Because doctors can prescribe codeine, many people think it’s harmless. However, codeine misuse or long-term use can lead to dependence and addiction.
Codeine, a prescription opioid pain reliever, is one of many opioids involved in the opioid crisis in the U.S. Codeine is typically safe to take as long as it’s prescribed for short-term use and not in large doses. While many people benefit from using codeine to manage pain, it is frequently misused and can become addictive.
In the 2021 National Survey on Drug Use and Health, an estimated 5.6 million people age 12 or older had opioid use disorder. In all, 9.2 million Americans misused opioids in 2021; most were prescription pain relievers.
It’s important to be aware of the codeine’s potential dangers. If a codeine addiction develops, The Recovery Village can help you or a loved one manage codeine use disorder and move toward an addiction-free life.
What Is Codeine?
Doctors prescribe codeine to help manage pain and suppress coughing. Codeine is considered an opiate, not an opioid, although the two terms are sometimes used interchangeably. Opiates are naturally derived from the poppy plant, while opioids are semi-synthetic or fully synthetic substances that provide people with the same effects as opiates.
Codeine can appear and be taken in tablet, capsule or liquid form and be swallowed or injected. People with a prescription for codeine or medication that includes codeine should take it as directed.
Low drug doses are available for over-the-counter purchase in some parts of the U.S. The opioid is an ingredient in some variations of Tylenol, and codeine is a major ingredient in several cough syrups, including:
Codeine Addiction
Because codeine is an opioid, people may wonder about the likelihood of developing a codeine addiction or if codeine is addictive at all. If you or a loved one take codeine, it is important to be aware of codeine’s addictive risk, side effects and complications from addiction. This includes the ever-present risk of a codeine overdose.
Is Codeine Addictive?
As an opioid, codeine is an addictive substance that can also cause physical dependence. However, not all forms of codeine are created equal. The most common forms of codeine are Schedule II or III controlled substances, meaning they carry a risk of abuse, addiction and dependence but have a medical benefit. Low-strength codeine is a Schedule V controlled substance, meaning it carries a low addiction risk. However, other forms of codeine are illicit Schedule I controlled substances, meaning they have a high addictive risk and no medically recognized use.
- Schedule I codeine: Codeine methylbromide and codeine-N-oxide
- Schedule II codeine: Codeine on its own, such as morphine methyl ester and methyl morphine
- Schedule III codeine: Codeine combination products
- Schedule V codeine: Codeine products containing less than 200 mg/100 ml
Effects of Codeine Addiction
Codeine addiction can have a devastating impact on a person’s life. It can lead to physical and psychological problems, including:
- Physical problems: Respiratory depression, liver damage, kidney damage and increased sensitivity to pain.
- Psychological problems: Depression, anxiety and personality changes.
- Social problems: Job loss, relationship problems and legal problems.
If you or someone you know is struggling with codeine addiction, help is available. Many treatment options exist, including medication-assisted treatment, therapy and support groups.
It is important to remember that you are not alone. Codeine addiction is a serious problem, but it is treatable. With the right help, you can overcome your addiction and reclaim your life. Speak with one of our Recovery Advocates to explore treatment options for you or a loved one.
Codeine Overdose
Codeine is a mild opioid but can still be dangerous if you take too much. Codeine is especially dangerous when mixed with other central nervous system depressants, such as promethazine (common in the concoction called “lean”).
If you think you or someone you know has overdosed on codeine, it is important to seek medical attention immediately. The symptoms of a codeine overdose can include:
- Irregular breathing
- Blue lips and fingernails
- Cool to the touch
- Uncoordinated behavior
- Tiny pupils
- Weak pulse
- Low blood pressure
If you see someone experiencing these symptoms, call 911 or your local emergency number. Do not leave the person alone until medical help arrives.
It is important to remember that even a small amount of codeine can be dangerous if you are not used to taking it. If you have any concerns about taking codeine, talk to your doctor.
How Can I Tell if I Have a Codeine Addiction?
When you or a loved one develops a codeine addiction, signs and symptoms quickly emerge. While not everyone will have all codeine addiction symptoms, someone with an addiction will display at least two of the following symptoms:
- Taking more codeine or for a longer time than intended
- Unsuccessful efforts to cut back on or control codeine use
- Spending a lot of time obtaining, using or recovering from codeine
- Cravings for codeine
- Problems meeting obligations at work, school or home due to codeine
- Social or interpersonal problems from codeine use
- Giving up other activities because of codeine
- Using codeine even when it is dangerous
- Continuing codeine even though you know that doing so is harmful to you
- Needing increasingly higher doses of codeine to get effects
- Withdrawal symptoms when you try to stop codeine
Showing codeine addiction symptoms is a red flag and a sign that it is time to seek help.
How Long Does Codeine Stay In Your System?
Codeine has a relatively short half-life, but its metabolites can take longer to clear from the body.
Codeine’s half-life is around three or four hours, meaning it takes up to 20 hours for half of a dose to leave the body. However, some of codeine’s metabolites, such as morphine-3-glucuronide and codeine-6-glucuronide, can have longer half-lives.
The time codeine remains in your body varies depending on the individual. Some people may have a shorter or longer half-life than others. The half-life of codeine can also be affected by other factors, such as liver function and age. If you are taking other medications, they may also affect the half-life of codeine.
Codeine Street Names
There are many codeine nicknames that people should be aware of when determining if a friend or a family member suffers from codeine addiction. Some of the most common street names for the drug include:
- Captain cody
- Cody
- Little c
- Schoolboy
- Dors
- Fours
- Texas tea
- Purple drank
- Sizzurp
Codeine Addiction Withdrawal and Detox
Over time, the body can become used to codeine, and a larger dosage is required to achieve the same effect. This is called tolerance.
When a person stops taking codeine after they have become tolerant, they may experience withdrawal symptoms. Withdrawal symptoms can be very unpleasant and make a recovery from codeine addiction especially difficult and painful. If you are struggling with codeine addiction, it is important to seek help. Many treatment options are available, including medication-assisted treatment, therapy and support groups.
The most common withdrawal symptoms are:
- Agitation
- Anxiety
- Diarrhea
- Dilated pupils
- Muscle aches
- Sweating
- Yawning
- Lacrimation (an abnormal or excessive secretion of tears)
- Strong desire to use codeine
How Long Does Codeine Withdrawal Last?
The length of the codeine withdrawal and detoxification process can vary depending on many factors, including the dosage amount and detox strategy. Symptoms can last anywhere from a few days to a week or more.
The physical symptoms of withdrawal are strongest during the first few days of the process, but some withdrawal symptoms and cravings can last several weeks or months.
Can Codeine Withdrawal Be Fatal?
Codeine withdrawal is rarely fatal. However, withdrawal can be life-threatening if the person experiences severe symptoms, such as dehydration due to vomiting or diarrhea.
Dehydration is a major concern during codeine withdrawal because it can lead to electrolyte abnormalities, low blood pressure, dizziness, confusion and even coma. If you are experiencing codeine withdrawal and any of these symptoms, it is important to seek medical attention immediately.
Codeine Addiction Detox
Codeine withdrawal can be difficult, and it is important to seek medical help if you are considering detoxing from the drug. Medical detox programs offer a safe and supervised environment for people detoxing from codeine. These programs typically include medications to help manage withdrawal symptoms and counseling and support services.
If you are considering detoxing from codeine, it is important to talk to a doctor about your options. They can help you decide whether a medical detox program is right for you. Here are some of the benefits of a medical detox program:
- Safety: Medical detox programs are staffed by medical professionals who can monitor your condition and provide the care you need, preventing complications before they arise.
- Comfort: Medical detox programs offer a comfortable and supportive environment where you can focus on your recovery.
- Success: Medical detox programs have a high success rate and can help you transition to a life free from codeine.
Treatment for Codeine Addiction
Overcoming codeine addiction requires medical treatment. Codeine addiction is a serious problem that can have a devastating impact on your life. If you are struggling with codeine addiction, it is important to seek professional help. Medical treatment can help you overcome your addiction and reclaim your life.
Inpatient Codeine Rehab
Residential inpatient treatment is the most intensive and expensive form of codeine addiction rehab. It requires the recovering person to live at a facility for a predetermined period, which can vary depending on individual needs, progress and insurance coverage.
The main benefit of inpatient rehab is the round-the-clock care provided by addiction experts at the facility. This careful professional monitoring can be especially helpful during the drug detox, when the recovering addict may experience uncomfortable withdrawal symptoms.
Outpatient Codeine Rehab
Outpatient codeine addiction treatment is a less intensive form of drug rehab that allows the recovering person to live at home and attend treatment sessions during the day. This type of treatment is often more affordable than inpatient rehab, and it can be a good option for people who have busy lives or need to maintain their jobs or school commitments.
Outpatient treatment typically includes individual therapy, group therapy and medication-assisted treatment. The frequency of sessions can vary depending on the individual’s needs, but attending sessions several times a week is common.
Codeine and Other Substances
People sometimes mix codeine with other agents, deliberately or by accident. Sometimes, a person might mix cough syrups or medications to try to control their symptoms better. Other times, a person might mix codeine with other drugs to get high. Knowing the risks of mixing codeine and other substances is important, as combining them can lead to an overdose in some cases.
Mixing Codeine and Alcohol
Mixing codeine and alcohol is extremely dangerous and can lead to serious health problems, including death.
Codeine and alcohol are central nervous system depressants, slowing down brain and nervous system activity. When these two drugs are taken together, the effects can be additive, meaning they are more pronounced than when either is taken alone.
Some of the side effects of mixing codeine and alcohol include:
- Drowsiness
- Dizziness
- Lightheaded feelings
- Difficulty concentrating
- Fainting
- Impaired judgment and thinking
- Slowed breathing
- Low blood pressure
- Coma
- Death
In addition to these side effects, mixing codeine and alcohol can increase the risk of accidents, injuries and overdose. If you are taking codeine, it is important to avoid alcohol altogether. If you do drink alcohol, it is important to wait at least 24 hours after taking codeine before you consume any alcohol.
If you think you or someone you know has overdosed on codeine and alcohol, it is important to seek medical attention immediately.
Purple Drank (Codeine and Sprite)
Purple drank emerged as a popular and dangerous trend among illicit drug users in Texas during the 1990s. Also known as “lean,” “sizzurp” or “dirty Sprite,” this recreational drug cocktail combines codeine, Sprite and Jolly Ranchers to achieve a potent high. The contents of purple drank can vary, with additional substances like promethazine (an antihistamine), dextromethorphan (a cough suppressant), sodas such as Mountain Dew and hard fruit candies like Jolly Ranchers being most common.
Purple drank poses serious health risks, including respiratory depression, addiction and potential fatal overdose. The trend’s slang names, often referenced in popular music, including “Texas tea” and “Robo tripping,” add to the allure and misconception
Codeine Guaifenesin Abuse
Doctors prescribe codeine combined with guaifenesin to address certain colds, allergies or flu cases. However, it is unsuitable for treating smoking or asthma coughs. Among the most common side effects of this combination are constipation and drowsiness.
A crucial warning is to avoid taking codeine with guaifenesin and other prescription narcotics or alcohol, as it can lead to a dangerous opioid overdose. This overdose often results in slowed or shallow breathing, potentially leading to coma and even death.
Sold under various brand names like Coditussin AC, codeine-guaifenesin cough syrup is taken orally every four to six hours. Drinking plenty of water while using this medication is advisable to counteract constipation or nausea side effects.
It’s essential to recognize that codeine-guaifenesin cough syrup is intended for short-term use only. Prolonged use may cause withdrawal symptoms if stopped suddenly. Due to the risk of addiction, individuals more susceptible to substance use disorders should inform their doctor before taking any medication containing opioids like codeine-guaifenesin.
Is Tylenol 3 with Codeine Addictive?
Yes, Tylenol 3 with codeine is potentially addictive. Tylenol 3 is a Schedule III controlled substance, meaning it has a moderate potential for abuse and addiction. If a person takes more of the drug than prescribed or more often than prescribed, they risk developing an addiction. Additionally, people who take Tylenol 3, which a doctor has not prescribed specifically for them, are also at risk of addiction.
FAQs
Doctors prescribe codeine to help manage pain and suppress coughing. Codeine is technically considered an opiate, not an opioid, although the two terms are sometimes used interchangeably. Opiates are naturally derived from the poppy plant, while opioids are semi-synthetic or fully synthetic substances that provide people with the same effects as opiates.
Codeine can appear and be taken in tablet, capsule, or liquid form and can be swallowed or injected. People with a prescription for codeine or medication that includes codeine should take it as directed.
Low doses of the drug are available for over-the-counter purchase in some parts of the United States. The opioid is an ingredient in some variations of Tylenol. Codeine also is a major ingredient in various cough syrups, including:
Since codeine can be obtained through a doctor’s prescription, some people might believe that it’s a harmless drug and can be taken regularly with no consequences. This is not true: codeine can be addictive if misused or taken for long periods.
As a prescription medication, many people begin taking codeine in small doses with little risk of addiction. They may only receive a short-term prescription and finish that prescription without becoming addicted. In higher doses, codeine is much more potent and highly addictive. Taking codeine in any way other than prescribed, including recreationally, is also codeine abuse and has a greater risk of addiction.
However, you can take codeine exactly as directed and still become addicted. As with any opioid, a tolerance can develop over time, where the body becomes used to the drug’s presence and needs more to get the same effects. If someone takes codeine consistently over a long period or in high doses, their body can also develop a physical dependence, where they experience withdrawal symptoms if they stop using codeine.
Codeine affects the way the brain and nervous system respond to pain and coughing. Codeine changes into morphine when it enters a person’s brain and binds to the central nervous system’s opioid receptors, leading to pain relief.
Like many opioids and opiates, the feel-good effects of the drug are what often lead to addiction — people who take codeine can experience a euphoric high similar to heroin.
Examples of codeine side effects can include:
- Feeling dizzy or drowsy
- Nausea, vomiting, or stomach pain
- Constipation
- Sweating
- Itching
- Urination problems
- Seizures
- Feeling extreme happiness or sadness
- Slow heart rate, weak pulse, fainting, or shallow breathing
- Confusion, agitation, hallucinations, or unusual thoughts or behaviors
When codeine withdrawal symptoms appear, this is a sign that someone is addicted to codeine and should seek treatment. Withdrawal symptoms can include:
- Agitation
- Insomnia
- Runny nose
- Sweating
- Yawning
- Increased tearing
- Muscle aches
- Anxiety
Late symptoms of withdrawal are usually more uncomfortable, including:
- Goosebumps
- Nausea and vomiting
- Diarrhea
- Dilated pupils
- Abdominal pain
There are many codeine nicknames that people should be aware of when determining if a friend or a family member suffers from codeine addiction. Some of the most common street names for the drug include:
- Captain cody
- Cody
- Little c
- Schoolboy
- Dors
- Fours
- Texas tea
- Purple drank
- Sizzurp
Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health“>Key Subs[…]se and Health.” January 3, 2023. Accessed August 24, 2023.
Substance Abuse and Mental Health Services Administration. “Alcohol, Tobacco, and Other Drugs“>Alcohol,[…]d Other Drugs.” June 20, 2023. Accessed August 24, 2023.
Drug Enforcement Administration. “Controlled Substances“>Controlled Substances.” August 7, 2023. Accessed August 24, 2023.
American Society of Addiction Medicine. “National Practice Guideline for the Treatment of Opioid Use Disorder“>National[…] Use Disorder.” December 18, 2019. Accessed August 24, 2023.
Substance Abuse and Mental Health Services Administration. “Protracted Withdrawal“>Protracted Withdrawal.” July 2010. Accessed August 24, 2023.
Drugs.com. “Codeine Monograph for Professionals“>Codeine […]Professionals.” April 19, 2023. Accessed August 24, 2023.
PsychDB. “Opioid Use Disorder“>Opioid Use Disorder.” May 3, 2021. Accessed August 24, 2023.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.