Codeine Addiction: Understanding the Risks

What Is Codeine?

Codeine, a naturally occurring chemical from the opium poppy plant, is a prescription pain reliever and cough suppressant. It is most often taken orally as a pill for pain relief and is used in liquid form for cough suppressants. When used as prescribed, codeine decreases activity in the central nervous system, lessening pain signals and reducing coughing. While codeine can alleviate pain and diminish symptoms, the drug does not and cannot treat the underlying cause of symptoms or speed up recovery. Codeine is an addictive opioid that has properties similar to morphine, oxycodone, hydrocodone, heroin, and fentanyl.

Decades before the opioid crisis began, codeine was available via over-the-counter medicines in the United States, including cough syrups and cough drops. But as codeine abuse started to rise and the opioid crisis became an epidemic, pharmacists removed codeine from the shelves. Today, a prescription from a licensed doctor is the only legal way to obtain codeine. Even still, the Drug Enforcement Administration (DEA) lists codeine as a Schedule III drug because of its potential for misuse and abuse.

Common Symptoms of Codeine Abuse

Typically, people who are misusing codeine will display symptoms that affect their emotions, behavior, body, and mind.

Emotional symptoms include:

• Euphoria
• Depression
• Anxiety
• Mood swings

Behavioral symptoms include:

• Drowsiness and increased sleeping
• Decreased appetite
• Apathy
• Frequent ER visits for vague pain complaints
• Faking illness to obtain more codeine
• Indifference toward family members and friends
• “Doctor shopping” or visiting several doctors to obtain more codeine prescriptions
• Forging prescriptions
• Ordering codeine or other drugs on the internet
• Stealing prescriptions from family and friends
• Lying to conceal the frequency and amount of codeine used
• Consuming more codeine than prescribed

Physical symptoms include:

• Dry mouth
• Dizziness
• Itching
• Fainting
• Muscle twitches
• Rashes
• Nausea and vomiting
• Decreased libido
• Constipation
• Hypotension
• Blue tinge to lips and fingernails
• Slowed breathing and respiratory depression
• Seizures

Psychological symptoms can include:

• Delusional behavior
• Lack of emotions
• Memory loss
• Hallucinations

How Does Codeine Affect the Body and Brain?

As a short-acting opioid, codeine’s effects on the brain and body only last for a few hours per dose. As a result, most people find themselves using codeine quite frequently. In fact, some patients and users take codeine every one to two hours. This, of course, significantly affects how the body and brain function.

When first consumed, codeine attaches to opioid receptors in the brain. The drug then blocks pain signals sent from the brain, which results in users feeling less pain. Codeine also impacts parts of the brain that affect the way people perceive pleasure and pain.

Although it’s not clinically categorized as a depressant, codeine does depress some activity in the central nervous system. In doing so, certain aspects of the physical body slow down, as seen in some of the drug’s side effects including nausea, dizziness, and numb or tingling sensations. Sluggish nerve signals can also cause constipation, irritable bowel syndrome, and a drop in blood pressure and heart rate.

Chronic codeine misuse and abuse can lead to depression, hallucinations, seizures, coma, and permanent lung, kidney, and brain damage.

Short-Term Adverse Side Effects of Codeine

The most common short-term effects of codeine on the body include:

• Fatigue
• Loss of consciousness
• A sudden drop in heart rate
• Decreased blood pressure
• Cold, clammy skin
• Heightened pain sensitivity
• Stomach pain
• Sweating
• Headaches
• Constipation

Long-Term Adverse Side Effects of Codeine

After consistent use of codeine over an extended period of time, the body starts to experience a range of long-term effects, which include:

• Insomnia and difficulty sleeping
• Nightmares
• Pain when not using the drug
• Intestinal blockage
• Liver damage
• Kidney damage
• Permanent brain damage
• Seizures
• Organ damage
• Coma

Is Codeine Use Dangerous?

Codeine is addictive due to its narcotic symptoms, which include a euphoric state; many patients self-medicate and abuse the drug, leading to addiction. Although codeine is far less potent than most opioids, it can still be a dangerous drug. Part of codeine’s risk comes from how it’s metabolized by the body. Codeine is first absorbed by the gastrointestinal tract followed by the liver. Once the drug has been metabolized by the liver and excreted through the kidneys, codeine breaks down into morphine.

Even though only a small portion of codeine converts to morphine, it’s important to remember that codeine is a short-acting opioid. As such, patients and users take it more frequently, building up potentially harmful levels in their system.

Other risks of codeine use include:

• An increased risk of coma and death when users mix codeine with other opioids or depressants like alcohol
• An increased risk for misuse of other opioids like morphine and heroin

If you or a loved one are taking codeine prescribed from a licensed physician, be sure to keep them informed of any unfamiliar symptoms. Do not significantly reduce the amount you’re taking or stop taking codeine without medical supervision as this can lead to withdrawal.

Codeine Withdrawal Signs and Symptoms

Chronic misuse and abuse of codeine can lead to physical dependence. When someone with a codeine dependence suddenly stops using the drug, they will likely experience unpleasant and potentially dangerous withdrawal symptoms. As such, codeine patients should only reduce or stop taking codeine under the supervision of a trained medical professional.

The most common symptoms of codeine withdrawal include:

• Runny nose
• Cravings
• Chills
• Extreme sweating
• Goosebumps
• Stomach cramps
• Mood swings
• Teary eyes
• Excessive yawning
• Muscle spasms
• Agitation and irritability
• Psychosis
• Hallucinations
• Anxiety and depression
• Diarrhea
• Suicidal thoughts
• Homicidal thoughts

Treatment for Codeine Addiction

Treating a codeine addiction begins with a professional detox program. Once complete, clients begin rehabilitation treatment in an inpatient or outpatient program. Clients that choose inpatient treatment live onsite at a residential facility while receiving treatment. Outpatient clients receive treatment while continuing to live at home. Although inpatient and outpatient programs have different residency requirements, both programs include:

• Counseling like Cognitive Behavioral Therapy, or CBT, which helps clients adopt healthier behavior patterns
• Education programs like life skills training, mindfulness training, post-trauma intervention, motivational interviews, and relapse prevention
• Family, individual, and group therapy
• Peer support groups like Narcotics Anonymous and 12 Step Programs

Read more about Codeine abuse and how to find help if you or a loved one are struggling with addiction to opioids at the full guide ‘Codeine Addiction Treatment’