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Codeine (methyl morphine) is an opioid medication typically taken in pill or liquid form. It is in the same class as other narcotics such as morphine (from which codeine is derived) and heroin.
As a medication, codeine is often used to treat chronic pain from cancer and other serious illnesses. It’s also sometimes used to treat chronic cough, often mixed with other medications such as a decongestant or expectorant. 1,2
Codeine may be effective in treating nighttime restless leg syndrome, especially if symptoms aren’t relieved by other drugs. It has also been found to be effective in treating persistent diarrhea as a result or symptom of serious illness.2
As a prescription opioid, codeine is one of several prescription medications (along with oxycodone, hydrocodone, morphine and others) that has contributed to a significant rise in opioid abuse and overdose deaths over the last decade. From 2004 to 2016, there were over 40,000 codeine-related adverse drug events reported to the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), resulting in just over 7,200 deaths.3 Although not as deadly as oxycodone, hydrocodone and fentanyl, the number of deaths resulting from codeine use is still significant.3
The United States Drug Enforcement Agency has classified codeine as a Schedule II drug, meaning that it has high potential for abuse and addiction, and it can only be legally obtained with a prescription from a physician.4 However, drugs containing less than 90 mg of codeine are classified as Schedule III drugs, suggesting a lower potential for addiction and abuse but still needing a prescription.4
As a narcotic medication, codeine’s mechanism of action is similar to other opioid drugs like morphine. It binds to receptors in the brain that are specialized receptors for endogenous opioid-like neurotransmitters. These particular neurotransmitters are involved in controlling pain and reducing the sensation of fatigue. Along with dopamine-facilitated neurotransmitters in the brain that are abundant in areas associated with reward and reinforcement, they produce feelings of euphoria, relaxation, and a sense of the general overall wellbeing. The reinforcing effects of opioid drug use contribute primarily to their potential for leading to abuse and addiction.2,5
Potential adverse reactions to codeine include:2
More serious potential side effects include:2
Indications of overdose include:2
Other potential serious side effects from long-term codeine use are its potential to result in physical dependence and/or the development of a substance use disorder.
At this time, there are no definitive causes to explain the development of a substance use disorder to any particular drug or in any particular individual. Research indicates that the development of substance use disorders is caused by a combination of factors that include the person’s genetic makeup, family history, psychological history, experiences, peer group, and a number of other potential factors.6
However, drugs that typically are capable of inducing physical dependence are also drugs that are believed to have a high potential for addiction. The reason for this is that the withdrawal syndrome associated with these drugs makes it particularly difficult for individuals to stop using the drug on their own, and when they experience withdrawal symptoms the quickest way for them to address these symptoms is to take more of the drug. Continuing to take more and more of a drug in spite of negative consequences is a hallmark of addictive behavior.5
Some general signs of codeine addiction include:7
Codeine is a narcotic medication. It’s a short-acting opioid that’s chemically similar to heroin and produces similar effects in the body, including tolerance and physical dependency, which can lead to addiction.8,9 Like other opioids, it can induce some fairly powerful withdrawal effects.
For people who have developed physical dependence to codeine, withdrawal begins within 8-24 hours of last use and lasts approximately 4-10 days. Withdrawal symptoms may include:8,9
Effective treatment of an opioid use disorder employs both the use of medications and behavioral therapy.7,8 Prescription medication such as methadone, buprenorphine and naltrexone can help reduce uncomfortable withdrawal symptoms, particularly cravings—which helps to prevent relapse.7 Depending on a person’s level of withdrawal severity and the support they’ll need to recover from their addiction to codeine, withdrawal management may be performed in either inpatient or outpatient addiction treatment programs.10
Inpatient treatment programs allow for closely supervised withdrawal by medical professionals as well as a multidisciplinary team that can cover different aspects of recovery. It also provides a safe environment for recovery and facilitates interactions with other people who are in recovery. This allows for both individual and group therapy sessions, which may help prevent relapse.10
Mutual-help groups, such as those held by 12-step programs like Narcotics Anonymous, offer a structured program built around social support that may be helpful throughout an individual’s recovery from codeine addiction.10 They are free and easy to access, with meetings available in nearly every city at nearly every time of day.