Quitting Codeine Cold Turkey: How Dangerous Is It?

Quitting codeine cold turkey can be dangerous due to the potential for relapse and risks associated with certain withdrawal symptoms, such as dehydration.

With medical support, you can effectively quit codeine without the pain commonly associated with opioid withdrawal. The use of medication-assisted treatment (MAT) can often allow you to avoid withdrawal altogether. MAT is an effective treatment for codeine addiction.

The Dangers of Quitting Opioids Cold Turkey

While withdrawal from opioids like codeine can be fatal, this is rare and often the result of negligence on the part of facilities where withdrawal may occur, such as prisons and jails. 

The two main dangers of opioid withdrawal are persistent vomiting and diarrhea, combined with heavy sweating, which can lead to serious complications if a person is unable to replace those lost fluids. In extreme cases, this can lead to hypernatraemia (elevated blood sodium level) and heart failure.

However, it needs to be emphasized that this isn’t a common occurrence. The real danger of quitting opioids cold turkey is that it is often ineffective. It may lead to an individual failing to stop their abuse of opioids when they could have been able to regain control over their drug use with the right treatment approach.

An individual’s tolerance to opioids like codeine declines when use stops. If they relapse and take a dose that used to be “normal” for them, they may overdose. Codeine overdose can be fatal.

Symptoms of Opioid Withdrawal

Opioid withdrawal, including withdrawal from codeine, is often described as flu-like. Symptoms can include the following:

• Diarrhea
• Nausea 
• Vomiting
• Heavy sweating
• Hot and cold flushes
• Watery discharge from eyes and nose
• Anxiety
• Insomnia
• Muscle cramps

These symptoms can vary in severity, but a patient can expect that the withdrawal process is likely to at least be uncomfortable. It will likely prevent them from working, going to school, and performing other important duties during the acute withdrawal phase, when withdrawal is most severe. 

This will usually happen within eight to 24 hours of stopping abuse of codeine and other opioids. Acute withdrawal can last four to 10 days, assuming a person hasn’t also been using long-acting opioids (like methadone) long term, in which case acute withdrawal may last longer.

After acute withdrawal is over, there is a protracted withdrawal phase that can last for up to six months. This is a phase of withdrawal where symptoms are generally less severe and a person can usually function well enough in their day-to-day life to meet responsibilities, but they may still experience some discomfort and strong opioid cravings. 

How to Quit Codeine Safely

To quit codeine or any opioid safely and effectively, talk to an addiction treatment specialist about your issues with these drugs and what you should do next. A medical professional can help you form an effective, evidence-based treatment plan designed to maximize your chances of recovery and regaining control over your drug use.

For opioid dependence, MAT will generally be recommended. By taking medication like Suboxone (buprenorphine/naloxone), you’ll bypass the discomfort of withdrawal. Cravings for codeine and unpleasant withdrawal symptoms will be managed, so you can focus on work you are doing in therapy to build a new life in recovery.

In some cases, you and your treatment team may decide against MAT. A tapered approach to codeine detox may then be recommended. This will involve gradually reducing your dose of codeine or another opioid every week or so until you are no longer taking the drug.

How Long Does Detox or Tapering Take?

A straight detox from short-acting opioids like codeine takes four to 10 days for a patient to get through acute withdrawal, where withdrawal is most severe. Then, they will go through protracted withdrawal for multiple months. When people discuss detox, they’re usually referring to the process of going through acute withdrawal and not the slower process of allowing their body to fully adjust to the absence of a drug that protracted withdrawal represents.

Depending on your needs, a doctor may decide that tapering your codeine doses is the best way to help you stop using them. This is especially true for patients who aren’t actually addicted to codeine, only physically dependent. This is when a person will go through withdrawal if they stop taking a medication due to chemical changes that continued use of a drug has caused in their body, but they aren’t compulsively using a drug. 

Drug tapering is complex and needs to be shaped around a person’s individual situation. It’s common for a person’s daily dose to be reduced by about 5% to 15% per week in situations where tapering makes sense.

An advantage of tapering is that it makes withdrawal less severe or even not occur when a person finally stops taking a drug. If you’ve been abusing codeine, a taper likely isn’t appropriate on an outpatient basis. You will simply be tempted to continue abusing the drug if you are taking it daily.  that people may be drawn to abuse like codeine. If you can’t control your level of drug use in a given day, tapering won’t be effective.

Help for Codeine Withdrawal Symptoms

It’s important to support your body during the withdrawal process. The standard treatment for opioid withdrawal is to consume at least two to three liters of water a day to replace lost fluids. Vitamin B and C supplements are often recommended. 

Individual withdrawal symptoms may be treated as needed. For example, anti-nausea medication may be prescribed to reduce nausea and vomiting.

Again, MAT is often the recommended treatment for those with opioid use disorder due to codeine abuse. MAT has repeatedly been shown to help individuals achieve and sustain recovery from opioid abuse.