The Addictive Morphine-Like Substance
What is Codeine?
Codeine is an opioid medication that turns into morphine when in the body. While it’s not nearly as powerful as pure morphine, in large quantities it can have similar effects. Codeine is typically found in cough syrups and in combination pain medications (e.g. T3s which are Tylenol and codeine combined). It acts as a depressant of the central nervous system, resulting in feelings of relaxation and drowsiness.
Codeine belongs to a class of medications called opiates as well as a class of medications called antitussives. As an opiate, it’s used to treat pain by changing the way that the brain and the nervous system respond to pain. As an antitussive, it suppresses coughing by decreasing the activity in the part of the brain that is responsible for coughing.
The Drug Enforcement Association (DEA) has a drug schedule that ranges from Schedule I to Schedule V. Drugs are categorized according to their medical use and potential for abuse on this schedule. Schedule I drugs have the highest potential for abuse and the lowest level of medical usefulness and Schedule IV drugs have the lowest potential for abuse and the highest level of medical usefulness.
In general, codeine is listed as a Schedule II controlled substance (substances with more than 90 mg).1 A Schedule II substance is one that has both a medically legitimate purpose but also carries a high potential for abuse. It also means that there are quotas on how much codeine can be produced, restrictions on the number of prescriptions, and punishments for illegal use.
Combination drugs that contain less than 90mg of codeine in them are classified as Schedule III controlled substances.1 Some medications such as Robitussin, which is cough syrup, contain very small amounts and are classified as Schedule V substances.
What is Codeine Used For?
Codeine is used for the relief of mild to moderate pain. When used in combination with other medications, it may be used to reduce coughing. Cough medication that includes the drug comes in a syrup form that is taken orally.
How is it Used?
Codeine, whether alone or in combination with other medications comes in the form of a tablet, capsule, and a liquid solution taken by mouth.2 It should always be taken as instructed by your doctor, however, some people misuse it.
When tablets are crushed and snorted, or when the liquid medication is mixed together with soda and drank, there is a much greater risk of addiction. Other ways this drug is misused includes taking it more frequently than prescribed, in higher doses than prescribed, and for longer than prescribed. It is also frequently misused in combination with alcohol and marijuana, which can increase the risk of an overdose.
Effects of Codeine
What are the Short-Term Effects?
Using codeine can result in any of the following short-term side-effects:
Changes in heartbeat
Changes in vision
Decreased sexual desire
Difficulty breathing or swallowing
Loss of coordination
What are the Long-Term Effects?
Prolonged use of codeine can lead to side effects that are more long-term. These include:
Irregular heart rate
Liver malfunction (particularly with Tylenol combination medications)
Can You Overdose on Codeine?
Yes, you can overdose. Just like other opioids, you can overdose if you take too much at once.
Symptoms of overdose include:
Cold and clammy skin
Loss of consciousness
In the event of an overdose, it is extremely important to seek emergency medical assistance immediately. Overdosing can be fatal so it is important to administer naloxone if available. Naloxone is a mediation that is used to reverse the life-threatening effects of an overdose. This medication can essentially “buy time” until you get to the hospital.
If one dose of naloxone is administered and symptoms of an overdose return after a few minutes, another dose of naloxone should be administered. Naloxone works by blocking off the effects of opioids in the brain, essentially reversing the effects. Reach out to your local healthcare provider for information on where to obtain naloxone kits.
Emergency Medical Help
Emergency medical help is still required in the event of an overdose, even after administering naloxone.
How Can You Safely Stop Using Codeine?
The safest way to stop opiate use is through medical detox. A medical detox program helps you to safely stop using an opiate by helping manage withdrawal symptoms and reduce the risk of relapse.
Suboxone is the most commonly used medication prescribed in the treatment of opioid addiction. Suboxone contains buprenorphine and naloxone which help to reduce cravings and help with withdrawal symptoms by replacing the codeine with Suboxone.
What are the Withdrawal Symptoms?
If you use codeine for a prolonged period, suddenly stopping it can lead to unpleasant withdrawal symptoms. Withdrawal symptoms occur when the body has developed a tolerance to and a dependence on the drug. The body learns to function with the presence of codeine, so its sudden absence causes negative effects.
Some withdrawal symptoms are:
Loss of appetite
Is Codeine Addictive?
Yes, just like all other opioids, codeine can be highly addictive when taken in high doses and for a prolonged time. Codeine is a morphine-like substance that affects the brain’s reward center, resulting in feelings of euphoria, pleasure, wellbeing, and relaxation. It can also help to suppress negative feelings such as anxiety, stress, or depression. You are at particular risk of developing an addiction if you are abusing codeine.
What are the Rates of Codine Abuse in the United States?
Although there are fewer statistics on codeine use specifically, statistics on opioid use, in general, give us an idea of how big the problem of opioid abuse really is. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey of Drug Use and Health states that in 2018, approximately 10.3 million people over the age of 12 reported misusing opioids.3 9.9 million of these people abused prescription pain killers such as codeine specifically, with the remainder of people abusing heroin.3
Signs of Codeine Use
If you or someone you know is experiencing some or all of the symptoms below, it may be time to talk to someone about the effects of codeine and how it is impacting yours or your loved ones’ life.
Some of the symptoms of substance use disorder include:
Sleeping more than usual
Decreased appetite/weight loss
Confused mental state
Other Signs of Substance Use Disorder
Using a great deal of effort to maintain a constant supply of the drug, like obtaining it without a prescription, illegally purchasing on the street, or stealing prescriptions
Experiencing strong urges and cravings
Using codeine in other ways than prescribed. For example, using a higher dosage than prescribed, taking it more frequently than prescribed, taking it for longer than prescribed, crushing and snorting it, or mixing the syrup with soda
Using the drug even after experiencing negative consequences like relationship problems, lack of responsibilities, not fulfilling home, work and school obligations, negative side effects, lack of interest in previously enjoyed hobbies
Experiencing withdrawal symptoms when not using codeine
Experiencing pain differently as a result of the excessive use of opioid pain medication
Treatment options for substance use disorder typically involve some form of counseling or therapy and medication-assisted therapy.
Suboxone is the medication that is most commonly used for addiction treatment. Suboxone is made up of buprenorphine and naloxone which helps to reduce cravings and help with withdrawal symptoms. Suboxone works to replace the codeine in the body until it is no longer needed.
In addition to medication-assisted therapy, an essential part of substance use disorder treatment is counseling, therapy, or peer support groups Counseling can take place at an inpatient facility or an outpatient facility. To be successful in treatment, it is important to tackle the underlying reasons that may have led to using or misusing substances.
Counseling and therapy can help to identify patterns surrounding substance abuse, problematic behaviors, healthy coping mechanisms, and overall improvement to your quality of life.
Treatment programs that include counseling can help you:
Learn relapse prevention skills, healthy boundaries, and communication skills
Engage in alternative recreational activities
Adopt skills that help to rebuild and maintain relationships
Receive education surrounding substance abuse disorders
Develop coping skills
Address any co-occurring disorders or mental illnesses
Peer support groups such as Narcotics Anonymous are also helpful for individuals who are looking to connect with people who are going through the same experience. Peer support groups can build a community of people who help to hold each other accountable as well as celebrate successes and milestones during treatment.
Substance use disorders can make you feel isolated from your friends and family, so having a strong support network is crucial. A support group can be made up of family, friends, colleagues, mentors, social workers, physicians, and more.
Find Help for Your Substance Use Disorder
The treatment of substance use disorders must address the whole person, including physical and mental health. Substance use disorders are typically affected by and affect various other aspects of your life. For example, a pre-existing mental health disorder might lead you to use substances to address untreated symptoms. A substance use disorder can also lead to mental health issues such as anxiety and depression. Because of the strong link that substance use disorders have to other aspects of your life, it is important the substance abuse treatment address all aspects of wellbeing.
Names for Codeine
What are the Brand Names?
Codeine is an opioid that is used in combination with many different medications, resulting in a lot of different brand names, depending on what combinations of medications are in the drug.2
When combined with the following drugs, the brand names of codeine combinations are:
Z Tuss AC
Anhydrous Calcium Iodide
Phenylephrine + Pyrilamine
Chlorpheniramine + Phenylrephrine + Potassium Iodide
Diphenhydramine + Phenylephrine
Guaifenesin + Phenylephrine
Brompheniramine + Phenylephrine
Phenylephrine + Promethazine
Guaifenesin + Promethazine
Prometh with Codeine
Ammonium Chloride + Chlorpheniramine + Phenylephrine
Brompheniramine + Guaifenesin
Caffeine + Pheniramine + Phenylephrine + Salicylic Acid
Dexchlorpheniramine + Phenylephrine
Phenylephrine + Pyrilamine
- Texas tea
- Purple drank
- Pancakes and Syrup
- Captain cody
- Little C
- School boy
Codeine + Tylenol