Codeine and hydrocodone are opioid painkillers. Both are chemically similar to heroin, but their pharmaceutical nature can make them seem safe for everyday use.
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.
Understanding 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.
Codeine is U.S. Food and Drug Administration (FDA) approved for pain. Doctors also use this medication to help people struggling with coughing and restless legs syndrome.[1]
Slang terms for codeine include Captain Cody, Cody, and school boy. Some codeine formulations also include Tylenol, and users often call these pills doors and fours. When codeine is mixed with alcohol and soda, it’s often called purple drank, lean, or sizzurp.
Hydrocodone is a strong opioid medication that is FDA approved for pain and coughing. Doctors only use this medication when other therapies (like aspirin) don’t work.[2] Some hydrocodone formulations include acetaminophen or ibuprofen.
Slang terms for hydrocodone include hydros and Watsons. It is also sometimes referenced by the brand name Norco.
Experts say hydrocodone has been the second most commonly encountered opioid submitted to forensic labs since 2009.[3] This suggests dealers are either stealing the drug from pharmacists to sell to customers or manufacturing the drug in clandestine labs.
How Do These Medications Work?
Codeine and hydrocodone are both opioids. While codeine comes from poppy sap and hydrocodone is partially synthetic, they work in the same way.
Prescription opioids are generally considered safe when taken as directed for short periods of time.[4] However, repeated use of hydrocodone and codeine can cause radical changes deep within the brain that may spark an opioid use disorder.
Codeine & Hydrocodone: A Comparison
Understanding the differences and similarities between these drugs can help you determine which is right for you.
| Factors | Codeine | Hydrocodone |
| Drug Class | Natural opioid | Semi-synthetic opioid |
| Drug Schedule | Schedule II to Schedule V depending on the product | Schedule II |
| Brand Names | Tylenol with codeine, Robitussin AC | Vicodin, Norco, Lortab, Zohydro, |
| Common Uses | Pain relief, cough suppressant, restless legs syndrome | Pain relief, coughing |
| Dosage | Varies; example dose is 15 mg to 30 mg every 4 hours as needed | Varies: example dose is 10 mg every 12 hours |
| Warnings | FDA warning for addiction, overdose and drug interactions with CNS depressants | FDA warning for addiction, overdose, drug interactions with CNS depressants and a warning against combining with alcohol |
| Drug Interactions | Avoid taking with other CNS depressants, including benzodiazepines | Avoid taking with other CNS depressants, including benzodiazepines |
| Misuse Potential | High | Very high |
| Common Street Names | Lean, Purple Drank, Sizzurp, Texas Tea, Captain Cody | Fluff, Hydros, V-itamin, Vic, Vike |
Side Effects of Codeine & Hydrocodone
Using opioids like codeine and hydrocodone can cause unpleasant side effects. The discomfort you might experience can vary between the two drugs.
| Codeine | Hydrocodone | |
| Individual Side Effects | Lightheadedness, Shortness of breath, Sweating, Changes in vision, Seizures | Itching, Loss of appetite, Difficulty urinating, Tight muscles, Hives or itching |
Common Side Effects | Dizziness, Drowsiness, Constipation, Nausea, and vomiting | |
Addiction Potential: Is One More Addictive Than the Other?
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.
Hydrocodone is stronger than codeine, and in a head-to-head comparison, hydrocodone has a higher misuse potential. 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 codeine.
Key Differences Between Codeine & Hydrocodone
While codeine and hydrocodone share many characteristics, important differences separate them. They include the following:
- Strength: Hydrocodone is 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.[6]
- Uses: Doctors use codeine to help with restless legs syndrome, but they don’t use hydrocodone for this purpose.
- Digestion: Codeine converts to morphine in the brain. Hydrocodone breaks down into norhydrocodone and hydromorphone.
- Origin: Codeine is a naturally occurring opioid derived from the poppy plant, while hydrocodone is partially synthetic.
- Risks: Hydrocodone also comes in extended-release formulations that people can misuse by crushing and snorting the pills. Doing so means getting a massive dose of drugs all at once, altering receptors dramatically.
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
- Peechakara B, Tharp J, Gupta M. Codeine. StatPearls. Published February 13, 2023. Accessed July 24, 2023. https://www.ncbi.nlm.nih.gov/books/NBK526029/
- Cofano S, Yellon R. Hydrocodone. StatPearls. Published October 24, 2022. Accessed July 24, 2023. https://www.ncbi.nlm.nih.gov/books/NBK526029/
- Hydrocodone. Drug Enforcement Administration. Published October 2019. Accessed July 24, 2023. https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf
- Safe Opioid Use. U.S. National Library of Medicine. Published July 18, 2023. Accessed July 24, 2023. https://medlineplus.gov/safeopioiduse.html
- U.S. overdose deaths in 2021 increased half as much as in 2020, but are still up 15%. Centers for Disease Control and Prevention. Published May 11, 2022. Accessed July 24, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm
- Opioid conversion table. Chronic Pain Management Toolkit. Accessed July 24, 2023. https://www.aafp.org/dam/AAFP/documents/patient_care/pain_management/conversion-table.pdf
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