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Reviewer Daniel Schimmel, LCSW, CADCII-CA
Editor Daniel Callahan MSW, CAP
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Codeine: Side Effects, Withdrawal & Detox

Codeine: Side Effects, Withdrawal & Detox

Codeine is a prescription drug that many people have had contact with in their lifetime. The tendency of manufacturers to mix it with other drugs, including mild pain medications, sleeping pills, and cough medicines, has reduced the public perception of its potential harmfulness. It’s hard to hear, for example, that codeine is used by a trusted brand name like Tylenol and feel like anything bad can come from it.

Unfortunately, codeine is actually an analgesic derived from morphine. That places the drug in a category with some others that people instantly recognize as addictive, including heroin, OxyContin and Vicodin. Once you know that, it’s not too surprising to learn that codeine usage is accompanied by many risks related to side effects, addiction, withdrawal, and detox. Regardless of your relationship with the drug, it’s a good idea to learn more about each of these.

What Exactly Is Codeine?

In the United States, codeine is classified as either a  Schedule II or Schedule III drug. It is labeled Schedule II when administered in amounts greater than 90 milligrams. It is considered a narcotic that has:

  • A high potential for being abused, especially by people with substance use disorders
  • Several accepted medical uses with strict rules in place
  • A history of severe psychological or physical dependencies in many patients who have been exposed to it

When available as a Schedule III drug, it is often available in some types of over-the-counter medicine. These medications include cough syrups, mild pain relievers, and sleep aids. The ready availability of the drug also makes it an ideal alternative for individuals who have substance use disorders as it allows them to get access to it without risking encounters with criminals or law enforcement.

At the same time, though, the Schedule III dosing level of fewer than 90 milligrams means that it may not produce a satisfactory experience for someone who has developed a strong tolerance. That’s particularly the case when a person has formed a tolerance to harder drugs in the same class.

Codeine is considered an opiate. There is frequent confusion about the differences between opioids and opiates, and the terms are often misused in an interchangeable manner. An opiate is a drug that is derived naturally from opium. Conversely, opioids are derived by synthetic processes, usually from precursors. For example, morphine in an opiate because it comes directly and naturally from opium. Heroin is manufactured from opiates, so it is an opioid.

Applications for codeine are centered on its use as a mild painkiller. We generally think of products like oxycodone as stronger painkillers, and codeine represents a step down the ladder from that sort of usage. Many who have come into contact with codeine have done so through the prescription of a form of Tylenol that includes the drug for added pain-dampening capabilities.

Side Effects

The side effects of the drug correspond very closely with what we know about opioids and opiates. For example, many who have been prescribed it report a sense of feeling dopey or confused. You may also experience:

  • Trouble concentrating
  • Stomachache
  • Dry mouth
  • Constipation
  • Rashes and itching
  • Sweating
  • Muscle stiffness or sensations of heaviness
  • Lowered heart rate
  • Heart palpitations
  • Hives

What is especially concerning in terms of the potential for abuse is that some patients also feel euphoria while using codeine. This also can be accompanied by a sense of being wholly disconnected from one’s pain.

It’s also possible for someone to develop a tolerance to the effects of the drug. Given that you can obtain it in OTC form, this leads some abusers to utilize it in conjunction with other products. Alcohol is an especially common choice. Many users choose to mix alcohol or caffeinated drinks with codeine-based cough syrup, producing something that’s often called “purple drank.”

Due to deaths that have occurred in children who had their tonsils or adenoids removed and given the painkiller, codeine is assigned a contraindication by the FDA. That means that it should not be prescribed to anyone below the age of 12. There are also warnings against its use for anyone below the age of 18, and warnings are included for teens who are obese as they may suffer increased breathing troubles.

Similarly, women who are breastfeeding infants are warned against using it. Neonatal incidents of non-addicted mothers having addicted infants have been documented. For this reason, those who are pregnant or plan to become pregnant should talk about that with their doctors before taking the drug. A woman who is opioid-dependent should not attempt to quit the drug without supervision as there are risks of miscarriage and premature delivery.

Intestinal blockages may give rise to discomfort in the lower torso, and many people have difficulty passing bowel movements. Decreased appetite is a known problem, too.

Symptoms of trouble often manifest in the form of noisy or shallow breathing, limpness, and confusion. If you begin to experience any of these symptoms after you’ve used the drug, you should immediately call 911 or get to an emergency room.

Drug Interactions

Interactions with other drugs and alcohol can make codeine misuse especially risky. Codeine is known to have adverse interactions with:

  • Antihistamines, including sleep medications like Unisom
  • Heart arrhythmia medications, especially Cordarone and Rhythmol
  • Leukemia drugs, including Gleevec
  • Many kidney medications, such as potassium phosphates and sodium phosphates
  • HIV meds, particularly Norvir and Aptivus

Alcohol interactions have a tendency to make the drug’s side effects more amplified. In particular, alcohol use alongside it can lead to sleeplessness, decreased concentration, drowsiness, dizziness, and odd dreams. If you believe that you’re experiencing an adverse interaction from a drug mixed with codeine, you should try to get in touch with an emergency services provider as soon as possible.

Addiction

As is the case with many other opiates and the opioids, codeine has a fairly short half-life. Most individuals who have formed physical dependencies on the drug will begin to experience cravings within 12 hours from the time of their last dose. For this reason, individuals often end up reinforcing addiction cycles by coming back to the drug in a regular manner. It’s normal for feelings of withdrawal to appear as nausea, aches and pains, headaches, shakes, and cravings.

Many people who start off with the drug eventually find themselves in a situation where it will no longer curb their cravings. This can lead to them seeking out harder opiates, such as:

  • Heroin
  • Oxycodone
  • Hydrocodone
  • Fentanyl

In many cases, patients with pain management issues will try to prompt their doctors to move them up to harder prescription drugs. Monitoring of patients who seek opioids and opiates has caused this to be a more difficult process than it once was because medical organizations now closely track who comes to them overtly seeking painkillers.

Unfortunately, the drugs that are available on the street represent their own set of problems. In particular, the growing practice of adding laboratory-grade fentanyl to street heroin has increased the risk that people already on track toward addiction will end up using very hard drugs. They may then experience the adverse effects associated with them.

Withdrawal

The earliest indicators of withdrawal tend to kick in between eight and 24 hours following a person’s last dose. These can be expected to last for between four and 10 days once withdrawal symptoms have begun to kick. Unsurprisingly, codeine withdrawal symptoms match very closely to the ones that people experience when they withdraw from other opiates and opioids. These include:

  • Runny or watery nose
  • Flashes of hot or cold sensations
  • Nausea
  • Vomiting
  • Sleeplessness
  • Sweating
  • Cramping of muscles
  • Watery eyes
  • Anxiety
  • Diarrhea

It is recommended that people undergoing withdrawal should be monitored by professionals three to four times a day. In some cases, hallucinations have been documented. Likewise, deaths have been recorded, although they are considered rare. Most fatal cases related to the withdrawal process have arisen from overdoses, decreased heart rates and stalled breathing. Urethral obstructions are also a known withdrawal symptom. The body can go into shock due to any of these potential problems.

Muscle spasms, especially kicking, have been noted in patients. In fact, this is where many people speculate that the phrase “kicking the habit” comes from. This is sometimes considered a form of restless leg syndrome.

Individuals who are suffering from withdrawal are encouraged to hydrate at higher rates than normal. Two to three liters of water per day is recommended. Your doctor may also have you acquire vitamin B and vitamin C supplements in order to replace nutrients that might be lost during the withdrawal period, particularly due to diarrhea.

Detox

Abruptly quitting the drug is not encouraged. In many cases, practitioners prefer to engage in what’s known as a taper with a patient. Rather than immediately cutting the drug out completely and cold turkey, the dose is slowly decreased in order to minimize the withdrawal symptoms experienced. Thanks to the short half-life of codeine, this process can be highly structured as long as the time of the last dose a patient consumed is known. Otherwise, a taper can be administered by adjusting it to correspond for when symptoms began to first present.

In some cases, a doctor may also prescribe drugs like methadone or suboxone. This is often the case if a person has been mixing codeine with other drugs or alcohol. These drugs cannot be obtained without a prescription from a professional.

A full detox will take between seven and 10 days, but many people express a sense of feeling better after a few days. Drugs like clonidine and naltrexone are sometimes utilized as part of the detox process, especially if a professional is aiming for rapid detox. Research indicates that some people who detox this way experience lower rates of temptation. The treatment may be beneficial for people who are particularly heavy abusers or have moved on to harder drugs.

Counseling is also highly encouraged during the process. Those who have formed physical or psychological dependencies may be placed on drug regimens to help them regulate cravings and temptations even after a detox cycle has been finished. Continuing support with group therapy or sessions at organizations like Narcotics Anonymous may be included, too. It’s a good idea to seek out a counseling organization with a location close to where you live. Meeting regularly with a group of people who have struggles similar to yours may help ensure that you stay on track.

Getting help is a process. You should come into it with the expectation that there is no cure-all for addiction issues involving any opiate or opioid. With time and persistence, however, you can begin to chart a path to recovery.

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