Famous for its use in cough syrups and over-the-counter cold medications, codeine is the most widely used opioid medication in the world. Due to its effectiveness for pain relief, cough suppression, and diarrhea prevention, codeine is a popular medication that is taken by millions of Americans each year.

However, like most opioids, codeine is very addictive and poses a high risk for abuse. Not only does tolerance build quickly in the body, requiring individuals to take larger doses, but it is also abused as a recreational drug to get high. Codeine’s frequent misuse and high tolerance potential mean that people who take it regularly can experience uncomfortable withdrawal symptoms when they stop using the drug.

However, there is hope for recovery. Numerous treatment options are available for codeine abuse, allowing individuals to restore their health and lead new lives free from addiction.

Before going into the treatment methods that are available for codeine addiction, this article will provide an outline of what codeine is and what the long-term effects of abuse are.

What Is Codeine?

Codeine — 3-methylmorphine — is an opioid-based drug that is used to treat mild or moderate pain, diarrhea, and coughs. Like other opioids, codeine is derived from the sap of the poppy plant. It is converted into morphine once it is metabolized in the liver.

In over-the-counter medications, codeine is often mixed with other pain relievers, such as Tylenol and Aspirin, to alleviate symptoms of cold or flu. Listed as one of the world’s essential medicines by the World Health Organization (WHO), codeine is cited as the most used opioid, with over 249,000 kg of it being used in 2013 alone.

Some of the common street names for codeine include:

  • Cody
  • Schoolboy
  • Loads
  • Pancakes
  • Syrup
  • Fours
  • Doors
  • Purple Drank
  • Sizzurp

How Does Codeine Work?

When it comes to pain relief, codeine works by interacting with the opioid receptors in the brain and nervous system. This leads to a decrease in pain and in how a person perceives pain. While the exact mechanism is not known, codeine converts to morphine in the body; however, it does not always eliminate the pain completely. Therefore, codeine is often mixed with other painkillers, like Tylenol or Aspirin, to maximize pain relief.

In terms of its other medicinal uses, codeine also suppresses the signals in the brain that trigger the cough reflex. This makes it a useful remedy for the common cold. When taken as a codeine sulfate tablet, codeine also works to prevent diarrhea by slowing down the passage of stool through the intestines.

Is Codeine Addictive?

The short answer is, yes. Codeine is a highly addictive opioid painkiller that has a strong reputation for abuse. Like many opioids, the body builds up a tolerance to codeine, requiring an individual to take higher and higher amounts. This tolerance then leads to physical dependence on the drug, as well as strong withdrawal symptoms if the person stops taking it. This cycle of tolerance and dependence can easily lead to a cycle of addiction.

Psychologically, codeine can also become addictive if a person uses the drug for emotional reasons or if they find it difficult to feel normal without it. Many individuals experience anxiety or depression if they stop taking codeine and become psychologically dependent.

Codeine Addiction Vs. Dependence

When it comes to drug abuse, there is a slight difference between dependence and addiction. Dependence, for example, is a state of adaptation in the body that develops after repeated use of the drug. In this state, a person isn’t mentally obsessed or attached to the drug. However, if the drug is discontinued abruptly, withdrawal symptoms can occur and the person may require medical assistance to taper off.

Addiction, on the other hand, is considered a chronic, primary disease that is marked by compulsive use, cravings, and continued use, despite any negative consequences. Therefore, if a person is addicted to codeine, they will be obsessed with taking it habitually and will usually take more of it than prescribed. People who have an addiction feel unable to function normally without the drug and will go to any lengths to keep taking it.

Statistical Overview of Prevalence of Abuse

Codeine is the most widely used opiate in the world, with roughly 300,000 kg of it being produced in any given year.

Other statistics include:

  • An estimated 33 million people use codeine every year (between 7% and 8% of the population).
  • The 2008 National Survey on Drug Use and Health reports that roughly 4.7 million Americans used prescription pain relievers, including codeine, for non-medical purposes that year.
  • Between 1999 and 2019, the Centers for Disease Control and Prevention (CDC) estimate that 500,000 people died of an opioid overdose.
  • According to the National Institute on Drug Abuse, nearly 50,000 people died of an opioid overdose in 2019 alone.
  • In 2016, more than 11.5 million Americans reported misusing prescription opioids in the past year.
  • According to the 2010 Drug Abuse Warning Network (DAWN) Report, 81,365 emergency room admissions were due to a combination of opioids and alcohol.

The History of Codeine

The name codeine is derived from the Ancient Greek word, “poppy head.” Throughout history, the opium poppy has been cultivated and synthesized for its active compounds, which consist of morphine, codeine, and papaverine. These components have been used for a variety of medicinal and illicit purposes, ranging from pain relief to aiding sleep.

Before the 19th century, raw opium was used as a pain reliever in the form of elixirs known as “laudanum.” Over time, chemists learned how to isolate opium’s active components to create more effective medicines. For example, in 1804, morphine was isolated by a German chemist named Friedrich Sertürner. Codeine was subsequently isolated in 1832 by Pierre-Jean Robiquet, a French scientist who is also credited with isolating caffeine.

While codeine was originally extracted directly from opium, modern firms synthesize it from morphine (as it is more abundant in this form) through a chemical process known as “O-methylation.” Since the drug was first discovered and synthesized, codeine has been converted into numerous types of preparations for various purposes.

In its modern form, codeine is the most abundant opioid drug on the planet, as well as one of the most widely used, according to reports from the World Health Organization (WHO).

Methods of Use

Codeine comes in a tablet, solution, or syrup form and can be ingested or injected. The tablets are white and come in three different dosages: 15mg, 30mg, and 60 mg. In terms of its effects, codeine starts working within 30 minutes to an hour and reaches its maximum effectiveness within 3 to 4 hours.

Dosage

The usual dose for pain relief is 30-60 mg every four hours and should not be repeated. The maximum daily dose of codeine is 240 mg.

For syrups or solutions, the typical dose is 5 ml every 4 to 6 hours, not to exceed 30 ml in 24 hours.

Physical and Neurological Effects of Codeine

Codeine influences brain chemicals and receptors that are responsible for pain, mood, and appetite. Some of the initial effects that a person may experience when taking codeine include:

  • Euphoria
  • Apathy
  • Drowsiness
  • Relaxation

Potential Side Effects

Codeine can also cause uncomfortable side effects, especially if it’s being abused or used in excess. These include:

  • Dizziness or drowsiness
  • Low blood pressure
  • Nausea, vomiting, or stomach pain
  • Constipation
  • Sweating
  • Itching
  • Urination problems
  • Seizures
  • Extreme happiness or extreme sadness
  • Slow heart rate, weak pulse, fainting, or shallow breathing
  • Confusion, agitation, hallucinations, or unusual thoughts or behaviors

Common Codeine Combinations

While codeine is primarily prescribed for medicinal purposes, many people abuse the drug to get high. It is also combined with other substances to maximize its intoxicating effects. Some of the most frequent combinations include:

Purple Drank

One of the most famous ways to abuse codeine as a recreational drug is to create a drink called “purple drank.” This is made by mixing prescription-grade codeine syrup with soft drinks, such as Sprite or Mountain Dew. The drink is often taken in large amounts and is commonly referred to as “lean,” “syrup,” or “sizzurp.” The issue with purple drank is that it encourages a person to drink large amounts all at once, which can potentially lead to an overdose. Purple drank is a common way to get high and it is often popularized in pop culture (e.g., rap songs) and the media.

Alcohol

Alcohol and codeine are a popular combination, especially with young people. Alcohol is known for increasing the high associated with opioids, but this combo is particularly dangerous, as both drugs are nervous system depressants. While alcohol targets the GABA system and codeine affects the opioid receptors, together they influence serotonin and dopamine neurotransmitters, leading to increased euphoria.

The problem with combining alcohol and codeine is that both cause sedation and can lead to respiratory depression. This means a person can take in too little oxygen and exhibit slowed breathing. Alcohol and codeine combinations can also lead to overdoses, coma, and seizures.

Xanax

Individuals are also known to mix Xanax (or other benzodiazepines) and codeine; however, this combination is hazardous. Like alcohol, both substances depress the central nervous system, which can lead to over-sedation and dangerously slowed breathing. Xanax and codeine are both known to depress the respiratory system, so individuals who abuse these drugs are putting themselves at risk for seizures, coma, or respiratory failure.

Another issue with Xanax and codeine is that tolerance develops quite quickly with these drugs, which means individuals need to take higher doses to feel any effects. This poses the potential for lethal overdoses, because a person’s increased tolerance can lead them to take more of both drugs than they would normally.

Other Opioids

Like alcohol, opioids are nervous system depressants, so combining these drugs with codeine can lead to coma, respiratory failure, and death. Individuals who abuse codeine and opioids may also combine other prescription opioids, like OxyContin, to enhance the high. The danger is that increased tolerance to these drugs can also lead a person to switch to stronger opioids, like heroin or fentanyl, to achieve a the desired effect.

Cannabis

While cannabis is not a depressant, certain compounds within it can depress the central nervous system. Therefore, combining codeine with cannabis can be dangerous because of the enhanced sedative effects. Research has indicated that people who use cannabis are more likely to misuse prescription opioids and develop an addiction. Studies have also shown that mixing cannabis and opioids can lead to increased anxiety and depression.

Negative Health Consequences

Long-term codeine use can lead to damaging effects on a person’s physical and mental health. Some of the potential consequences include:

  • Depression
  • Anxiety
  • Gastrointestinal disturbances
  • Pain
  • Fatigue
  • Impaired memory
  • Liver damage
  • Kidney damage
  • Muscle spasms
  • Death

Overdose

Another important thing to look out for is a potential codeine overdose. Key signs and symptoms of an overdose include:

  • Slow, labored breathing
  • Cold, clammy skin
  • Extreme drowsiness or fatigue
  • Dizziness
  • Weakness
  • Lightheadedness
  • Loss of consciousness
  • Low blood pressure
  • Intestinal spasms
  • Muscle twitches
  • Weak pulse
  • Bluish lips or fingernails

Signs & Symptoms of Codeine Addiction


Codeine can be both physically and psychologically addictive, especially if it is used for sustained periods. The signs and symptoms of addiction can vary from person to person, depending on how much they take and how long they’ve used it. However, there are key signs to watch out for.

Physical Signs of Addiction

Individuals who regularly take codeine for long periods can exhibit physical signs of addiction, such as:

  • Blue lips
  • Drowsiness
  • Slurred speech
  • Short attention span
  • Impaired judgment
  • Stomach pain
  • Dilated pupils
  • Lack of coordination
  • Changes in vision
  • Apathetic behavior
  • Sleeping more than usual
  • Nodding off
  • Clammy hands or feet
  • Nausea/irregular appetite

Behavioral Signs

Any sudden changes in behavior can be clear indicators of a problem. Some of the behavioral signs of codeine addiction also apply to other drug dependencies, and may include:

  • Running out of prescriptions early
  • Faking symptoms to get codeine prescriptions
  • Hiding or lying about codeine use
  • Difficulties controlling codeine use
  • Frequently taking codeine
  • Continuing to use codeine, despite any negative side-effects
  • Isolation from work, family, and social life
  • Loss of interest in activities or hobbies
  • Insomnia or over-sleeping
  • Worsening performance at school or work
  • Suspicious behavior
  • Abusing other substances (poly-substance)
  • Relationship problems

Other Abuse Signs

Aside from the signs above, there are other identifying behaviors to watch out for if you suspect someone has a codeine addiction.

“Doctor Shopping”

Doctor shopping is a common behavior exhibited by people who abuse prescription drugs. Because doctors will only prescribe a limited amount of codeine, a person who is addicted and taking larger amounts than prescribed will often visit multiple doctors. This allows them to gain several prescriptions at once and then fill them out at different pharmacies. Doctor shopping is often a more extreme sign of prescription drug addiction as the person is going to great lengths to acquire more of the drug. Individuals will also tend to travel great distances to new pharmacies so that they remain undetected.

Mood Swings

A common symptom of people who are addicted to drugs is mood swings. While each drug produces different effects when they’re abused, people who are struggling with addiction can often suffer from sudden mood changes. This can be due to the way that certain drugs affect the neurotransmitters responsible for mood, and it can also be due to a person’s feelings of guilt and shame about their drug use. If you or someone you know is having mood swings (which are not normally part of their personality), then it may be a sign of ongoing addiction.

Financial Problems

Financial problems are another hallmark trait of people who are suffering from addiction. While some drugs are cheaper than others, codeine is usually only available by prescription, which means the cost can add up. Individuals may exhibit signs such as not being able to buy food, frequently running out of money, and being unable to afford their rent and bills. Also, long-term drug use can lead to job losses or an inability to acquire a new one, which can result in a downward spiral of substance abuse, debts, and financial problems.

Resources

If you or a loved one are struggling with codeine abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Centers for Disease Control and Prevention (CDC). (2021). Opioid Data Analysis and Resources. CDC.gov. https://www.cdc.gov/drugoverdose/data/analysis.html.

Hensler, J. (n.d.). 4 Signs of Codeine Addiction You Probably Didn’t Know. WebMD. https://www.webmd.com/connect-to-care/addiction-treatment-recovery/prescription/signs-of-codeine-addiction.

Jones, C., Paulozzi, L., Mack, K. (2014). Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths — United States, 2010. Morbidity and Mortality Weekly Report (MMWR). 63(40), 881-885. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm.

National Institute on Drug Abuse (NIDA). (2021). Opioid Overdose Crisis. Drugabuse.gov. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis.

RxList. (2020). Codeine Sulfate. RxList. https://www.rxlist.com/codeine-sulfate-drug.htm#description.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.