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Codeine Addiction: Signs, Risks, & Getting Help

Codeine is a prescription opioid that is often used as a pain reliever for mild to moderate pain and to treat chronic cough.1 Although codeine is a prescription medication, it is possible to misuse it in an effort to “get high” or for uses other than those prescribed by a doctor.2

In 2020, 0.9% of people in the U.S. aged 12 and older reported misusing codeine in the past year.3 Misusing codeine can increase the risk of developing codeine addiction.4 If you think you or a loved one are struggling with codeine misuse or a codeine addiction, you may find this article helpful. Read on to learn more about what codeine is, the signs of codeine addiction, and available resources for treating codeine addiction.


Find Out if Your Insurance Plan Covers Codeine Rehab

American Addiction Centers provides comprehensive rehabilitation services for those seeking recovery from opioid misuse and opioid use disorder (OUD). To find out if your insurance covers treatment at an American Addiction Centers facility, click here or fill out the form below. Your information is kept 100% confidential.


What Is Codeine?

You likely have heard of opioids and may be wondering what codeine is and how it differs from other opioids. Opioids are mostly used to alleviate moderate to severe pain, but some can also be used to treat diarrhea and reduce coughing.4 Opioids include substances that are legal, such as prescription medications like codeine and oxycodone, and illegal, such as heroin.5

Codeine is an opioid commonly prescribed in liquid or pill form to be taken orally. In addition to reducing pain or bodily discomfort, opioids can also produce effects such as a general feeling of happiness, decreased muscle tension, and a sense of calmness.6


What Is Codeine Addiction?

An individual has developed an addiction if they can’t control their codeine use and are compulsively taking codeine and seeking it out despite negative effects on their physical health, relationships, and other important areas of life.7 To determine if someone has an  opioid use disorder (OUD), the clinical term for an opioid addiction, medical providers use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) which provides a list of criteria and guidelines for diagnosing substance use disorders.

To be diagnosed with an OUD, someone must have recurrent opioid use and meet at least 2 of the following 11 criteria within a 12-month period:7

  • Using larger amounts of opioids or using opioids more frequently over a longer period of time than initially planned.
  • Unsuccessful attempts to reduce or completely stop using opioids.
  • Spending a lot of time using opioids or recovering from their effects.
  • Having a strong urge or desire to use opioids (also referred to as “cravings”).
  • Difficulty fulfilling major life responsibilities, including those related to work, school, family, and home.
  • Continuing to use opioids despite the presence of relationship problems with family, friends, and others.
  • Giving up enjoyable activities or reduced engagement in activities due to opioid use.
  • Using opioids in physically hazardous situations (e.g., driving, or operating machinery).
  • Experiencing recurring physical and psychological symptoms that are caused by or made worse by opioid use.
  • Building up a tolerance to the drug, meaning that you need to use larger amounts of opioids than previous doses to still feel its effects.
  • Experiencing opioid-related withdrawal symptoms or taking opioids to avoid experiencing withdrawal symptoms.

According to the DSM-5, OUD ranges in severity from mild to severe. Meeting a higher number of the criteria means a more severe OUD.7


Is Codeine Addictive?

Codeine, like other prescription opioids, has addictive properties, and anybody with a prescription for an opioid medication has an increased risk of developing an addiction vs. somebody who isn’t prescribed opioids.4,5 When following the guidance of a doctor and taken for a short time, codeine and other opioid medications are generally safe to take. Misuse of the medication, such as taking the medicine in a way or dose other than prescribed, taking someone else’s codeine prescription, or taking the medicine for reasons other than what it is prescribed for (such as to get high or cope with psychological distress, may increase the risk of developing a codeine addiction.5,8,9

An estimated 2.7 million people aged 12 and older met the criteria for an OUD in 2020.3


Side Effects and Risks of Codeine Use

Although codeine is prescribed by doctors and can be safe and effective when taken as directed, there can still be side effects and risks to using it, even when it is used as prescribed. Some potential adverse side effects associated with codeine use include:1,3,12

  • Constipation.
  • Feeling sick to one’s stomach.
  • Vomiting.
  • Drowsiness or sedation.
  • Confusion.
  • Slowed breathing.

Addiction and overdose are also very real risks when using an opioid like codeine. Even when taking codeine as prescribed, a person can become dependent on the medication, meaning if they stop using codeine they will experience symptoms of withdrawal. Withdrawal symptoms for opioids are similar to flu symptoms and can include nausea, vomiting, depressed mood, muscle aches and body pain, sweating, diarrhea, fatigue, and fever.7

Anybody prescribed opioids is at increased risk of accidental overdose, and there are increasing concerns about opioid-related overdose deaths, which have grown in recent years. For example, in 2020, there were over 100,000 deaths related to drug overdose.10 Of those fatal drug overdoses, approximately 78,000 (78%) included an opioid. This is the highest number ever recorded.11 The risk of experiencing a fatal overdose increases with misuse of opioids.

It is important to know the signs that may indicate an overdose. An overdose is a medical emergency, as it can lead to a person being unable to breathe, which can result in brain damage, coma, or death. A drug called naloxone can reverse the effects of a potentially life-threatening opioid overdose.11 Some signs of overdose include:3

  • Slowed, shallow, or stopped breathing.
  • Constricted, or “pinpoint,” pupils.
  • Loss of consciousness or being unable to wake.
  • Cold and damp skin.
  • Choking or making gurgling sounds.
  • Lips and fingernails turning blue.

Using opioids over an extended period and at higher dosages increases the risks of dependence, overdose, and even the development of an OUD.8


Getting Help for a Codeine Addiction

Although a codeine addiction may feel difficult to overcome, it is a treatable condition. There is a wide variety of treatment options available to treat codeine addiction. Treatments may be delivered in individual or group format and may include outpatient (where you attend treatment but leave the treatment facility) and inpatient or residential programs (where you may stay for a longer period at the treatment facility). Treatment is available throughout the country, ranging from private rehab programs, to detox programs, and to state and local treatment programs.

Even with the many treatment options available, treatment can look different for everyone. Individualized treatment plans which focus on the needs of the patient are the standard of care for addiction treatment.13 Some common treatments for codeine addiction include:13-15

  • Behavioral therapies. Behavioral therapies are some of the most commonly used therapies for treating substance use. Behavioral therapies can help people identify and change their thoughts and behaviors surrounding opioid use.
  • Medication can be used to help eliminate or alleviate withdrawal symptoms as well as prevent relapse and reduce cravings for codeine and other opioids.
  • Co-occurring disorders. Addiction can co-occur with other mental health conditions, like anxiety, depression, and posttraumatic stress disorder. Some addiction treatment programs also are equipped to help people manage, treat, and improve symptoms from other conditions as well as OUD.
  • Relapse prevention. Understanding factors, such as situations, people, and emotions, that increase your desire to use codeine or other opioids is important for recovery from OUD. Mutual help or peer support groups during and after formal treatment can be an opportunity to practice coping strategies once you have quit using codeine.

What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment (MAT) refers to the use of medications, typically in combination with counseling or behavioral therapy, to treat opioid use disorder. MAT can improve a person’s quality of life and help to reduce relapse by alleviating cravings. Certain medications can also alleviate withdrawal symptoms and can help to reduce the risk of relapse or continued use of codeine and other illicit opioids. Medications used to treat OUD include buprenorphine, methadone, and naltrexone. These medications work by reducing cravings to use opioids and limiting the pleasurable effects of using opioids.16 Medications may be one component in an individualized treatment plan and may be combined with other treatments, including individual and group therapy programs.


Sources

  1. Peechakara, B.V., Gupta, M. (2021). Codeine. Treasure Island (FL): StatPearls Publishing.
  2. National Institute on Drug Abuse. (2021). Brain and addiction.
  3. Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  4. National Institute on Drug Abuse. (2021). Prescription pain medications (opioids).
  5. National Institute on Drug Abuse. (2021). Prescription opioids drugfacts.
  6. Drug Enforcement Administration. (2017). Drugs of abuse: a DEA resource guide.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, Fifth edition (DSM-5). Arlington, VA: American Psychiatric Association.
  8. S. Department of Labor. (n.d.). Risk factors for opioid misuse, addiction, and overdose.
  9. Marie, B. (2019). Assessing patients’ risk for opioid use disorder. AACN Advanced Critical Care, 30(4), 343–352.
  10. Centers for Disease Control and Prevention. (2021). Drug Overdose Deaths in the U.S. Top 100,000 Annually.
  11. National Institute on Drug Abuse. (2021, March 11). Opioid overdose crisis.
  12. National Institute on Drug Abuse. (2020, June). Misuse of prescription drugs research report.
  13. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of effective treatment.
  14. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction drugfacts.
  15. Guenzel, N., McChargue, D. (2022). Addiction relapse prevention. Treasure Island (FL): StatPearls Publishing.
  16. Substance Abuse and Mental Health Services Administration. (2022). MAT medications, counseling, and related conditions.

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