Codeine Withdrawal & Detox

Codeine is a prescription opioid painkiller prescribed to treat pain or relieve a persistent cough. However, many people misuse codeine for its euphoric and relaxing effects. Chronic codeine abuse can lead to physiological dependence, which means the body has adapted to the presence of this opioid and requires it to function optimally. When someone is dependent on codeine and abruptly stops taking it, they’ll experience distressing codeine withdrawal symptoms. [1]

Uncomfortable psychological and physical symptoms often begin within a manner of hours of last use. Their severity and the overall length of withdrawal and detox depend on the extent of codeine use and other personal factors.

What Is Codeine Withdrawal?

Codeine withdrawal occurs when someone who is physically dependent on this opioid abruptly stops taking it, resulting in a myriad of symptoms.

Repeated opioid exposure alters the brain so it functions normally when drugs are present and abnormally when they are not. The locus coeruleus (LC) located at the base of the brain stem is largely responsible for unpleasant withdrawal symptoms.[9]

The LC produces noradrenaline, which stimulates breathing, blood pressure, and general alertness. Opioids like codeine prompt the LC to make less noradrenaline. In time, the LC adjusts by making much more. When long-time users quit, the LC keeps pumping out high levels of noradrenaline. Severe sickness results.[9]

In time, the LC can adjust to a lack of codeine. However, that adjustment process can be long-lasting, and sometimes, people relapse before it’s complete. Treatment helps people adjust while reducing the temptation to return to drugs.

While dependence is common in cases of sustained codeine abuse, it can also occur when the drug is used as prescribed. This is why many physicians won’t recommend codeine or any prescription opioid for long-term use.[2]

Codeine Withdrawal Symptoms

Codeine withdrawal symptoms are similar to those of most opioids. Codeine withdrawal can cause both physical and emotional discomfort, and it usually lasts several days to a couple of weeks. Symptoms typically begin within a day of last use. 

Common symptoms of codeine withdrawal include the following:[1-3]

• Anxiety
• Agitation 
• Muscle aches and pains
• Increased tearing and runny nose
• Sweating 
• Yawning
• Insomnia 
• Nausea and vomiting 
• Stomach cramps
• Diarrhea 
• Dilated pupils
• Goosebumps 

The symptoms of codeine withdrawal are uncomfortable but not typically life-threatening. The greater danger lies in individuals who have recently detoxed and returned to codeine use. Unaware of their lower drug tolerance, they may take a dose that would be considered normal for their prior levels of use. With their reduced tolerance, this can lead to unintentional overdose, which can be life-threatening.

Factors That Influence the Intensity of Withdrawal Symptoms

The severity of codeine withdrawal symptoms varies depending on the history of use and an individual’s physiological response to detox. Individuals with a high level of codeine intake for six months or longer are likely to have more severe withdrawal symptoms. Withdrawal symptoms may also be worse for individuals who also abuse other substances, such as other opioids and benzodiazepines. [3]

Other factors that may influence the withdrawal process include the following:[4]

• Length of codeine use
• Average codeine dose used
• Method of administration (e.g. snorting or injecting)
• Age
• Kidney and liver functioning
• Individual metabolism
• Medical conditions
• Mental health conditions

How Long Does Codeine Withdrawal Last? 

People withdrawing from short-acting opioids, such as codeine, are likely to experience a quicker onset of symptoms but also a shorter length of withdrawal. 

As a short-acting opioid, codeine withdrawal begins within 6-12 hours after the last use, and these acute symptoms tend to last between 5 and 7 days.[4] However, protracted withdrawal symptoms can linger for weeks, months, or even years after acute withdrawal resolves. 

If you opt for medication-assisted treatment (MAT) with buprenorphine or methadone, you may largely avoid the withdrawal process. These medications manage withdrawal symptoms and cravings, enabling you to focus on the therapy involved in addiction treatment.[5]

The key to remember is that no matter how long withdrawal takes for your situation, long-term recovery is possible.

Codeine Withdrawal Timeline 

Withdrawal from codeine begins relatively quickly. A sample codeine withdrawal timeline may look like this:[7]

• Day 1: Symptoms begin 6 to 12 hours after last use. People may feel anxious, sweaty, and uncomfortable. They may also have watery eyes and a runny nose.
• Day 2: Symptoms intensify. Stomach pain can become nausea or vomiting. Sweating can become chills and goosebumps. People may be unable to sleep, sit still, or concentrate.
• Day 3: Symptoms peak in intensity. Some people develop severe vomiting and diarrhea at this stage, and they may have high blood pressure, tremors, and a fast breathing rate.
• Day 5: Symptoms start to fade. People may still feel nausea and anorexia. However, they may find they can begin to focus.
• Day 6: People may gain control over nausea and vomiting. Food may seem appealing again. However, they may start to feel cravings for drugs.
• Day 7: Physical signs of withdrawal have largely resolved. However, drug cravings remain and intensify.
• Week 2 onward: People who develop protracted withdrawal symptoms will start them when the acute phase is finished. They may feel intense cravings for drugs, along with anxiety and insomnia.

Depending on the stage of withdrawal, the symptoms may vary:[7]

Protracted Withdrawal

Protracted or post-acute withdrawal symptoms refer to symptoms that linger after acute codeine withdrawal has resolved. These symptoms can last for months or years and may include:[4]

• Anxiety
• Depressive mood
• Insomnia
• Anhedonia (inability to feel pleasure)

These symptoms may waver in intensity and be brought on by stress or triggering situations, which can increase the risk of relapse. This is one of the many reasons it’s important to receive ongoing care and support throughout your recovery.

Codeine Detox Services

The safest way to detox from codeine is under the care of a medical professional. Opioid withdrawal symptoms can be highly uncomfortable and even life-threatening in some cases. When people attempt to detox from codeine or other opioids on their own, they often relapse back to codeine misuse simply due to the discomfort of withdrawal.

With medical detox, the risk of relapse is much lower. Treatment providers provide a combination of medication, therapy, and support to ease the process and increase the likelihood of a successful detox.

A variety of medications can be used to safely detox from codeine including the following.

Buprenorphine

Buprenorphine is a partial opioid agonist that latches weakly to the same receptors used by codeine and other opioids. This medication can “trick” the brain into believing it has the drugs it’s accustomed to, but buprenorphine won’t make people feel high.

In the past, doctors started buprenorphine treatment after detox. However, some doctors use the medication as soon as 12 to 24 hours after the last dose.[10]

Buprenorphine has proven safe and effective for detox. However, it can cause unpleasant side effects like constipation, drowsiness, and insomnia. Doctors monitor their patients carefully to find a dose that comes with few problems.[10]

Methadone

Methadone is a full opioid agonist that latches to opioid receptors typically held by codeine. When taken properly, it reduces cravings and eases withdrawal symptoms. While it’s effective, it must be administered in a clinic or hospital. While people using buprenorphine can take the drug at home, methadone doesn’t work that way.[11]

Methadone’s side effects include nausea, vomiting, and slow breathing. Doctors watch the dosage carefully and make adjustments if patients seem uncomfortable.[11]

Clonidine

Clonidine doesn’t latch to opioid receptors, so it’s different from the other medications we’ve discussed. It can’t be given alongside methadone and buprenorphine, but it can be helpful for those who don’t react to those therapies.[12]

Clonidine can help with physical problems like sweating, chills, insomnia, vomiting, and diarrhea. It can cause unpleasant side effects like drowsiness, dizziness, and low blood pressure.[12]

Post-Detox Addiction Treatment

Codeine addiction isn’t solved by just going through detox. Further treatment is needed to address the addiction. 

Whether in the form of inpatient or outpatient treatment, addiction treatment will involve therapy. This is where the bulk of recovery work will take place, as you identify the root causes that led you to abuse codeine. You’ll also begin to build skills that help you to better cope with temptations to abuse substances. 

At Boca Recovery Center, we offer a comprehensive codeine addiction treatment program that includes medical detox services as well. We offer individualized treatment planning that addresses your unique needs. We accept a variety of insurance providers and plans, and if you are uninsured, we will work with you to create a financing plan.

While opioid detox isn’t easy, it is the first step on the path to a better life in recovery.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More