What Is Codeine?

Codeine is a naturally occurring substance that makes up 0.7% to 2.5% of opium. It’s available as a solo prescription pain medication. It’s also mixed with other substances in some over-the-counter medicines.

Codeine, in solo or combined form, is used to:

• Relieve mild to moderate pain
• Reduce coughing
• Treat diarrhea, especially related to irritable bowel syndrome (IBS)

In the U.S., codeine is a Schedule II drug. It has a high potential for abuse, leading to severe psychological or physical dependence.²

Is Codeine an Opioid?

Codeine is technically an opiate, though it’s also referred to as an opioid. Although opiates and opioids have similar effects, they are different substances. Because of their similarities, the terms are often used interchangeably.^1,3,4

Here’s the difference:

• Opiate: A naturally occurring compound extracted from the opium poppy plant (opium, morphine, heroin, and codeine)
• Opioid: A synthetic or semi-synthetic compound made in a lab (hydrocodone, oxycodone, oxymorphone, and fentanyl)

Both substances can be prescribed as pain relievers and cough suppressants. Some people also illicitly use them for their euphoric effects.

Codeine Drug Interactions

Codeine can interact with other substances, including prescription drugs, increasing the risk of adverse effects and death.

Medicines that should never be mixed with codeine include but are not limited to:⁵

• Medications for coughs, colds, and allergies
• Medicines for asthma, motion sickness, or IBS
• Other opioids
• Sedatives like Valium
• Sleeping pills
• Muscle relaxants
• Antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)

How Do You Use Codeine?

Codeine is available in tablet, capsule, and solution forms. It’s usually taken as needed every 4 to 6 hours.

Here are a few guidelines for using codeine safely:^5,6

• Take codeine exactly as prescribed by your doctor.
• Don’t increase your dose or frequency of use unless prescribed.
• Don’t crush, chew, or dissolve the pills.
• Don’t stop taking codeine suddenly, as this may cause withdrawal if you’re dependent.
• Ask your doctor how to stop taking codeine safely.
• Tell your doctor about any codeine cravings or withdrawal.
• Don’t share codeine with anyone, especially someone with a drug abuse history.
• Don’t keep leftover medication; other people might misuse it.
• Don’t drink alcohol while taking codeine.
• Don’t ingest codeine with interacting drugs.
• Skip a missed dose if it’s time for the next.
• Don’t take 2 doses to make up for a missed one.

You should also tell your doctor if you're pregnant. A newborn baby might undergo withdrawal if you take codeine regularly during pregnancy.

Codeine Abuse

Codeine can be mixed with promethazine to create an illicit substance known as "lean" or "purple drank." Promethazine was formerly a common cough syrup used for nausea.

Lean can be used to alter your perception and induce euphoric feelings. However, it's a dangerous combination that can cause seizures and lower heart rate.¹

Other methods of abusing codeine include:

• Taking the pill for non-medical purposes
• Crushing the tablet and snorting the powder

In 2018, the Food and Drug Administration (FDA) required labeling changes for cough and cold medicines to limit codeine intake.¹³

Why Do People Abuse Codeine?

Like other opioids, codeine can cause relaxation, euphoria, and a dopamine rush. In 2016, 11.5 million people in the U.S. misused prescription opioids. About 62% of this population said they used them to treat pain.⁹

Opioid users may sometimes switch to codeine when they can't use heroin or stronger opioids. In some cases, people may use codeine to reduce cravings and withdrawal.

People who take prescription codeine may also misuse the drug. Once they develop tolerance, their doctor might prescribe a higher dosage. In some cases, people self-medicate with higher doses.

Sponsored

Online Therapy Can Help

Over 3 million people use BetterHelp. Their services are:

• Professional and effective
• Affordable and convenient
• Personalized and discreet
• Easy to start

Find a Therapist

Answer a few questions to get started

Risks of Codeine Abuse

Prolonged codeine use can lead to tolerance, dependence, and addiction. Opioid abuse can increase the risk of overdose and death. 

Having an increased tolerance means you'll need to take higher and more frequent doses of codeine to experience its euphoric effects. If you become dependent on codeine, you may experience uncomfortable withdrawal symptoms when you suddenly stop using it.^7,8 

Overall, codeine abuse can lead to dangerous side effects and symptoms. Many of these symptoms can lead to long-term health problems.

Common Side Effects of Codeine Use

Common side effects of codeine include:^5,6,10

Severe Side Effects of Codeine Abuse

The body metabolizes codeine into morphine, which can cause life-threatening respiratory depression or even death. This is why codeine is no longer appropriate for people under 18.

Prolonged codeine use can lead to long-term side effects, including:^5,6,10

• Memory impairment
• Increased risk of substance use disorders
• Depression
• Anxiety
• Fatigue
• Kidney disease
• Liver damage
• Infertility
• Erectile dysfunction
• Decreased sex drive

Codeine Overdose

Opiates like codeine can weaken the central nervous system (CNS), which controls vital life functions like your heartbeat and breathing. A codeine overdose can be dangerous, if not fatal.

From 1999 to 2019, about 500,000 people died from opioid overdose. Nearly half of these overdose deaths were caused by prescription opioids like codeine.^11,12

Some symptoms of codeine overdose include:^5,6

If you or someone you know has overdosed on codeine, seek emergency medical attention. Medical professionals will conduct life-saving procedures, including providing supplemental oxygen.

Sponsored

Get Professional Help

BetterHelp can connect you to an addiction and mental health counselor.

Find a Therapist

Answer a few questions to get started

Codeine Withdrawal Symptoms

When you become dependent or addicted to codeine, the body becomes accustomed to its effects to feel normal. If you suddenly stop using codeine, your body will adjust to the absence of the drug, leading to withdrawal.

Withdrawal can lead to unpleasant and uncomfortable symptoms. Because of this, many people find it hard to quit and continue using the drug despite its negative consequences.

Codeine withdrawal symptoms include:^5,6

Consult your doctor before attempting to quit codeine use. They will provide the safest way to stop or help you taper off the drug.

Signs of Codeine Addiction

Codeine addiction develops with excessive or regular use. Certain behaviors may indicate that you've developed an addiction, including:¹⁶

• Buying codeine illegally or on the street
• Faking symptoms for prescription codeine
• “Shopping” for doctors to get multiple prescriptions
• Stealing codeine from a healthcare provider
• Stealing money to buy the drug
• Being unable to stop taking codeine after unsuccessful attempts
• Taking other opioids if codeine is unavailable
• Experiencing withdrawal symptoms when not taking codeine

Sponsored

Phone, Video, or Live-Chat Support

BetterHelp provides therapy in a way that works for YOU. Fill out the questionnaire, get matched, begin therapy.

Get Started

Answer a few questions to get started

How Is Codeine Addiction Diagnosed?

Diagnosing any opioid addiction requires a thorough medical evaluation. In order to diagnose people, healthcare providers use lab tests and monitor prescription medications.

Doctors use the 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose opioid use disorder (OUD). These criteria include:⁹

• Excessive cravings
• Recurrent use
• Tolerance
• Withdrawal symptoms

Risk Factors for Codeine Addiction

Many factors can cause codeine addiction, including:

• Genetic factors: A genetic predisposition to addiction or a history of substance abuse
• Environmental: A stressful home environment or having access to drugs at an early age
• Psychological: Stress and negative feelings due to anxiety, trauma, depression, etc.

Codeine & Opioid Addiction Treatment

Consider seeking treatment if you develop a codeine addiction. Treatment for codeine addiction does not differ from that of other opioids.

Available codeine treatment programs include:¹⁷

• Inpatient treatment: Involves checking yourself into a rehab facility for 24-hour medical supervision
• Outpatient treatment: A treatment program where you are freely allowed to leave the rehab facility
• Cognitive behavioral therapy: A short-term therapy technique that explores the link between thought patterns and addiction
• Medication-assisted treatment: Involves using medication, counseling, and therapy to treat addiction
• Support groups: Groups or organizations that provide a much-needed community to help maintain sobriety after treatment

Summary

Codeine is a prescription opiate used to treat mild to moderate pain. It's also classified as a Schedule II substance with a high potential for abuse and addiction. 

The opiate is often misused for its euphoric side effects. It can be mixed with promethazine to create an illicit substance known as "lean" or "purple drank."

Codeine abuse can lead to tolerance, dependence, addiction, and even death. Fortunately, various treatment options are available to help you recover from substance abuse.

Sponsored

Get matched with an affordable mental health counselor

Find a Therapist

Answer a few questions to get started