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Codeine Addiction

Codeine is a prescription painkiller in the opioid class.[1] While it’s not as strong as drugs like oxycodone, it’s still dangerous. Abusing the drug can lead to dependence, overdose, and death.

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What Is Codeine?

Codeine is an opioid painkiller used to treat mild-to-moderate pain. It is sometimes combined with other medications to reduce coughing. Codeine isn’t as strong as other types of opioids.[1]

While it has legitimate medical uses, codeine has significant abuse and addiction potential. You should use it as prescribed, and your doctor should limit your prescription length.

Key Facts About Codeine

Key Facts

  • The U.S. Food and Drug Administration (FDA) only approves codeine as a painkiller.[1] But doctors also use it to treat conditions like coughing and restless legs syndrome.
  • While codeine is an opioid, it’s less potent than other drugs in this class.[2] You must take more codeine to get the effects other drugs produce at smaller doses.
  • Studies on codeine addiction are limited. Researchers know the United States is grappling with an opioid abuse epidemic. In 2021, 16,706 people died from overdoses of prescription painkillers like codeine.[3]
  • Researchers are especially concerned about street codeine contaminated with the much stronger opioid fentanyl. This drug was involved in close to 24% of deaths involving prescription painkillers like codeine.[4]

Common Names for Codeine 

Some people use technical terms when discussing their drugs, but others use slang to mask their substance abuse. And since codeine is often included in designer drug cocktails (like lean, purple drank, and sizzurp), it could be lumped into generic terms for drinks and powders. 

Common Street NamesCodeine Mixed With TylenolCodeine Mixed With Soda
Captain CodyT1Lean
CodyT2Purple drank
Little CT3Sizzurp
School boyT4Texas tea
Doors and fours

Who Typically Abuses Codeine?

Like all opioids, codeine isn’t available without a prescription. People who abuse the drug must visit doctors or dealers to get it. But since codeine causes brain cell changes, anyone who uses the drug repeatedly may be compelled to abuse it. No natural immunity exists. 

Young people, particularly college students, often abuse codeine products. In a study of wastewater originating from a college campus, researchers estimated that one student in 1,000 was taking the equivalent of 50 mg per day of codeine.[5]

People with advanced opioid abuse may have a preference for a specific drug, such as codeine. But they may settle for any drug their dealers carry that day.[6] 

Nearly all ethnic and age groups have seen a rise in opioid-involved overdose deaths, with older Black people aged 45 to 64 in large central metropolitan areas and non-Hispanic white people aged 25 to 34 years in large fringe metropolitan areas seeing especially big jumps.[7]

Codeine: How Addictive Is It?

Like all opioids, codeine acts on specialized receptors deep within the brain. Chemicals like dopamine are released, causing a burst of euphoria and relaxation. While this process can block pain, it can also hijack your reward system.[9] 

With repeated use, people become physically and psychologically dependent on opioids. Brain cells associate opioids and pleasure, resulting in drug cravings. And when the drug is absent, uncomfortable withdrawal symptoms appear. 

Codeine can create a feedback loop, where people crave the good effects of opioids and feel bad without them. 

“It has been estimated that 3% of the Caucasian population is associated with ultrarapid metabolism, making those individuals more susceptible to adverse effects from some prodrugs such as codeine and tramadol. In this sense, the risk of codeine abuse becoming a gateway into drug addiction can be elevated depending on receptors’ distribution in the mesolimbic system, which serves to modulate dopaminergic activity and, thus, reinforces these reward circuits.”[8]

Side Effects: How Codeine Affects the Body Over Time 

Codeine is relatively safe when taken for short periods as directed by a doctor. But any dose comes with side effects, and they tend to worsen with time.[9]

Short-Term Effects 

Opioids like codeine are sedating. Breathing and heart rates slow, sometimes to dangerous levels. You may also experience lightheadedness, vomiting, sweating, and constipation.[9] 

Long-Term Side Effects

Opioids slow the digestive tract. Constipation is a common side effect in people who use the drug for long periods. You may become physically dependent on the drug and develop flu-like withdrawal symptoms when you quit.[9] 

Tolerance may appear, meaning you must take more to get the same effect. You can overdose due to drug tolerance. You take a higher dose to overcome your tolerance, and it’s more than your body can handle.

Short-Term Side EffectsLong-Term Side Effects
Sedation Drug dependence 
DizzinessDrug tolerance
Constipation Overdose 
Confusion Withdrawal 

Source: [9]

Mixing Substances With Codeine 

Combining codeine with other drugs is dangerous. Any medical emergency (including an overdose) tied to opioids is harder to treat when other drugs are present.[9] 

People often combine opioids and benzodiazepines. The mixture can significantly increase your overdose risks. Both substances are sedating, so your breathing can slow enough to cause brain cell death. 

Mixing codeine syrup with alcohol and soda to make purple drank (also called lean) is another common codeine combination. Despite the popularity of this kind of drug abuse on social media, this mixture comes with serious health risks, including respiratory depression, delirium, and overdose.[10]

Combining opioids and marijuana can increase overdose risks too. And researchers say this mixture can reduce your inhibitions, making opioid abuse more likely.[11]

Don’t mix codeine with any substance without first asking a doctor. Codeine should only be used if prescribed and only as prescribed.

Symptoms of Codeine Addiction 

Most opioids cause more or less identical symptoms when used. The intensity of symptoms is dependent on several factors, with the amount and potency of the opioids used playing a major role.


People who abuse codeine can exhibit a variety of physical symptoms, including the following:[9]

  • Drowsiness or fatigue
  • Changes to sleep habits
  • Weight loss
  • Frequent flu-like symptoms (a common sign of opioid withdrawal)
  • Decreased libido


People with addictions can also experience several mental health symptoms, including an inability to control opioid use, even once the negative consequences of that use are understood. People may also experience uncontrollable drug cravings, especially when one has not used opioids for some time.


As addiction worsens, a person’s habits and lifestyle can change. Isolating behaviors are common, as is stealing from friends, family, and business. People may also neglect their work, school, or other duties that don’t involve drug use. 

Physical MentalBehavioral
DizzinessPsychosisWithdrawing socially
FaintingHallucinationsSocial isolation
Dry mouthDelusionsFinancial problems
ConstipationWorsening of mental healthStealing or borrowing prescriptions
Itchiness or rashesDecreased memoryLegal problems
Low blood pressureLack of emotionsDoctor shopping
Decreased sex driveFrequent ER visits complaining of pain

Sources: [9,14]

Signs of Codeine Overdose 

Take too much codeine, and you can overwhelm the central nervous system. Overdose is a medical emergency that can result in death without quick and proper treatment. 

Signs of codeine overdose can include the following:[9]

  • Pale, clammy skin 
  • Limp limbs or weakness 
  • Purple or blue fingernails or lips 
  • Unresponsiveness 
  • Slow heartbeat

What to Do in the Event of a Codeine Overdose 

Take action when someone is overdosing. Your quick thinking could save a life. 

Take the following steps:[9]

  • Call 911 and tell the operator about the signs and symptoms you see.
  • Give Narcan (naloxone) if it’s available. This drug will inactivate codeine and restore sobriety immediately. 
  • Stay with the person until help arrives. 
  • If the person doesn’t wake up, offer another dose of Narcan. 

Codeine Withdrawal Symptoms

Brain cells grow accustomed to codeine. Quit using the drug suddenly, and you can develop withdrawal symptoms. If your addiction is severe, you may even have mild discomfort between doses. 

Withdrawal symptoms of Codeine can include the following:[9]

  • Goosebumps
  • Tearing
  • Runny nose
  • Diarrhea
  • Nausea
  • Vomiting
  • Heavy sweating
  • Hypertension
  • Hyperthermia
  • Irregular heartbeat
  • Yawning

Treatment for Codeine Addiction 

The best way to treat opioid addiction of any kind generally involves a comprehensive addiction treatment program. The following components are usually included: 

Medical Detox 

Cold-turkey codeine withdrawal can be life-threatening.[15] It can cause severe dehydration, and this can be dangerous. It’s also deeply uncomfortable, and many people relapse before it’s finished. Medical detox is different. 

In a medical detox program, doctors use medications to ease withdrawal symptoms and cravings. This helps people to find their footing in the early stages of recovery when they are often most vulnerable to relapse.

Inpatient Rehab 

Once this very early stage of withdrawal is over, a person may continue to feel generally unwell and experience strong drug cravings. While still uncomfortable, it is usually easier to function at this stage. But relapse risks are real and dangerous. 

Inpatient rehab for Codeine allows people to move out of their homes (and away from their triggers). This break can help people to build strong relapse prevention skills in a safe environment. 

Medication-Assisted Treatment

Oftentimes, medication-assisted treatment (MAT) is recommended for opioid addiction.[16] Pharmaceutical therapies can lessen chemical imbalances long term and allow people to experience fewer cravings and relapse risks. 

Medications can include the following:

  • Buprenorphine: This prescription medication latches weakly to opioid receptors, allowing for fewer cravings. It’s safe to use at home. 
  • Methadone: This older prescription therapy must be used under a doctor’s supervision. It’s appropriate for people with addictions to large codeine doses. 
  • Suboxone: This prescription medication includes buprenorphine and naloxone in combination. The abuse-prevention component makes this one of the safest MAT options. 
  • Naltrexone: This medication doesn’t ease opioid cravings, but it can make a relapse less rewarding. 

Behavioral Therapy

While medications can relieve chemical imbalances, they can’t change the way you think and react. Behavioral therapy can. 

Your care team can use cognitive behavioral therapy (CBT) to help you pinpoint how your thoughts cause drug cravings. When you identify your thought patterns, you can take action before you relapse. 

Researchers say medications like buprenorphine work best when they’re given as part of a comprehensive treatment program that includes counseling.[12]

Frequently Asked Questions About Codeine Addiction

We’ve compiled some of the most frequently asked questions about codeine abuse.

How long does codeine stay in your system?

Codeine can stay in your system (and detectable in urine drug tests) for about two days.

Is codeine an opioid?

Yes. Codeine is a painkiller in the opioid class. 

Is codeine a narcotic?

Yes. Codeine is considered a narcotic, as it’s a painkiller. 

What is codeine used for?

Codeine is FDA approved for pain, but doctors use it for other illnesses, including to treat a cough. 

How does codeine make you feel?

Codeine can cause relaxation blended with euphoria.

Updated March 19, 2024
  1. Peechakara B, Tharp J, Gupta M. Codeine. StatPearls. Published February 2023. Accessed July 17, 2023.
  2. Dose equivalents and changing opioids. Royal College of Anaesthetists. Accessed July 17, 2023.
  3. Drug overdose death rates. National Institute on Drug Abuse. Published June 30, 2023. Accessed July 17, 2023.
  4. Drug overdose death rates. National Institute on Drug Abuse. Published June 30, 2023. Accessed July 17, 2023.
  5. Other drugs. Centers for Disease Control and Prevention. May 12, 2023. Accessed July 17, 2023.
  6. Asphianto A. Tracking criminal actions on drug consumption on campus with wastewater. Exima Journal. 2021;2(1):63-71.
  7. Cicero T, Ellis M, Kasper Z. Relative preferences in the abuse of immediate-release versus extended-release opioids in a sample of treatment-seeking opioid abusers. Pharmacoepidemiology and Drug Safety. 2017;26(1):56-62.
  8. Lippold KM, Jones CM, Olsen EO, Giroir BP. Racial/ethnic and age group differences in opioid and synthetic opioid–involved overdose deaths among adults aged ≥18 years in metropolitan areas — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:967–973. DOI:
  9. Zandonai T, Escorial M, Peiro A. Codeine and tramadol use in athletes: A potential for abuse. Frontiers in Pharmacology. 2021;12.
  10. Codeine prescribing information. U.S. Food and Drug Administration. Published April 2013. Accessed July 17, 2023.
  11. Garcin, L., Le Roch, M., Agbessi, C. A., Lobut, J. B., Lecoeur, A., & Benoist, G. (2016). Purple drank : un dangereux cocktail à connaître [Purple drank: A dangerous cocktail]. Archives de pediatrie : organe officiel de la Societe francaise de pediatrie, 23(11), 1165–1168.
  12. Marijuana and public health: Pain. Centers for Disease Control and Prevention. Published October 19, 2020. Accessed July 17, 2023.
  13. What is buprenorphine? Psychiatric Research Institute. Accessed July 17, 2023.
  14. Street and commercial names. National Institutes of Health. Accessed July 17, 2023.
  15. Dydyk AM, Jain NK, Gupta M. Opioid use disorder. StatPearls Publishing. Published January 2023. Accessed July 17, 2023.
  16. Shah M, Huecker MR. Opioid withdrawal. StatPearls Publishing. Published January 2023. Accessed July 17, 2023.
  17. Maglione MA, Laura R, Christine C, et al. Effects of medication-assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review. Rand Health Q. 2020;8(4):RR-2108-OSD. Published 2020 Jun 15.
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