Is Codeine Addictive?

Because codeine is widely prescribed, most people don’t think of codeine as a problem drug like fentanyl or heroin, but as an opioid, it’s commonly abused. In 2022, more than 19.8 million people used codeine, with 9.3% of those people misusing the drug.

Like any opioid, codeine is addictive and carries many risks, including overdose.

What Is Codeine?

Codeine is a commonly prescribed opioid for pain relief and cough suppression. It is often combined with acetaminophen, guaifenesin, or promethazine. It produces feelings of relaxation and euphoria, which is why it can lead to dependence and addiction.

Codeine has many side effects, including:

• Drowsiness
• Impaired performance, both physically and mentally
• Dizziness
• Nausea and vomiting
• Constipation
• Dry mouth
• Sweating
• Shortness of breath
• A feeling of discomfort
• Abdominal pain
• Itching

When combined with acetaminophen, large doses can lead to liver failure. When used with alcohol or some other drugs, it can lead to depression of the respiratory system.

Codeine Addiction

Codeine activates opioid receptors in the brain, modifying pain signals. It also increases dopamine activity in the brain, which is what leads to feelings of euphoria. This can lead to dependence because, over time, the brain requires codeine to produce feelings of pleasure. It becomes an addiction when the user begins to seek codeine despite its negative consequences.

Signs of Codeine Addiction

The Diagnostic and Statistical Manual of Mental Disorders uses the following criteria to diagnose addiction to codeine or any opioid.

• Taking codeine longer or in higher quantities than intended.
• An inability to cut down on or stop codeine use.
• Spending significant amounts of time obtaining, using, and recovering from codeine use.
• Extreme cravings for codeine.
• Failing at responsibilities at home, work, or school.
• Continuing to use codeine despite negative consequences.
• Giving up pleasurable activities because of codeine use.
• Using codeine in dangerous situations.
• Developing tolerance, meaning needing to use more codeine to get the same effects.
• Withdrawal symptoms when not using.

Codeine Overdose

Codeine overdose causes severe respiratory depression, which is life threatening. Signs include:

• Losing levels of consciousness
• Extreme drowsiness that may lead to stupor and coma
• Constricted pupils
• Limp muscles
• Cold, clammy skin

If the codeine was in a combination form of one of the commonly prescribed combination drugs, the following can occur.

• Nausea, vomiting, and sweating caused by liver cell death
• Kidney damage
• Hypoglycemic coma
• Coagulation defects
• Central nervous system depression
• Low blood pressure
• Unconsciousness and sudden death due to respiratory depression

Narcan can be administered if available, and immediate emergency medical treatment is required.

Codeine Withdrawal

Codeine withdrawal symptoms are similar to those of any opioid. They include:

• Nausea and vomiting
• Diarrhea
• Anxiety
• Insomnia
• Muscle spasms
• Bone and muscle pain
• Fast heartbeat
• High blood pressure
• Increased body temperature
• Heightened reflexes
• Sweating and chills
• Fever
• Yawning
• Runny nose and watering eyes

Codeine Addiction Treatment

The first step in any treatment program, such as the program provided by Bridges of Hope, will be a multi-level assessment that will provide information that allows the provider to build a personalized treatment plan. The assessment will also determine if any co-occurring mental health disorders exist, such as anxiety or depression. Treatment will include treating these co-occurring disorders.

The first stage of treatment is a medically supervised detox to keep the patient safe and as comfortable as possible. During the detox phase, therapy will also begin.

Cognitive behavioral therapy (CBT) has been found to be the most effective therapy used to treat codeine addiction. CBT involves learning to recognize and control negative or detrimental thoughts by rethinking them using reasonable, reality-based information that they learn during therapy.

For example, people with a codeine addiction may think that they can use codeine in moderation. In CBT, they learn that this is not rational because of the nature of drug dependence and addiction, and to rethink the thought into something productive, like “I can’t control my codeine use, so I need to stop. I can use healthy coping strategies so that I’m not putting my health and life at risk.” CBT involves learning these healthy coping strategies, as well as problem-solving skills to manage life’s challenges without codeine or other substances.

Motivational interviewing is another method of therapy, which involves setting goals for both recovery and in life and building motivation to meet those goals. For example, the patient may set recovery goals and celebrate milestones such as 30 days clean, 60 days clean, etc. They may also set life goals, such as going back to school or starting a career.

Group therapy is also an important part of recovery. Peer support is invaluable in the recovery process, reducing feelings of isolation and providing opportunities for patients to share emotions and experiences with people who are going through the same challenges.

Many patients also continue to find this support after treatment in peer support groups such as 12 step programs.

The Structure of a Codeine Treatment Program

An ideal treatment program for codeine addiction will start with an inpatient program for at least 28 days. In this program, medically supervised detox and various types of therapy will occur.

Inpatient treatment is followed by a partial hospitalization program (PHP), which involves therapy for five to eight hours a day for four to six weeks.

PHP is followed by an intensive outpatient program (IOP), which consists of therapy for two to three hours per day, five days a week, for 60 to 90 days.

Individual therapy may then continue for the long term, as should support group involvement. Recovery from codeine addiction, or any addiction, is a lifelong process, requiring continuous learning and support.

Help Is Available

If you are struggling with codeine addiction, help is available. The treatment process may seem overwhelming and long, but with each day of treatment, you’ll feel healthier and more able to cope with life. When it’s done, you’ll be able to move forward with the life that you desire, able to deal with challenges and to find personal fulfillment and even joy. It takes one phone call to start your journey to recovery and a healthy, happy future.