Accessed April 2023.
  2. Relative Addictive Potential of Opioid Analgesic Agents. Pain Management. December 2020. Accessed April 2023.
  3. Opioid Conversion Table. American Academy of Family Physicians. Accessed April 2023.
  4. Opioid Withdrawal. Stat Pearls. January 2023. Accessed April 2023.
  5. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed April 2023.
  6. Recovery Is Possible: Treatment for Opioid Addiction. Centers for Disease Control and Prevention. September 2021. Accessed April 2023.

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