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Codeine addiction: signs, effects, and treatments

Reading time: 8 mins
Codeine addiction: signs, effects, and treatments

Codeine is an opioid medication that doctors prescribe to treat pain, but it is used in cough syrups as well. Codeine is misused like other opioids such as hydrocodone or morphine. Certain people develop Codeine addiction, a strong need to keep using the drug despite the consequences it causes.

Signs of Codeine addiction include strong cravings for Codeine, withdrawal symptoms when not using it, unsuccessful attempts to stop taking Codeine and spending a lot of time and money on getting, using and recovering from Codeine. 

People with Codeine addiction forge prescriptions and engage in other risky activities just to obtain it. They experience various physical effects such as appetite and weight changes, dizziness, urinary retention, and changes in blood pressure and heart rate.

The effects of Codeine are either short- or long-term. Short-term effects revolve around temporary reactions to the drug, such as nausea and vomiting, dry mouth, memory loss, and fatigue. Long-term effects of Codeine include organ damage, financial problems, legal troubles, and relationship issues.

What is codeine addiction?

Codeine addiction is an overpowering desire to use Codeine, increased tolerance to it, and withdrawal symptoms when discontinued. Codeine is a prescription drug used to treat mild to moderately severe pain. It is a type of opioid medication.

It has abuse potential and leads to both physical addiction as well as dependence. People with Codeine addiction have a strong urge or craving to keep using it, despite the problems they experience as a result. 

Codeine comes in the form of tablets, but it’s available in syrup form to treat cough as well. All opioids are habit-forming, including Codeine. People abuse Codeine for its calming effects. 

Codeine is less potent as compared to other opioids such as morphine. However, it has a similar structure to stronger drugs such as morphine and hydrocodone. For that reason, it causes similar reactions in the body.

Codeine addiction is included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) by the American Psychiatric Association among opioid use disorders.

What are the street names for codeine?

Street names for codeine refer to the informal, colloquial terms used to describe this opioid drug in non-medical or recreational contexts. The street names for Codeine are listed below:

  • Cody
  • Captain Cody
  • Little C
  • Schoolboy 
  • Lean
  • Sizzurp
  • Purple jelly
  • Purple stuff
  • Purple tonic
  • Sip-sip
  • Player potion
  • Purp
  • Barre 
  • Purple drank (when combined with promethazine)
  • Doors & fours (when combined with glutethimide)
  • Loads (when combined with glutethimide)
  • Pancakes and syrup (when combined with glutethimide)
  • Texas tea (when combined with promethazine)

What are the signs of codeine addiction?

signs of codeine addiction

Signs of Codeine addiction manifest through mood, behavioral, and physical symptoms. The most common signs of codeine addiction are listed below:

  • Depression and anxiety
  • Euphoria
  • Emotional numbness
  • Mood swings
  • Sense of calmness and well-being
  • Low blood pressure
  • Dizziness and fainting
  • Urinary retention
  • Reduced sex drive
  • Hallucinations and delusions
  • Impaired memory
  • Worsening of mental health
  • Trying unsuccessfully to stop taking Codeine
  • Withdrawal symptoms when not using Codeine
  • Developing tolerance thereby having to use higher amounts of Codeine to experience the same effects
  • Social withdrawal or isolation
  • Doctor shopping i.e. visiting multiple doctors (often using fake names) to obtain prescriptions for greater amounts of Codeine
  • Forging prescriptions to obtain Codeine
  • Frequent ER visits and/or faking illness, just to get Codeine
  • Borrowing or stealing Codeine from family and friends
  • Financial and legal problems
  • Losing interest in activities once enjoyed
  • Ordering Codeine on the internet
  • Spending a lot of time and money on thinking about Codeine, buying, and using it
  • Engaging in risky activities such as healthcare fraud
  • Lying about the extent of Codeine use
  • Impaired performance at work or school
  • Sleepiness and nodding off in the middle of conversations
  • Indifference toward loved ones and life in general

What are the possible causes of codeine addiction?

codeine addiction causes

Possible causes of Codeine addiction involve different factors that play a role in its development. It’s more likely that a combination of different factors contributes to the development of Codeine addiction rather than a single cause. The possible causes of codeine addiction are listed below:

  • Genetics: Certain people have a genetic predisposition to developing an addiction. The journal Current Psychiatry Reviews published a paper by Mistry et al., in 2014 that discussed genetics related to dopamine and opioid receptors. The paper reported that there is a genetic contribution to addiction disorders, including opioid addiction. In fact, the scientists observed variation within the DRD2, OPRM1, BDNF, and OPRD1 loci as a consistent factor in the development of opioid dependence. Critical components of the pathophysiology of substance use disorders are receptors and signaling molecules encoded by these specific genes. Individuals who have substance-dependent first-degree relatives, including parents or siblings, have an increased susceptibility to developing addiction themselves. For that reason, Codeine addiction has a genetic component.
  • Biological: Certain brain abnormalities and impaired levels of neurotransmitters contribute to the development of Codeine addiction. In fact, a study by Thomas R. Kosten and Tony P. George, published in the July 2002 issue of Science & Practice Perspectives  stated that people with addiction exhibit abnormalities in the prefrontal cortex (PFC) region of the brain. The prefrontal cortex (PFC) plays a crucial role in regulating planning, decision-making, as well as other executive functions. People with addictive disorders have impaired prefrontal cortex (PFC) signaling to the mesolimbic reward system, making them prone to compulsive drug-taking and impaired judgment in controlling impulses. When it comes to the reward system, the neurotransmitter dopamine is in charge. An impaired balance of dopamine and weakened dopamine receptors play a role in the development of addiction because the brain and body seek higher amounts of the drug just to experience the same effects.
  • Psychological: Numerous people struggle with mental illnesses such as anxiety or depression. These conditions have a wide range of symptoms that affect a person’s emotions, behaviors, thoughts, and other aspects of life. In these cases, people start using various substances, including opioids like Codeine, to “numb” the psychological impact of the mental illness and generate positive feelings. Repeated use leads to abuse, tolerance, dependence, and addiction to Codeine.
  • Environmental: People who are raised in turbulent, dysfunctional homes are more likely to develop an addiction to various substances, including Codeine. Substance abuse becomes a coping mechanism to deal with traumas they experience. In addition, people whose family members were addicted to Codeine are at a higher risk of developing an addiction to this opioid too. It’s not just due to genetic predisposition but because they are exposed to a behavior that is normalized in that environment. For that reason, socializing with people who are addicted to Codeine increases the risk of addiction as well.

What are the side effects of codeine?

Side effects of codeine refer to the often adverse physiological or psychological consequences that result from the use of this opioid medication. The side effects of Codeine are listed in the table below. 

Short-term effects Long-term effects 
Nausea and/or vomitingLiver and/or kidney damage
Pinpoint pupilsIntestinal blockage
Dry mouthDifficulty sleeping
Memory lossChanges in vision
Fatigue Anxiety and/or depression 
Loss of consciousness Cognitive difficulties
Changes in heart rate and blood pressureBrain damage due to reduced oxygen flow
Dizziness Severe memory problems such as amnesia 
Reduced or depressed breathingSeizures 
Constipation Financial problems
Stomach painEmotional or relationship issues
Headaches Drug-seeking behaviors such as “doctor shopping”
Sweating Overdose, coma, and death

How is codeine addiction diagnosed?

Codeine addiction is diagnosed through an intensive evaluation and includes assessment by a psychologist, psychiatrist, or licensed addiction counselor. 

A 2022 article titled, “Drug addiction (substance use disorder” from Mayo Clinic reported that blood and urine tests are necessary, but they do not serve as diagnostic tools for addiction. Instead, they’re used to monitor treatment and recovery.

In order to diagnose substance use disorder, in this case, Codeine addiction, a psychiatrist uses DSM-5 criteria. When it comes to diagnostic criteria for opioid addictions, such as Codeine addiction, a person needs to have at least two of them within 12 months. 

The criteria include taking the drug in larger amounts or over a longer period than intended, having the persistent desire and unsuccessful attempts to quit, and spending a lot of time on obtaining, using, and recovering from the drug.

Other criteria include strong cravings for Codeine, failing to fulfill obligations at home or work/school, continuing using the drug despite problems it causes, giving up social activities in favor of drug use, and using the drug in situations when it’s physically hazardous.

Continued drug use despite knowledge of persistent physical/psychological problems that is caused or worsened by the opioid, developing tolerance, and experiencing withdrawal symptoms are additional diagnostic criteria for Codeine addiction.

What are the codeine addiction statistics?

The Codeine addiction statistics are relatively scarce mainly because the reports focus on opioid addiction in general. What we do know is that in 2022, a total of 131,778,501prescriptions for opioid medications were issued, as per a publication titled, “United States Dispensing Rate Maps” last reviewed in December 2023 by the Centers for Disease Control and Prevention (CDC). Codeine is one of the most frequently prescribed opioids in the United States. 

Numbers show that 33 million people use Codeine every day. Various people misuse their prescriptions. According to results from the 2019 National Survey on Drug Use and Health published by the Substance Abuse and Mental Health Services Administration (SAMHSA), around 10.1 million people misused opioids in 2019, of which 9.7 million misused prescription pain relievers. Codeine is one of them. 

A publication titled, “Data Overview” from the CDC last reviewed in August 2023 additionally reported that more than one million people have died from drug overdose since 1999. Opioids accounted for over 75% of drug overdose fatalities in 2021.

What are the codeine withdrawal symptoms?

codeine withdrawal symptoms

The most common Codeine withdrawal symptoms are listed below:

  • Craving for Codeine
  • Difficulty sleeping
  • Irritability or anxiousness
  • Runny nose
  • Teary eyes
  • Yawning
  • Sweating
  • Faster heart rate
  • Muscle aches
  • Loss of appetite
  • Weight loss
  • Stomach cramps
  • Nausea and vomiting
  • Enlarged pupils
  • Goosebumps or chills
  • Diarrhea 

Codeine withdrawal symptoms occur in two phases. The first phase happens a few hours after the last use of the drug, whereas the second phase takes place as the body readjusts to functioning without Codeine. 

Withdrawal symptoms typically last for a week, or longer in certain people. Physical withdrawal symptoms are the strongest in the first few days after stopping Codeine use and are usually gone within two weeks. Cravings and behavioral symptoms last longer than that.

What are the treatments available for codeine addiction?

Treatments available for codeine addiction target the physical, psychological, and behavioral components of addiction to this opioid drug. Treatments available for Codeine addiction are listed below:

  • Detox: This is the first stage of addiction treatment. It’s a period when a person stops taking the drug, and the body experiences withdrawal symptoms as a result. Depending on the severity of withdrawal symptoms and the type of program, patients receive medications to reduce their severity. Medicines are a part of medication-assisted treatment (MAT). According to an article titled, “Medications for Substance Use Disorders” from the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine, naltrexone, and methadone help ease cravings and withdrawal symptoms among people with opioid addiction. The main purpose of MAT is to enhance patient survival, boost therapy adherence, reduce drug use, and support recovery.
  • Residential treatment program: This type of substance abuse treatment is mainly suitable for people with moderate to severe addiction to Codeine. Patients live in a treatment facility throughout the course of the treatment e.g., 60 or 90 days or longer. During their time in a rehab center, patients attend behavior therapy sessions. The most common type of behavioral therapy is CBT (cognitive-behavioral therapy), which teaches patients to identify negative thoughts that affect their emotions and contribute to unhealthy behaviors. Then, they learn to replace those thoughts with positive alternatives, which ultimately lead to healthier behavior patterns. Patients further learn coping skills, communication skills, and other skills they need to know to maintain their recovery and prevent relapse. 
  • Outpatient treatment program: This approach is suitable for people with mild to moderate addiction as well as for persons who have completed a residential program and want more structure and support. For this program, patients don’t need to live in a facility. They live in their homes and attend therapy sessions regularly. That means patients are able to maintain employment while receiving treatment for Codeine addiction. According to an article titled, “Opioid Use Disorder (OUD) Treatment” last updated in July 2023 by MedlinePlus, therapy sessions include CBT or other approaches such as support groups, counselings and their purpose is the same – to empower a patient to adopt healthier behaviors, develop new skills, and prevent relapse.