How Is Codeine Abused? Is It Dangerous? - AmbrosiaTC Ambrosia Drug & Alcohol Addiction Treatment Center
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Codeine Abuse Is It Dangerous?

Medications are designed to soothe distress. When we’re ill or hurt, we pop open pill bottles to make our symptoms fade away. But some of the solutions we lean on to solve problems can create others in time.

Consider codeine. This is one of the oldest medications used in modern medicine. When it’s given properly, it can make very ill people feel a whole lot better. But this same drug has been implicated in rising rates of drug use and addiction.

Could this happen to your family? We’ll help you find out. In this article, we’ll cover:

  • How codeine abuse develops.
  • Symptoms of drug abuse.
  • Treatment challenges and approaches.

woman with a cough

What Is Codeine?

Codeine has a unique chemical profile that makes it a good solution for a very specific type of illness. It’s also metabolized in the human body in a slightly unusual way, and that makes its addiction potential slightly difficult to determine.

Codeine is technically considered a narcotic and an antitussive. That means this one medication has the power to:

  • Address pain. Codeine tinkers with brain chemistry, boosting the presence of a pleasure chemical known as dopamine. This doesn’t kill pain, but it can make the discomfort easier to ignore.
  • Block coughing. Codeine can suppress the urge to cough, which can allow distressed tissues in the lungs and throat to heal.

Respiratory infections, including bronchitis, can respond to treatment with codeine. Stronger illnesses, including lung cancer, may also be addressed with this drug.

But the medication is also used as a standalone treatment for pain, even in people who don’t have a coughing or hacking component to their illness.

Codeine’s classification as a narcotic makes it similar to well-known dangerous drugs, including Vicodin and OxyContin. But it works within the body in a slightly unique way that could increase its associated risks.

Codeine is considered a pro-drug, according to the American Academy of Pediatrics. Drugs like this aren’t active when they enter the body. Instead, these medications must be altered by the body in some way before they can spark changes. Codeine is metabolized by the liver, and there, it turns into morphine.

The body’s ability to make this transformation varies. Some people are very good at making the shift, and those people could have much higher blood-level concentrations when compared to people who don’t have such finely tuned systems.

Let’s put this in perspective.

When you’re given an OxyContin pill, you know just how much active ingredient is included. If you stick to your doctor’s dosing protocols, you’ll have a predictable experience. Codeine, on the other hand, is not so easy to predict. Even if you follow instructions, you could end up with a very high blood dose. And that can alter your brain in a way that leads to abuse.

dark tunnel

How Does Codeine Abuse Begin?

Opioids like codeine change brain cells in predictable ways that lead to the development of abuse and then addictions. Use becomes mandatory. Otherwise, the person feels incredibly ill. When that happens, people with a codeine addiction must go to desperate measures to get the drug they love.

The flood of pleasure chemicals opioids trigger harms brain cells. They become accustomed to the constant stream of dopamine, and they require bigger and bigger doses to deliver relaxation and euphoria. People developing a dependence may take doses closer and closer together, and they may take more and more each time.

Codeine is typically considered a Schedule II controlled substance, and that means people must have a prescription to get it. But there is an exception.

Products that have 90 milligrams of codeine per dose (or lower) are Schedule III controlled substances, and that means pharmacists can sell them without a prescription.

Someone may develop an addiction through a prescription for cough syrup. But when that bottle runs dry, they’ll need more. They could feign illness to pharmacists to get more, or they could buy pills from dealers. Some people move from using codeine to using another type of opioid, like Vicodin.

This process doesn’t happen quickly, but it is relatively common.

In a study published in 2013, researchers found that 6.8 to 17.8 percent of people exposed to codeine developed a misuse or dependence problem. This result surprised researchers, as they didn’t expect so many people to have trouble with this common medication. But the findings suggest exposure to codeine can trigger brain changes that lead to addiction in time.

Codeine and other opioids also suppress the central nervous system, and at high doses, they can result in a coma-like state. People with addictions may be chasing a high, but they could take so much that they overwhelm their bodies and cause death due to overdose.

drug user in despair

What Does Codeine Abuse Look Like?

Addictions are characterized by denial, so it isn’t uncommon for people with problems to deny that they exist. But codeine causes such large issues that outsiders can spot the changes.

To maintain the addiction, people must have a consistent supply of codeine. That could lead people to:

  • Steal. They may go to open houses, visit friends, or drop in on relatives to raid medicine cabinets.
  • Lie. They may feign illnesses to convince doctors to fill prescriptions.
  • Borrow. Maintaining an addiction is expensive. Money may be very tight.
  • Sell. Pawning prized possessions can help to raise money for codeine.

These changes in habits can be easy for family members to spot. But they’re not the only adjustments that are sparked by addiction.

Codeine also causes physical changes, and that can lead to visible symptoms, such as:

  • Persistent headaches.
  • Nausea or vomiting.
  • Dry mouth.
  • Itchy skin.

During intoxication, people may also seem sedated, and they may have a sickly sweet tinge to the breath if they’ve been drinking codeine substances. They may call those drinks “purple drank” or something similar.

join hands

How Is Abuse Treated?

A doctor can be a great ally in detecting drug abuse and prompting someone to get help. But codeine is slightly different, and that could result in the need for more significant therapy programs.

Researchers point out that codeine is relatively easy to get, even without a prescription. People can prompt pharmacists to get it, or they can buy it from other countries, where its use isn’t regulated at all. That can mean an addiction moves on unchallenged for a long time, and it grows in severity.

An entrenched addiction can be treated, but the program must also scale in severity. People may benefit from medications to soothe flu-like withdrawal symptoms, so they don’t relapse to drug use before learning begins.

After detox, people need a treatment program that incorporates multiple solutions, such as:

  • Group therapy.
  • Couples therapy.
  • Individual therapy.
  • Support group meetings.
  • Medication management.
  • Alternative therapies.

If people can’t stay sober at home, they can enroll in inpatient programs to get both supervision and around-the-clock help. But if they have a strong support system at home, they may be able to get care on an outpatient basis.

The key for anyone struggling with codeine is to get help as quickly as possible. Treatment really does work, but the sooner it starts, the better.


Codeine. (March 2018). U.S. National Library of Medicine.

Codeine: Time to Say ‘No.’ (October 2016). Pediatrics.

Controlled Substance Schedules. U.S. Department of Justice.

Identifying and Treating Codeine Dependence: A Systematic Review. (June 2018). The Medical Journal of Australia.

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