Codeine Withdrawal & Detox

Codeine is a prescription opioid (opiate) drug prescribed for pain relief and coughing. The drug is considered generally safe for short-term use, but it is possible to become dependent on it. Codeine addiction is greater for people using the drug for six months or longer. It is also dangerous for those who mix codeine with other drugs, especially Valium and Xanax.
Evidence Based
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Although codeine is considered a milder opioid, it can still be dangerous. It is possible to overdose on codeine because tolerance develops over time, and higher doses of the drug must be taken to achieve the same effect. 

Codeine integrates easily within the brain’s existing processes. The brain interacts with the drug in the same way it interacts with its natural neurotransmitter chemicals. This increases tolerance, causes physical dependence, and triggers withdrawal faster than many other drugs.

Long-term codeine use negatively affects a person’s brain cells and makes it difficult for them to perform normally without the drug. Over time, the brain will no longer be able to regulate bodily functions properly. This creates an ever-increasing risk of codeine overdose and severe drug addiction.

Graphic human body showing symptoms.

Codeine Withdrawal Symptoms

When someone has developed an addiction and dependence on codeine, they will experience withdrawal symptoms if they stop using it. Symptoms of codeine withdrawal include:

  • Intense cravings
  • Distorted sense of reality
  • Changes in blood pressure, respiration rate, and irregular heartbeat
  • Mental health issues, such as depression and anxiety
  • Irritability
  • Restlessness
  • Crying
  • Headaches
  • Sinus congestion
  • Difficulty concentrating
  • Dilated pupils
  • Bloating, diarrhea, constipation
  • Nausea
  • Muscle aches
  • Chills
  • Hot flashes
  • Bone and joint pain
  • Tremors
  • Insomnia
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Codeine Withdrawal Timeline

The duration and intensity of withdrawal symptoms vary based on a person’s:

  • Overall health
  • Co-occurring addictions, especially if the other addiction is to benzodiazepine
  • Pregnancy

In general, codeine withdrawal begins within a few hours. For most, withdrawal starts around six or seven hours after the last dose of the drug was taken. Physical symptoms usually worsen within a few days and then begin to ease. Emotional and psychological symptoms can last several weeks.

Taking the drug after withdrawal has begun, even if you only use a small amount, resets the withdrawal period. This results in longer-lasting and more severe withdrawal symptoms.

12 to 40 Hours after the Last Dose

During this period, withdrawal symptoms begin. These symptoms may include nausea, headache, shakiness, general flu-like symptoms, irritability, and cravings.

3 to 5 Days

The most severe withdrawal symptoms subside, but feelings of general malaise, shakiness, insomnia, loss of appetite, headaches, and cravings continue.

Week to 10 Days

Most withdrawal symptoms ease within a week, but some people continue to experience mood swings, cravings, lack of motivation, and loss of appetite.

Weeks and Months

The most moderate to intense withdrawal symptoms have faded, but some people continue to experience some issues. Post-acute withdrawal syndrome (PAWS) might develop. PAWS is different from initial withdrawal and is extensive. It can last from six months up to two years after someone stops using a substance and includes symptoms such as:

  • Irritability
  • Aggression
  • Hostility
  • Chronic physical pain
  • Anxiety
  • Depression
  • Severe mood swings
  • Low energy
  • Fatigue
  • Insomnia
  • Foggy thinking
  • Lack of focus
  • Lack of interest in sex
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How to Detox from Codeine Addiction (Detoxification)

Codeine withdrawal triggers intense symptoms, but the worst of them usually only last a few days. Medically supervised withdrawal can ease these symptoms and increase the likelihood of a successful recovery.

Medication-Assisted Therapy (MAT) is an option for someone with a codeine addiction. Buprenorphine (Subutex) is a partial opioid agonist that satisfies the body’s need for codeine. It also eases withdrawal symptoms without increasing a person’s dependence on the drug.

In some severe cases of codeine addiction, a doctor might prescribe methadone, which is also an opioid agonist. Methadone is addictive, but the risks of using it tend to be less than with some other opioid drugs.

Naltrexone is also used for treating opioid addiction and alcoholism. Naltrexone is also an opioid inhibitor that has no risk for addiction or overdose. It has no serious adverse side effects when used as directed. Like other opioid inhibitors, it works by blocking the euphoric effects of opioid-based pain relievers like codeine. It differs from methadone and buprenorphine because it’s effective after detox to help with cravings. 

Methadone and buprenorphine only minimize withdrawal symptoms during detoxification of opioids. Naltrexone also prevents the euphoric effect of codeine if relapse occurs. However, it will cause instant withdrawal symptoms.

Other treatments available for treating codeine addiction are used to treat specific symptoms of withdrawal include:

  • Pain relievers, including NSAIDs
  • Antidiarrheal medications
  • Anti-nausea medications
  • IV fluids if dehydration is present
  • Clonidine to reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping

After Codeine Detox

Detox is the first step in breaking a codeine addiction. Treating codeine addiction and preventing relapse is much the same as treating any other opioid addiction.

The rehabilitation process begins with a medical assessment before detox. During or shortly after detox, a person with a codeine addiction will begin counseling. This might include group, individual, and family counseling sessions. Treatment programs will also likely include cognitive behavioral therapy and participation in a 12-step program such as Narcotics Anonymous.

Preventing Relapse

Successful codeine addiction treatment requires long-term attention. 

The initial withdrawal is only the first stage of rehabilitation after a codeine addiction. Sober living requires ongoing support, understanding the reasons behind the addiction, and treatment for co-occurring disorders, such as depression. Other changes that help a person succeed with long-term recovery include:

  • Lifestyle changes
  • Participation in support groups
  • Ongoing therapy
  • Non-opioid treatment for chronic pain
  • Medication

Resources

“Codeine Withdrawal: Symptoms, Timeline, Causes, and Treatments.” Www.Medicalnewstoday.Com, www.medicalnewstoday.com/articles/326849.

“Codeine: MedlinePlus Drug Information.” Medlineplus.Gov, 31 Dec. 2017, medlineplus.gov/druginfo/meds/a682065.html.

Schmitz, Joy M., et al. “High-Dose Naltrexone Therapy for Cocaine-Alcohol Dependence.” The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, vol. 18, no. 5, 2009, pp. 356–362, www.ncbi.nlm.nih.gov/pmc/articles/PMC2907651/, 10.3109/10550490903077929.

“Can You Overdose on Codeine?” Codeine.Com, www.codeine.com/about/can-overdose-codeine.html.

“Why Post-Acute Withdrawal Syndrome Can Be a Barrier to Recovery.” Verywell Mind, www.verywellmind.com/what-is-post-acute-withdrawal-syndrome-22104.

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Updated on: July 17, 2020
Author
Addiction Group Staff
About
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Medically Reviewed: June 4, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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