Codeine Addiction: Symptoms, Effects, & Treatment

Codeine is a prescription pain medication that belongs to the opioid class of drugs. It is used to treat mild-to-moderate pain, and it is also sold in combination medications to address a bad cough or diarrhea. It works by attaching to opioid receptors in the brain that are responsible for sending pain messages throughout the brain and body. As a result, the sense of pain is blocked. Codeine also works by suppressing the cough reflex.

As an opioid, the risk of developing an addiction to codeine is high. All opioids are known to be habit-forming, even when consumed in some of their milder forms, such as codeine.

Once consumed, the body converts codeine into morphine, though it is only about 8 percent to 12 percent as powerful as pure morphine. Nonetheless, tolerance to codeine can develop within just a few days or weeks of daily use. Tolerance can then lead to dependence and addiction if you do not restrict your use very carefully.

For this reason, codeine, like all opioids, is only meant for the short-term treatment of pain or severe cough.

Use that extends beyond a couple of weeks greatly increases the chances of users developing a substance use problem. Use that goes beyond a few months leads to dependence in most people.

What Is Codeine?

Codeine is an opiate used as an active ingredient in pain medications and other drugs. The naturally occurring chemical is found in opium poppy plants, along with morphine. Codeine and morphine were discovered and isolated from the milky sap of the poppy plant in the 1800s, and it has been used in medications ever since. Codeine was a popular drug throughout the 19th and 20th centuries. 

Opioids like codeine are very similar to the body’s natural endorphins, which are its main pain-management neurotransmitter. Codeine can bind to opioid receptors and mimic endorphins, blocking pain signals that nerve cells send and receive. Codeine is stronger than your body’s natural endorphins, but it’s milder than other prescription opioids like morphine and oxycodone. 

As a mild opioid, codeine is used in various formulations all over the world. It’s also one of the most commonly used pain relief drugs globally. Codeine may also be combined with other pain relievers, including paracetamol, aspirin, or ibuprofen. As a pain reliever, it is used to treat mild-to-moderate pain symptoms. However, it’s not as effective at treating severe pain symptoms as other opioids. 

It’s also used in cough medicines, though it’s not clear if codeine cough syrup effectively treats coughs. It also may not be recommended for children under age 12. It’s also used to treat diarrhea since opioids can bind to receptors in the bowels that can control movement. A common side effect of opioid medications is constipation.

Is Codeine Legal?

Codeine is a legal substance though it can be abused and used for unintended purposes. It is a Schedule II or Schedule III substance, depending on the form you are taking, as classified by the U.S. Drug Enforcement Administration (DEA). The DEA classifies codeine in such a way as to raise consumers’ awareness about the acceptable medical uses of codeine as well as the potential for misuse and dependency.

While codeine is a legal substance when it’s used with a prescription, it can be used illegally. Opioids like codeine are often attractive as recreational drugs. However, high doses of the drug are used to achieve a euphoric high. Using the drug without a prescription or buying or selling it on the street is illegal. 

Illicit and prescription opioids are popular products in illegal markets. Many transnational criminal organizations buy and sell opioids as recreational drugs, including codeine, morphine, heroin, and synthetic opioids like fentanyl. Illicit codeine use significantly increases your risk of developing codeine addiction. Long-term use could lead to codeine dependence and substance use problems.

Drug dealers may also create and sell fake codeine. Dealers can press pills to look like legitimate pharmaceutical drugs. However, getting codeine from an illicit source may mean it’s mixed with other substances like fentanyl. Fentanyl is a powerful opioid that can be dangerous in even relatively small amounts. Mixing opioids with other depressants may also increase your risk of a codeine overdose.

What Are the Side Effects of Codeine?

Side effects experienced by each person taking codeine will vary, as everyone responds to medications slightly differently. There are several common, as well as more severe, side effects you can expect to experience with codeine use. Among them are:

Side Effects of Codeine

•  Dry mouth

•  Nausea and vomiting

•  Constipation

•  Dizziness

•  Drowsiness

•  Headache

•  Sweating and chills

•  Increased or decreased heartbeat

•  Weak pulse

•  Changes in vision

•  Abdominal pain or cramps

•  Low blood pressure

•  Shallow breathing

•  Intestinal blockage

•  Depression

•  Anxiety

•  Changes in mood

•  Hallucinations

•  Seizures

•  Cardiac arrest

It is important to be aware of the side effects you may encounter so that you know how to respond appropriately. Some of the milder side effects, such as headache and nausea, may be managed through simple home remedies and improve as your body gets used to taking codeine. Other side effects, such as changes to your breathing, cardiac arrest, and seizures, require emergency medical attention.

What Constitutes Codeine Misuse?

Recent studies have found that prescription opioid misuse has doubled during the past 10 years. It has become a public health crisis that requires immediate and significant attention. Codeine, specifically, is commonly misused by people who mix it with soda, alcohol, and other drugs, such as marijuana and benzodiazepines.

Anytime prescription medications are used in ways other than as prescribed by a doctor, they are misused. Even if codeine is legally obtained through a prescription, it can still be misused. Taking more codeine at one time than your doctor instructed or taking it for a longer duration than intended can indicate misuse. Additionally, taking codeine simply to get high constitutes misuse.

Prescription opioids are relatively affordable and easy to obtain, making them easy to misuse.

Why Do People Misuse Codeine?

People can misuse codeine intentionally and unintentionally. Unintentionally, people may misuse codeine even when a doctor has prescribed it to them. Perhaps they began taking the medication to address the pain that did not respond to other forms of medication. If taken for too long, their bodies may have developed a tolerance to and dependence on the drug. If those conditions are addressed by increasing dosage amounts, then the chance of misuse leading to addiction is very high.

Recreationally, people misuse opioids like codeine for the sake of getting high. When taken in high enough doses, they can cause a sense of euphoria and relaxation.

“Recreational opioid use is dangerous, however, as opioid drugs mix very poorly with many medications and other substances. Alcohol, as well as benzodiazepines and other opioids, can cause serious adverse effects in people who use them concurrently.

Purple Drank

The mixture is very popular in the hip-hop culture of the southern United States, where many artists have written songs about “purple drank”. It also goes by the name “lean,” because the narcotic effects are so strong that users are unable to remain upright.

The Washington Post reports that codeine is most commonly mixed with promethazine (another cough syrup), carbonated soda, and Jolly Rancher candy.  The consumption of promethazine induces the liver to produce an enzyme, which makes the body respond to the opioid effects of codeine at a much stronger degree than it normally would.

The cough syrup itself is usually consumed at much higher doses than a doctor would recommend. The most popular sodas to use are Sprite, Mountain Dew, and Fanta. A piece of Jolly Rancher candy is typically added to sweeten the mix.

The Daily Beast writes that the codeine mix is sometimes cut with over-the-counter cough syrups to induce hallucinations.

Cough syrup, soda, and Jolly Ranchers might seem harmless, but the codeine lacing of purple drank can lead to seizures and the very real possibility of an opioid overdose.

Despite its innocuous appearance, codeine is nonetheless an opioid, and its preparation in purple drank is typically not restricted to medicinal levels.

Speaking to the Los Angeles Times, a doctor warned that “the amount of codeine these guys ingest is massive,” comparing it to a heroin addiction without the needles.

How massive? The amount of cough syrup in purple drank can be more than 25 times the recommended dose.

Additionally, when codeine is taken in this context alcohol is involved — either in the purple drank itself or consumed separately.

Alcohol is a central nervous system depressant, and when taken with codeine, it puts users in danger of depressing their CNS to the point where even basic functions like breathing and heartbeat slow down.

If the body’s vital organs do not get enough oxygen and blood, systemic organ failure ensues, leading to coma and eventually death.