Codeine is a prescription medication that treats mild to moderate pain. It can also be used alone or in combination with other medications as a cough suppressant. It belongs to the opioid family and is considered weaker than other opioids like oxycodone and hydrocodone. Although its effects as a pain reliever may not be as powerful, its potential for abuse is high.

Codeine misuse tends to be higher in Florida because it is available in combination with other medications and over-the-counter (OTC) to treat cough. Proof of identification is required for purchase, and restrictions limit the amount that can be purchased, but it is more accessible in Florida because it does not require a prescription.

What Is Codeine Used For?

Codeine can treat short-term pain as a result of surgery or dental work. This medication is usually an option if non-controlled medications like Ibuprofen or Tylenol are ineffective. It can also treat chronic pain, like cancer-related or arthritic pain. Codeine may treat dry cough. It is actually dangerous to use codeine for a wet or mucus-producing cough because it can prevent the body’s natural mechanism of clearing out the mucus, which may lead to respiratory conditions like pneumonia. In some instances, codeine may treat diarrhea.

Codeine treats pain by binding to opioid receptors in the brain that prevent the release of certain chemicals that cause pain. It treats cough by binding to those same receptors in a different area of the brain, the medulla. This suppresses the cough reflex.

Codeine Dosage

Codeine is available in a variety of dosages and formulations. As an immediate-release tablet, it is available in 15 mg, 30 mg and 60 mg. As a controlled-release tablet, meaning small amounts of medication are released throughout the course of the day, it comes in 50 mg, 100 mg, 150 mg and 200 mg. It is also available as an oral solution with a strength of 25 mg of codeine per 1 ml of liquid. These formulations all require a prescription in the United States. Codeine is generally advised to be taken every four to six hours.

Codeine Drugs

There are several prescription and OTC medications that contain codeine. Some of the more common medications with codeine include:

Active Ingredients	Popular Brand Names	Use	Prescription (Rx) or OTC
codeine and acetaminophen	Tylenol # 3, Tylenol # 4	Pain	Rx
codeine and guaifenesin	Cheratussin AC, Iophen-C NR	Cough	OTC (in Florida)
codeine and chlorpheniramine	Tuxarin ER, Tuzistra XR	Cough	Rx
codeine and promethazine	Phenergan-Codeine	Cough	Rx
codeine, aspirin and carisoprodol	Soma Compound with Codeine	Pain	Rx

Codeine Side Effects

Codeine, like other opioid medications, is associated with potential side effects. Experiencing adverse effects from this drug depends on the individual’s age, weight, how long the medication is being used, how often and the strength of the dose. The higher the dosage and the longer codeine is used, the more risk there is for side effects. Some of these adverse effects include:

• Constipation
• Nausea
• Vomiting
• Dizziness
• Sleepiness
• Sexual dysfunction
• Itchiness
• Blurry vision
• Shaking
• Abdominal cramps
• Weakness
• Slowed breathing

Codeine and Alcohol

Alcohol should be avoided while using codeine. Some people assume that because codeine is not as strong as other opioids, it may be safe to use with alcohol, but this is wrong. Consuming alcohol while taking codeine dramatically increases side effects, like drowsiness and dizziness. It can also severely impact a person’s judgment and ability to think clearly.

Combining alcohol and codeine can result in slowed breathing, unconsciousness, coma and possible death. If a person is taking an extended-release form of codeine, alcohol will cause the drug to be released into the bloodstream more quickly, increasing the risk of overdose.

Codeine Overdose

If someone takes more than the recommended dose of codeine or mixes codeine with alcohol or other narcotics, the risk of overdose is possible. If a person has been taking a codeine medication for a long time, their tolerance may be higher, requiring them to take greater amounts of the drug. This increases the potential for an overdose. Signs and symptoms of codeine overdose include:

• Difficulty breathing or slowed breathing
• Excessive sleepiness
• Unable to wake up or unresponsiveness
• Cold and clammy skin
• Slowed heartbeat
• Weak pulse
• Fainting
• Confusion

If an overdose of codeine is suspected, the poison control center at 1-888-572-1994 is available to help. If the person is unresponsive, has difficulty breathing or has collapsed, call 911 immediately. 

Codeine Addiction

As an opioid, codeine can be very addictive. There is a misconception that codeine is less likely to be misused since it’s weaker than other opioids, but this is not true. It binds to the same opioid receptors in the brain, causing feelings of calm and euphoria. In fact, this false assumption may make it more likely to be misused.

The risk of abuse is higher in someone that takes the drug long-term because they build a tolerance to the medication. The longer an individual takes this medication, the higher the dose is required to produce the same effect.

If a person abruptly stops taking codeine after misuse or long-term use, withdrawal symptoms are likely to occur, which can prompt the person to take the drug again. It is also common for a person with a codeine use disorder to take it with other opioids or alcohol.

Since codeine is available in OTC products in Florida, the risk for abuse may be higher than in other states. The ease of access to codeine provides a higher risk of codeine addiction and misuse.

Codeine Abuse Facts and Statistics in Florida

• There was a 9% increase in the number of deaths involving at least one opioid from 2016 to 2017.
• Opioid-related emergency room visits increased by 19% from 2016 to 2017.
• In 2020, there were 3,034 opioid-related deaths, an increase of 51% from the previous year.
  • 253 of those 3,034 people had codeine in their system, and 36 died directly from codeine use.

How Long Does Codeine Stay in Your System?

The half-life of codeine is 3–4 hours, meaning it can stay in your system for up to 20 hours since it generally takes five half-lives to expel a substance. This is after one dose of codeine, so the length of time it is detectable in the blood depends on the dose and length of time an individual has used it.

Generally, codeine may be detected in the blood for up to two days and in the urine for up to three days. Codeine can be detected in the hair for up to ten weeks.

Codeine Withdrawal

Codeine withdrawal can cause many adverse physical effects. Withdrawal symptoms may begin as soon as 8–24 hours after the most recent use. For extended-release formulations, the onset of withdrawal symptoms may begin 12–48 hours after last use. Symptoms associated with codeine withdrawal include:

• Flu-like symptoms
• Nausea
• Vomiting
• Anxiety
• Inability to sleep
• Sweating
• Muscle cramps
• Watery eyes
• Increased heart rate
• Abdominal cramps
• Diarrhea

Detoxification is the first step to manage codeine withdrawal symptoms and help someone struggling with codeine addiction. Medical detox involves removing the substance from the body in a controlled environment where an individual can be monitored, assessed and treated. Depending on the severity of the substance use disorder, detox may require medication-assisted treatment (MAT) to be given. Whether other drugs are required or not, the person will be safe and as comfortable as possible under the supervision of licensed and empathetic medical professionals.

Codeine Addiction Treatment

The right codeine addiction treatment depends on the person’s situation. Someone with a codeine use disorder needs to be assessed properly so that the treatment meets their unique needs. Orlando Recovery Center is an accredited facility that is equipped to provide optimal care to anyone struggling with a substance use disorder. This includes detox and rehabilitation in either an inpatient or outpatient setting, which is determined in consultation with our credentialed staff. Inpatient treatment involves living at the rehabilitation center during treatment, and outpatient care allows the client more autonomy with routine visits to the facility. Both levels of care provide psychotherapy, group therapy, substance use therapy and access to all of the facilities’ amenities.

Orlando Recovery Center is dedicated to assisting anyone struggling with codeine addiction begin and maintain recovery, allowing the individual to achieve a healthy and happy life. If you or someone you love is dealing with codeine abuse and addiction, contact us now to speak with a professional team member and learn more about how our treatment programs can help.