Codeine Addiction: Symptoms, Effects, and Recovery Options

Codeine is an opioid medication prescribed by physicians for pain management, though it's also utilized in cough suppressants. Similar to other opioids like hydrocodone or morphine, Codeine can be misused. Some individuals develop Codeine dependency, characterized by a compelling urge to continue using the substance despite its harmful consequences.

Indicators of Codeine dependency include intense urges for the drug, withdrawal manifestations when usage stops, failed efforts to discontinue Codeine consumption, and dedicating substantial time and financial resources to acquiring, consuming, and recuperating from Codeine.

Individuals struggling with Codeine dependency may falsify medical prescriptions and participate in other dangerous behaviors merely to secure the substance. They encounter numerous physical symptoms including alterations in appetite and body weight, lightheadedness, difficulty urinating, and fluctuations in blood pressure and cardiac rhythm.

Codeine's impacts can be categorized as either immediate or enduring. Immediate effects involve temporary responses to the substance, such as queasiness and emesis, oral dryness, cognitive lapses, and exhaustion. Enduring effects of Codeine encompass damage to vital organs, monetary difficulties, encounters with law enforcement, and complications in personal connections.

Is codeine addictive?

Yes, codeine is addictive. Codeine is a prescription opioid used to treat mild to moderate pain and suppress coughing, but like other opioids, it has the potential to cause both physical dependence and psychological addiction. When taken regularly, especially in higher doses or for longer than prescribed, the body can build tolerance, requiring more of the drug to achieve the same effects. This cycle can lead to misuse, dependence, and ultimately addiction.

Addiction to codeine is marked by compulsive drug-seeking behavior, cravings, and continued use despite negative consequences. Over time, users may experience withdrawal symptoms such as nausea, muscle aches, anxiety, and insomnia when they try to stop. Even though codeine is considered less potent than opioids like oxycodone or heroin, its chemical structure is similar, and it can produce comparable effects, particularly when misused. Because of this, it is classified as a controlled substance and should be used strictly under medical supervision.

What is codeine addiction?

Codeine dependency is a compelling need to consume Codeine, heightened tolerance levels, and withdrawal reactions upon cessation. Codeine represents a prescribed medication administered for mild to moderate pain relief. It belongs to the opioid category of pharmaceuticals.

It possesses misuse potential and results in both physiological addiction and chemical dependence. Those experiencing Codeine dependency feel an intense need or longing to maintain their usage, regardless of the difficulties they face.

Codeine is manufactured as pills, yet it's also available in liquid formulation for suppressing coughs. Every opioid substance, including Codeine, can form habits. Individuals misuse Codeine seeking its relaxing properties.

Codeine exhibits lower strength when compared with alternative opioids like morphine. Nevertheless, its molecular composition resembles more potent substances such as morphine and hydrocodone. Consequently, it triggers comparable bodily responses.

Codeine addiction is classified within the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) by the American Psychiatric Association among disorders related to opioid consumption.

What are the street names for codeine?

Street names for codeine denote the casual, slang expressions employed to identify this opioid substance in illicit or recreational settings. The informal designations for Codeine are enumerated below:

• Sizzurp
• Purple jelly
• Purple stuff
• Cody
• Captain Cody
• Little C
• Schoolboy
• Lean
• Purple tonic
• Sip-sip
• Player potion
• Purp
• Barre
• Purple drank (when combined with promethazine)
• Doors & fours (when combined with glutethimide)
• Loads (when combined with glutethimide)
• Pancakes and syrup (when combined with glutethimide)
• Texas tea (when combined with promethazine)

What are the signs of codeine addiction?

Signs of Codeine addiction appear through emotional, behavioral, and physical indicators. The most prevalent symptoms of codeine dependency are cataloged below:

• Depression and anxiety
• Euphoria
• Emotional numbness
• Mood swings
• Sense of calmness and well-being
• Low blood pressure
• Dizziness and fainting
• Urinary retention
• Reduced sex drive
• Hallucinations and delusions
• Impaired memory
• Worsening of mental health
• Trying unsuccessfully to stop taking Codeine
• Withdrawal symptoms when not using Codeine
• Developing tolerance, thereby having to use higher amounts of Codeine to experience the same effects
• Social withdrawal or isolation
• Doctor shopping, i.e,. visiting multiple doctors (often using fake names) to obtain prescriptions for greater amounts of Codeine
• Forging prescriptions to obtain Codeine
• Frequent ER visits and/or faking illness, just to get Codeine
• Borrowing or stealing Codeine from family and friends
• Financial and legal problems
• Losing interest in activities once enjoyed
• Ordering Codeine on the internet
• Spending a lot of time and money on thinking about Codeine, buying, and using it
• Engaging in risky activities such as healthcare fraud
• Lying about the extent of Codeine use
• Impaired performance at work or school
• Sleepiness and nodding off in the middle of conversations
• Indifference toward loved ones and life in general

What does codeine feel like? 

When taken for the first time, codeine typically produces a sense of calm, drowsiness, and pain relief, along with a mild sense of euphoria or emotional numbness. It slows activity in the central nervous system, making users feel relaxed or slightly sedated. Some people also report feeling detached from their surroundings, with reduced anxiety and physical discomfort. Physically, it may cause lightheadedness, a warm sensation throughout the body, and slower breathing. Mentally, it can dull thoughts and reduce emotional intensity.

However, when someone becomes addicted to codeine, the drug’s effects shift. Instead of mild relaxation, it becomes a source of compulsion, used not for relief, but to avoid withdrawal or chase the fleeting calm it once provided. Over time, users may feel less pleasure from codeine and more emotional flatness, mental fog, and fatigue. Instead of comfort, its absence brings cravings, anxiety, muscle aches, and depression. The initial “high” fades, replaced by a cycle of temporary relief followed by growing dependence and emotional instability.

Can codeine get you high?  

Yes, codeine can get you high, especially when taken in higher-than-prescribed doses or misused.

Codeine works by binding to opioid receptors in the brain, which can trigger a release of dopamine, the neurotransmitter associated with pleasure and reward. This creates feelings of euphoria, calm, and emotional detachment, often described as a "high." People may also experience a warm, drowsy sensation and reduced physical or emotional pain.

However, the intensity of the high varies depending on the dose, the individual’s body chemistry, and whether codeine is taken alone or in combination with other substances like promethazine (commonly seen in “lean” or “purple drank”). While the high may feel pleasant at first, repeated misuse quickly leads to tolerance and dependence, requiring larger doses to feel the same effects and increasing the risk of addiction, respiratory depression, and overdose.

What are the possible causes of codeine addiction?

Codeine addiction typically arises from a combination of genetic, biological, psychological, and environmental factors, and can develop even at medically prescribed doses if misused or taken over extended periods. There is no fixed amount of codeine that universally causes addiction, but research indicates that daily doses as low as 60 mg, especially when taken without proper medical oversight, can lead to dependency. A 2022 study published in Obat Pembuktiannya found that repeated, unsupervised use of codeine, especially beyond 7 to 14 days, significantly increases the risk of developing compulsive use behaviors.

Genetic factors play a critical role in this process. A 2014 study published in Current Psychiatry Reviews by Mistry et al. identified specific genetic variations (in DRD2, OPRM1, BDNF, and OPRD1) that heighten vulnerability to opioid dependence. People with a family history of substance use disorders are more likely to develop codeine addiction due to inherited differences in their brain's reward system.

From a biological perspective, abnormalities in the prefrontal cortex, the brain region responsible for impulse control and decision-making, combined with disrupted dopamine signaling, make certain individuals more susceptible to the reinforcing effects of codeine. As tolerance develops, they require larger amounts of the drug just to feel normal.

Psychological factors also contribute. Individuals coping with depression, anxiety, or unresolved trauma may turn to codeine to numb emotional pain. Initially used for relief, it gradually becomes a crutch, leading to tolerance, dependence, and addiction.

Finally, environmental influences such as growing up in a household where substance misuse is normalized, experiencing childhood trauma, or socializing with peers who abuse opioids can further increase the likelihood of addiction. In these settings, access to codeine and exposure to permissive attitudes toward drug use make misuse more likely, and addiction more probable.

How quickly do you get addicted to codeine? 

Codeine addiction can develop relatively easily, especially when the drug is taken in higher doses or for longer than prescribed. As an opioid, codeine activates the brain’s reward system, producing a calming, euphoric effect that can lead to repeated use. According to a study by Nielsen and Hout (2023), even over-the-counter codeine use can escalate from therapeutic use to misuse in a short timeframe, particularly among individuals with underlying vulnerabilities or easy access to the drug.

While addiction typically develops over time, it’s possible for a person to become dependent on codeine in as little as one week, especially with daily use at higher doses. Factors such as genetics, individual brain chemistry, and psychological conditions significantly influence how fast dependence sets in. What begins as legitimate pain relief can quickly spiral into misuse if not carefully managed, making codeine addiction both easier and faster to develop than many expect.

What are the side effects of codeine?

Side effects of codeine refer to the commonly unfavorable physical and psychological outcomes associated with this opioid medication. These effects may occur with short-term or long-term use and can range from mild discomfort to serious, life-threatening complications.

Short-term side effects of codeine include:

• Nausea and/or vomiting
  
• Pinpoint pupils
  
• Dry mouth
  
• Fatigue
  
• Dizziness
  
• Loss of consciousness
  
• Changes in heart rate and blood pressure
  
• Constipation
  
• Stomach pain
  
• Headaches
  
• Sweating
  
• Reduced or depressed breathing
  

A 2020 case series by Wong et al., titled “EPA1011 – A case series of codeine cough syrup–induced low potassium and acute muscle weakness,” also identified muscle weakness and electrolyte imbalances as potential short-term complications in individuals misusing codeine cough syrups.

Long-term side effects of codeine include:

• Liver and/or kidney damage
  
• Intestinal blockage
  
• Difficulty sleeping
  
• Anxiety and/or depression
  
• Memory loss
  
• Cognitive difficulties
  
• Brain damage due to reduced oxygen flow
  
• Severe memory problems, such as amnesia
  
• Seizures
  
• Financial problems
  
• Emotional or relationship issues
  
• Drug-seeking behaviors such as “doctor shopping”
  
• Overdose, coma, and death

Chronic use can also affect reproductive health. A study by Akhigbe and Ajayi titled “Testicular toxicity following chronic codeine administration” found that prolonged codeine exposure may lead to testicular damage, hormone disruption, and reduced fertility in males, an underrecognized but significant long-term consequence of codeine misuse.

Does using cocaine worsen the side effects of codeine?

Yes, using cocaine alongside codeine can significantly worsen the side effects and increase the risk of serious health complications.

Codeine is a central nervous system (CNS) depressant, meaning it slows down brain activity, heart rate, and breathing. In contrast, cocaine is a CNS stimulant that rapidly increases heart rate, blood pressure, and energy levels by boosting dopamine activity. When combined, these two drugs create conflicting effects in the body, a phenomenon known as pharmacological antagonism, which places severe strain on the cardiovascular and nervous systems.

This combination may lead to:

• Irregular heartbeat and cardiac arrest, as the stimulant effects of cocaine and the depressant effects of codeine clash
  
• Respiratory suppression, intensified by codeine’s effects, which may go unnoticed due to cocaine-induced overstimulation
  
• Seizures, confusion, or stroke, as the brain struggles to reconcile the opposing signals
  
• Increased risk of overdose, since cocaine may mask the sedative effects of codeine, leading users to take more than intended
  

Moreover, using both substances together can rapidly accelerate tolerance and dependence, compounding the risk of developing dual addictions and complicating withdrawal and treatment.

Does codeine give you diarrhea? 

No, codeine typically does not cause diarrhea; in fact, it is more likely to cause constipation.

As an opioid, codeine slows down the movement of the gastrointestinal (GI) tract by binding to opioid receptors in the gut. This action reduces intestinal motility, which means food and waste move more slowly through the digestive system. The result is harder, drier stools and less frequent bowel movements, making constipation one of the most common side effects of codeine use.

However, if someone suddenly stops taking codeine after prolonged use, they may experience withdrawal symptoms, one of which can be diarrhea. In that context, diarrhea is not caused by codeine itself but by the body’s response to its abrupt absence.

How do professionals diagnose codeine dependency?

Codeine dependency is diagnosed through a comprehensive evaluation and involves assessment by a psychologist, psychiatrist, or certified addiction specialist.

A 2022 publication entitled "Drug addiction (substance use disorder" from the Mayo Clinic indicated that blood and urine analyses are required, but they don't function as diagnostic instruments for addiction. Rather, they're utilized to track treatment and recovery.

To diagnose substance use disorder, specifically Codeine dependency, a psychiatrist employs DSM-5 guidelines. Regarding diagnostic standards for opioid addictions, such as Codeine dependency, an individual must exhibit at least two criteria within a 12-month timeframe.

These standards include consuming the substance in greater quantities or for extended durations than intended, harboring persistent wishes and failed efforts to discontinue use, and devoting considerable time to acquiring, using, and recovering from the substance.

Additional standards encompass intense urges for Codeine, neglecting responsibilities at home or work/school, persisting with drug use despite resulting problems, abandoning social engagements in favor of substance use, and utilizing the drug in circumstances where physical danger exists.

Ongoing substance use despite awareness of continuing physical/psychological issues caused or exacerbated by the opioid, building tolerance, and encountering withdrawal manifestations represent further diagnostic indicators for Codeine dependency.

What are the codeine addiction statistics?

Accurate statistics on codeine addiction are limited, as most data groups it with other prescription opioids. However, the available research shows that codeine misuse plays a notable role in the wider opioid crisis.

According to the CDC, around 131.7 million opioid prescriptions were dispensed in the United States in 2022, with codeine remaining among the most commonly prescribed opioids. It is estimated that 33 million people use codeine daily. The 2019 National Survey on Drug Use and Health reported that 10.1 million people misused opioids that year, including 9.7 million who misused prescription pain medications, such as codeine.

In the United Kingdom, a study by Kimergård and Foley found rising rates of codeine dependence, particularly from over-the-counter use. Many individuals reported tolerance and problematic use but rarely sought help. Another study by Fogarty linked codeine-containing cold and flu products to 51 overdose deaths, highlighting the risk of non-prescription misuse.

These findings show that codeine, while often considered less dangerous than stronger opioids, contributes significantly to opioid misuse and overdose deaths, both in prescription and over-the-counter forms.

What are the codeine withdrawal symptoms?

The most prevalent Codeine withdrawal manifestations are enumerated below:

• Runny nose
• Teary eyes
• Yawning
• Sweating
• Craving for Codeine
• Difficulty sleeping
• Irritability or anxiousness
• Faster heart rate
• Muscle aches
• Nausea and vomiting
• Enlarged pupils
• Goosebumps or chills
• Loss of appetite
• Weight loss
• Stomach cramps
• Diarrhea 

Codeine withdrawal symptoms develop in two stages. The initial phase arises within hours after the last dose, while the subsequent phase occurs as the body adapts to operating without Codeine.

Withdrawal symptoms usually persist for about a week, though some individuals may experience them for a longer period. Physical symptoms are most intense during the first several days following discontinuation and generally resolve within two weeks. However, cravings and behavioral symptoms can continue beyond this timeframe.

Can dogs become addicted to codeine? 

Yes, dogs can become addicted to codeine if exposed to it over an extended period or in high doses.

Codeine is sometimes prescribed by veterinarians to manage moderate to severe pain in dogs, often in combination with other medications like acetaminophen. Like humans, dogs have opioid receptors in their nervous systems, which means they can respond to opioids similarly. With repeated use, especially without proper medical supervision, a dog’s body may develop tolerance and physical dependence on codeine.

Signs of codeine dependence in dogs may include restlessness, withdrawal-like symptoms if the drug is stopped suddenly, and behavioral changes such as lethargy or anxiety. However, addiction in dogs is less common because veterinary use is typically short-term and carefully monitored.

To prevent risk, codeine should only be used in dogs under the direct supervision of a veterinarian, with strict adherence to dosage and duration. Any sudden changes in behavior during or after treatment should be reported to the vet immediately.

What are the treatments available for codeine addiction?

Treatments for codeine addiction address the physical, psychological, and behavioral aspects of opioid dependence. A combination of medical supervision, behavioral therapy, and structured support is typically recommended to support long-term recovery.

• Detox is the first step, during which the individual stops using codeine and experiences withdrawal symptoms. Depending on symptom severity, medications may be used to reduce discomfort. This approach is part of medication-assisted treatment (MAT), which often includes buprenorphine, naltrexone, or methadone. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT improves survival rates, reduces drug use, and supports long-term recovery.
• Residential treatment programs are ideal for moderate to severe codeine addiction. Patients live at a treatment facility for 60 to 90 days or longer, participating in individual and group therapy. Cognitive-behavioral therapy (CBT) is commonly used to help individuals recognize and change harmful thought patterns, develop coping strategies, and build healthier behaviors.
• Outpatient treatment programs are suited for those with mild to moderate addiction or for individuals transitioning out of residential care. Patients live at home and attend scheduled therapy sessions while maintaining their daily routines. According to MedlinePlus, outpatient programs often include CBT, support groups, and counseling, all focused on relapse prevention and life skill development.

A systematic review by Nielsen and Macdonald (2023) emphasized that effective treatment for codeine dependence must combine structured withdrawal management, education, and individualized psychological support. Their findings highlighted the need for increased awareness among healthcare providers and improved access to evidence-based therapies for people struggling with codeine addiction.

Can you use suboxone for codeine addiction treatment?  

Yes, Suboxone can be used to treat codeine addiction. Suboxone is a combination medication containing buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). It is FDA-approved for treating opioid use disorder (OUD) and is commonly used to manage dependence on both prescription opioids, like codeine, and stronger opioids such as heroin or oxycodone.

Buprenorphine helps by reducing cravings and withdrawal symptoms without producing the full euphoric high of other opioids, while naloxone discourages misuse by triggering withdrawal if the medication is injected. This dual action makes Suboxone effective in stabilizing individuals in recovery, especially during the early stages of detox and maintenance.

A 2023 publication by the Substance Abuse and Mental Health Services Administration (SAMHSA) confirms that Suboxone is one of the leading medications used in medication-assisted treatment (MAT) for opioid addiction, including codeine. It has been shown to improve treatment retention, reduce illicit opioid use, and lower the risk of overdose.

Therefore, under medical supervision, Suboxone is a proven and effective option for treating codeine addiction as part of a comprehensive treatment plan that may also include counseling and behavioral therapies.

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