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Codeine Addiction

Several powerful drugs come from the opium poppy, and codeine is one of them. This addictive opioid drug is prescribed to manage mild-to-moderately severe pain on a short-term basis. It is also prescribed as a cough suppressant. While codeine is used therapeutically for certain conditions, the potential for its abuse is high. At higher doses, it is addictive, and long-term recreational use and misuse can lead to addiction.

What Is Codeine?

Codeine is a prescription opiate pain reliever that is in the same family as heroin, oxycodone, and other opioid pain medications. It is similar to morphine and hydrocodone and may be prescribed in liquid form or as a tablet. Some diarrheal medicines also contain codeine. There also are medicines that combine codeine with acetaminophen (which is commonly found in Tylenol), aspirin, or ibuprofen. 

Codeine slows down the brain and the body’s respiratory and nervous systems.

When codeine enters the body, it takes anywhere from 10 minutes to a half hour to take effect. Effects can last four to six hours, depending on how large the dose taken is. The drug floods the brain and stimulates its reward center. This causes the brain to release neurotransmitter chemicals that make users feel relaxed, happy, and sedated.  In particular, two chemicals—dopamine and serotonin—are affected when codeine is ingested.

These chemicals help to regulate several functions of the body, including feelings of pain and emotional well-being. Prolonged codeine use will change the way these chemicals regulate body processes and cause the chemicals to be produced in excessive amounts. As a result, physical and psychological dependence on codeine increases with each use.

Street names for codeine include Captain Cody, Cody, and Schoolboy. Codeine cough syrup mixed with alcohol is called Lean, Sizzurp, and Purple Drank. Codeine mixed with glutethimide, a sedative, is called Doors and Fours, Loads, and Pancakes and Syrup.

What Are the Signs of Codeine Addiction?

  • Higher tolerance levels for codeine. Prolonged codeine use increases tolerance, which results in users taking more of the drug to achieve stronger effects
  • Becoming increasingly focused on finding and using codeine
  • Using more codeine than prescribed or taking a dose at the incorrect time
  • Feeling unable to stop using codeine despite previous attempts
  • Continuing to use the drug despite the negative consequences of doing so
  • Experiencing withdrawal symptoms when effects wear off or codeine use stops

Chronic codeine users may appear sedated and have dilated pupils. They also may experience abdominal pain, diarrhea, and muscle aches as well as depression, anxiety, or irritability, among other withdrawal symptoms

If you experience any of these symptoms along with cravings for codeine, you or your loved one may have a substance abuse disorder that needs professional treatment.

What Is Involved in Codeine Addiction Treatment?

People in active codeine addiction who want to end their dependence on the drug will likely need to seek professional treatment at a licensed rehab facility. This ensures they safely detox from the drug and manage uncomfortable withdrawal symptoms and help avoid a relapse. Detox is traditionally the first step to take before an addiction recovery program starts. Codeine users are strongly advised not to go “cold turkey,” or quit the drug abruptly. Doing so can bring more harm than good. 


Professional treatment starts with a 24-hour medically monitored detox that is administered by medical care personnel who understand addiction and what is needed for a successful recovery. During this process, clients’ vitals are observed, such as their heart rate and breathing rate, and they may be given medications for nausea, insomnia, and other conditions that make withdrawal a challenging period. 

Medical professionals also may decide to have their clients go through a tapering process in which they are slowly and safely weaned off the addictive drug as they work toward stability. 


After stability has been achieved during the detox process, which can last three to seven days or longer, depending on the person’s situation, the next step is to enter a recovery program. Enrolling in such a program gives you or your loved one the time needed to face codeine addiction head-on and learn how to maintain full-time sobriety.

There are plenty of options available to make your recovery program meet your unique needs.  

Popular ones include residential treatment and outpatient treatment. Residential treatment requires at least a 30-day stay and therefore requires more commitment than an outpatient program.

There is no one-size-fits-all approach to drug recovery, but research shows treatment that lasts a minimum of 90 days, or three months, is the most effective for significantly reducing or stopping drug use.


If you’ve completed residential treatment or you can’t put your responsibilities on hold to live at a facility for 30 days, then outpatient treatment is a great option or next step.

Man pouring codeine into a spoon

By providing the same quality of weekly treatment while allowing you the freedom and flexibility of living at home, your counselors can equip you with the mental and emotional tools that are necessary for fighting off relapse triggers as they appear in your everyday life. 

How Dangerous Is Codeine?

Codeine is less potent than morphine, but it is still a powerful drug that should be used with care. Still, people who chronically use it in high doses are at risk of overdose, which can lead to death. The drug slows down the heart rate, which can lead to dizziness or fainting. It also slows down breathing and causes the blood pressure to drop. Excessive codeine use can lead to a loss of consciousness or decreased awareness. Other signs of overdose are:

  • A lack of blood pressure or pulse
  • Cardiac arrest
  • Blue lips, skin
  • Shallow or halted breathing
  • Chest pain
  • Excessive vomiting
  • Extreme fatigue

Seek immediate medical attention by calling 911 or visiting a hospital emergency room if any of these symptoms are present.

Using codeine for long periods to the point where addiction has set in also has long-term effects, which include kidney and liver damage, muscle problems, memory problems, and continued cravings for codeine long after use has stopped. Death is also a possibility.

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Codeine and Alcohol

The popular practice of mixing cough syrup with codeine with alcohol is highly dangerous. The nervous system will feel effects from both drugs, which can lower users’ blood pressure and cause lightheadedness, mental impairment, and respiratory distress is possible as well. Alcohol can also speed up the effects of codeine and cause it to enter the bloodstream at a faster rate, which increases the likelihood of overdose. Concurrent alcohol and codeine use can also damage the liver and kidneys and lead to death. 

Also, recreational users may indulge in “Purple Drank,” which is a mix of a cough medicine made with the antihistamine promethazine and codeine, soda, such as Sprite or Mountain Dew, and hard Jolly Rancher candies. Despite the glorification of this combo in hip-hop culture, sipping on this “sizzurp” drink can be fatal.

Codeine Abuse Statistics

  • Codeine is classified as a Schedule II drug in the U.S., which means it has a high potential for abuse, and use can lead to severe psychological or physical dependence.
  • From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription opioids.
  • In 2014, almost 2 million Americans abused or were dependent on prescription opioids, such as codeine.


(n,d). Drug Scheduling. United States Drug Enforcement Administration. Retrieved September, 2018 from

Bella, T, (March, 2017). Hip-Hop’s Unlikeliest Icons: Promethazine Codeine Syrup Manufacturers. Bloomberg. Retrieved September, 2018 from

(January, 2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute Drug Abuse. Retrieved September, 2018 from

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