Codeine Side Effects, Addiction, and Treatment

Side Effects of Codeine

Codeine side effects can range from mild to severe. Knowing the symptoms can help you to determine when to call your medical provider.

Drowsiness
Fatigue
Lightheadedness
Shortness of breath
Nausea
Sweating
Euphoria, or feeling high
Dysphoria or feeling uneasy, dissatisfied or restless
Slowed heart rate
Palpitations
Flushing
Cramping in the abdomen
Digestive issues
Dry mouth
Anxiety
Sleep disturbances
Overdose

While visible signs of codeine use may only last a few hours, codeine can remain in the system for 16 hours or longer.³

Factors that affect the length of time include:

Age
Weight
Metabolism
Body fat
Body mass
Genetics
Liver and kidney health
Tolerance

Misuse or abuse of codeine can lead to tolerance, dependence and addiction. It’s important to seek help if you’re concerned about your codeine use.

Call 800-934-1582(Sponsored) today to discuss available treatment options.

Long-Term Effects of Codeine

Abusing codeine long-term can cause problems for all parts of the body.⁴

Effects on the Brain

Because codeine alters neurotransmitters in the brain, symptoms of depression and anxiety may occur. Codeine also causes slower breathing and, if abused, it may stop your breathing completely. When you stop breathing, your brain starts to lack much-needed oxygen, which can cause brain damage.

Digestion Problems

Opiates cause damage to the digestive system. For some, constipation is a big problem due to the sedation of the digestive tract caused by codeine use. This can lead to bowel obstructions, nausea, vomiting and perforations.

Pain

Opiates like codeine can, over time, make your body more sensitive to pain. While they may provide relief initially, their effectiveness can diminish, and some individuals may experience worsening pain instead of continued relief.

Liver Damage

Acetaminophen toxicity occurs when excessive amounts are taken, including when it is combined with other medications like codeine that also contain acetaminophen. High doses can overwhelm the liver’s ability to process the drug, leading to serious liver damage. In severe cases, this can impair overall health and make the body more susceptible to illness and infection.

Codeine Addiction

Codeine addiction often develops due to misuse, which means taking more than prescribed, combining codeine with other drugs to achieve intoxication or taking someone else’s prescription codeine.

Below are some signs you may have a codeine addiction:

Misusing codeine prescriptions (lying to get additional drugs, doctor hopping).
Spending time trying to find codeine.
Mood swings from happy and relaxed to angry and aggressive.
Experience withdrawal without codeine.
Cravings for codeine.
It is too hard to stop using codeine, even if it is causing consequences.
Using codeine interferes with the ability to work or have relationships.
Build up of tolerance.

Treatment for Codeine Addiction

Treatment for codeine addiction typically follows a structured step- down approach that is similiar to other substance use treatments. It begins with the most intensive level of care and as progress is made, individuals transition to lower levels of support that are less restrictive and less intensive.

Step One: Evaluation

Treatment cannot begin until you receive a thorough assessment from a licensed addiction specialist. The goal of the assessment is to gather information that can help establish the correct diagnosis.

Evaluations include discussing your and your family’s medical, psychological and addiction history, as well as your lifestyle, including home environment, habits and support system.

Based on the information you provide, the mental health professional can make a recommendation for treatment. Depending on the severity of your codeine addiction, detox may be recommended.

Step Two: Codeine Detox

Detox can be difficult; that’s why most treatment facilities recommend a medically supervised detoxification, where you are admitted into a hospital setting and have round-the-clock medical supervision.

Medications are often used to make the process easier and safer. These medications help to ease withdrawal symptoms and curb cravings. The time you spend in detox is focused mainly on ridding codeine from the body so you can move to the next step of rehab with a clear mind.

Step Three: Inpatient Rehab

Inpatient rehabilitation commonly follows detox and includes medical supervision, but in a residential setting.

Inpatient rehab therapies include:

Individual
Group
Family
Peer support counseling

Call 800-934-1582(Sponsored) to learn more about what to expect during inpatient rehab.

Many treatment facilities also provide alternative therapies to help you overcome codeine addiction, such as:

Massage
Acupuncture
Yoga
Meditation
Art therapy
Music therapy

Through behavioral therapies, you set short- and long- term goals and learn healthy coping skills that prepare you for life outside of treatment.

Step Four: Outpatient Services

Several types of outpatient services can help you overcome codeine addiction.

Sober living homes allow you to move into a residence outside of rehab with other people in recovery. There, you have more freedom and get a chance to practice the skills you learned before returning home. You can stay in sober living for many months, allowing you to build confidence in your recovery while you attend meetings, get a job and maintain peer support.

Intensive outpatient programs provide 10 or more therapy hours each week. This type of treatment is best for people with moderate to severe addiction and who need flexibility to maintain family, work or school commitments. Intensive outpatient treatment typically consists of attending multiple group, individual and peer support therapy sessions weekly.

Once completed, you can step down to individual counseling, support groups or both. Support groups are held in the community and meet daily in most places. Here, you get to receive and give support to others who understand opiate addiction.

Codeine and the Brain

Opioids increase dopamine levels in the brain, activating the brain’s reward pathways, creating feelings of pleasure and reinforcement. This surge in dopamine is significantly greater than what the brain typically produces on its own.

As codeine leaves the body, the brain signals a need for more to restore those pleasurable effects. Over time, this can lead to a cycle of cravings and continued use to avoid withdrawal symptoms and maintain a sense of well-being.

You may think prescribed codeine is not as harmful as illicit drugs, but that is not true.

Doctors consider many factors when choosing to prescribe codeine, including:

Has the patient been taking codeine? If so, at what dosage?
Does the patient have a tolerance?
What is the current health of the patient?
What is the medical history of the patient?
What other medications is the patient currently taking? Will they cause an interaction with codeine?
What type of pain is the patient having?
How severe is the pain?
Does the patient have risk factors for abuse? A prior history of abuse or addiction?

Codeine Aliases

Most prescription drugs have brand and generic names, including codeine.

Codeine, or codeine sulfate, is considered an opioid analgesic drug and is often combined with over-the-counter type drugs. Some examples include:

Fioricet is codeine combined with acetaminophen and caffeine to ease headaches.
Cotabflu is codeine combined with acetaminophen and chlorpheniramine for colds and flus.
Tylenol with Codeine #3 is used to alleviate pain.

Other examples of codeine combination drugs, including codeine cough syrup, include Phenflu CD, Maxiflu CD, Nalex AC, Colorex Compound and Pediatuss.

Several slang names exist for codeine syrups mixed with alcoholic, non-alcoholic or super-caffeinated beverages such as:

Lean
Purple Drank
Sizzurp
Syrup

Resources

National Institute on Drug Abuse. (2024). National Institutes of Health. Opioid overdose crisis.
Baldini, A., Von Korff, M., & Lin, E.H.B. (2012). A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. The Primary Care Companion for CNS Disorders, 14(3).
National Association of Addiction Treatment Providers. (2026). Addiction treatment statistics.

the Take-Away

Learn more about codeine, the side effects, long-term effects, risk for addiction, and treatment for abuse and/or addiction.

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