Codeine Abuse Signs & Symptoms, Withdrawal And Treatment Options

Codeine is a common drug found in a number of off the shelve products, but as a family member of the opioids, its risk of abuse is high. If you or a loved one are struggling with codeine addiction, you’re not alone.

What is Codeine?

Codeine is a narcotic pain-reliever and cough suppressant. Codeine binds to opioid receptors in the brain which regulate the sensation of pain throughout the body and brain.

Codeine works by increasing tolerance to pain and minimizing discomfort. In addition to reducing pain, codeine also causes sedation drowsiness and depresses breathing.

Codeine is a class B, schedule 2 drug. If prepared for injection it becomes a class A substance. It is illegal to possess without a prescription or to supply or produce without a licence.

Codeine is marketed as both a single-ingredient drug and in combination with paracetamol (as co-codamol: e.g., brands Paracord, Panadeine, and the Tylenol-with-codeine series, including Tylenol 3 and 1,2,4); with aspirin (as co-codaprin); or with ibuprofen (as Nurofen Plus). These combinations provide greater pain relief than either agent alone (drug synergy).

Use and Dosage

Codeine is usually used to treat mild to moderate pain and to relieve coughs.[2] Codeine can also be used to treat diarrhoea and diarrhoea-predominant irritable bowel syndrome.

The usual adult dose of codeine for pain is 15-60 mg every 4-6 hours as needed. The dose for cough is 10 to 20 mg every 4-6 hours as needed. The maximum dose for treating a cough is 120 mg every 24 hours. Tablets: 15, 30, and 60 mg. Solution: 15 mg/5ml (teaspoon). Injection: 15 and 30 mg/ml.

Under the Misuse of Drugs Act, 1971 codeine is a Class B controlled substance or a Class A drug when prepared for injection. The possession of controlled substances without a prescription is a criminal offence. However, certain preparations of codeine are exempt from this restriction under Schedule 5 of the Misuse of Drugs Regulations 2001. It is thus legal to possess codeine without a prescription, provided that it is compounded with at least one other active or inactive ingredient and that the dosage of each tablet, capsule, etc. does not exceed 100 mg or 2.5%.

Side Effects

Because Codeine is habit forming, addiction and dependence can occur, but this is unlikely when it is used for short-term pain relief.

Using codeine during pregnancy can cause opioid withdrawal syndrome for the baby, which may be life-threatening if not treated appropriately.

The most frequent side effects of codeine include:

  • Lightheadedness
  • Dizziness
  • Nausea
  • Vomiting
  • Shortness of breath
  • Sedation
  • Allergic reactions
  • Constipation
  • Abdominal pain
  • Rash
  • Itching

Serious side effects of codeine include:

  • Life-threatening respiratory depression
  • Severe low blood pressure
  • Adrenal insufficiency
  • Accidental ingestion of codeine can result in fatal overdose
  • Codeine can impair thinking and reaction times so driving or operating machinery is not advised.

Additionally, alcohol and other sedatives when combined with codeine can exacerbate the symptoms above. Therefore, alcohol and other sedatives should not be used when taking codeine.

Overdose and Withdrawal

Codeine overdose occurs when you ingest enough of the drug to cause dangerous—even fatal—side effects. If overdose is suspected, promptly seek emergency medical assistance.

Some of these overdose effects may include:

  • Fatigue, drowsiness, and confusion.
  • Dizziness and lightheadedness.
  • Breathing problems.
  • Cold and clammy skin.
  • Fingernails and lips with a bluish tint.
  • Stomach and intestinal spasms.
  • Constipation.
  • Constricted pupils.
  • Low blood pressure and weak pulse.
  • Unresponsiveness and coma.
  • Liver failure.
  • Kidney failure.
  • Hypothermia.
  • Anoxic brain injury.
  • Seizures.
  • Pulmonary oedema.
  • Breakdown of skeletal muscles.
  • Trauma (falls, automobile accidents)

The most common cause of death from opiate overdose is respiratory failure, wherein the user simply stops breathing.

Codeine is highly addictive. If you use Codeine over an extended period of time your tolerance to the drug builds up. This means that you will need higher and higher doses of codeine to feel its effects. After prolonged use, you may become physically and psychologically dependent on codeine.

Codeine use triggers changes in the central nervous system and in brain chemistry. If you are addicted to codeine and suddenly stop taking codeine you will experience a number of withdrawal symptoms.


Codeine addicts, especially those who have been using large amounts over a long period of time, may begin to feel the effects of withdrawal within a few hours after taking their last dose.
Codeine withdrawal symptoms are similar to those of other opiates. Common symptoms of codeine withdrawal include:

  • Headaches
  • Insomnia
  • Muscle aches
  • Fever
  • Nausea
  • Vomiting
  • Sweating
  • Stomach pains
  • Diarrhoea
  • Dehydration
  • Depression
  • Cravings

Duration of Withdrawal

The symptoms of codeine withdrawal can begin in as little as a few hours from the last dose. The duration of withdrawal varies by individual and is dependent on the duration of addiction and how much codeine you use, but the worst physical symptoms generally last for about a week.

The psychological symptoms of withdrawal, such as depression, can last for an extended period after detox but will ease with time and with the development of effective and healthy mechanisms to replace addiction.

Treatment Options for Addiction

If you are struggling with addiction you should always seek professional help. Trying to detox alone can be very uncomfortable and sometimes dangerous. There are various treatment options available for Codeine addiction in the form of rehab, medication, and therapy.


In rehab, you will be assessed on the day of your admission by a doctor who will prescribe you a medical detox where necessary. You will be supported through the detox process by the counsellors and the support staff. You will also benefit from being in a community with others who have been through detox and are now well.

Residential rehabs aim to create a welcoming atmosphere of acceptance and connection, as a therapeutic community. Recovering within a residential rehab will give you the opportunity to benefit from addiction specialists and to connect with like-minded peers, learn from each other’s insights, and encourage each other on your journey of recovery.

In rehab, you will focus on detoxing and leaving your addiction behind. You will address those things that lead you to addiction and also on planning relapse prevention, to enable you to stay sober in the future.

Beyond these core functions, you will also learn to work on your self-esteem, your relationships with others, and how to manage your thoughts and feelings, and much more.

In rehab you will be offered a blend of:

  • Expert therapists
  • Cognitive behavioural therapy
  • Dialectical behaviour therapy
  • Individual counselling
  • Group counselling
  • Family groups
  • 12 steps
  • Exercise and fitness programs
  • Art therapy
  • Healthy eating
  • Educational talks
  • Relapse prevention
  • Aftercare
  • Complimentary therapies

The aim of rehab is to enable you to deal with your past, present and future in a safe and effective way.

We provide all of the above treatment options and facilities as part of our drug rehab programme.


You should not stop your codeine use suddenly, without physical and support and supervision. The side effects of withdrawal may be very uncomfortable and even have dangerous complications.

Medications, such as anticonvulsants, antidepressants, and other symptom-specific pharmaceuticals, can be useful during medical detox to control and minimize your symptoms.

Tapering the dosage during medical detox is usually the recommended approach to detox to prevent the rapid onset of acute withdrawal symptoms.

There is no one-size-fits-all approach to detox. Commonly prescribed narcotic medications for opioid detoxification include:

  • Methadone – Helps alleviate codeine cravings
  • Buprenorphine – Lessens the severity of symptoms and shortens the detox process
  • Clonidine – Assists in managing physical and mental symptoms
  • Naltrexone – Helps prevent recurring use

Codeine tapers call for a slow and steady reduction in dosage at a rate of around 10 per cent-per-week range. Some patients will be able to reduce by 25 per cent, or even 50 per cent, depending on their history with codeine. Overall, the longer the individual used the opioid, the longer the taper should be.


One-to-one counselling

One-to-one counselling is usually a core component of addiction therapy. Through one-to-one sessions, you will have the opportunity to work through your issues privately and confidentially with your chosen counsellor.

Group Therapy

Group Therapy sessions will be made up of a small number of your peers who have similar issues to yourself and will be facilitated by a therapist and often a support worker. In this setting, you will be able to help your peers by offering your insights and benefit from their insights into your addiction.

The counsellor may also use group therapy to utilise group dynamics and to work on communication, assertiveness, and relationship building skills.

Some of the types of therapy available for addiction are:

  • Person Centred Counselling
  • Cognitive behavioural therapy
  • Dialectical behaviour therapy
  • Trauma therapy
  • Relapse prevention
  • Gender group
  • Body image group
  • Relationship therapy

Therapy can help you address your addiction and to develop effective and healthy coping mechanisms that you can use in place of addictive behaviour. Counselling aims to give you tools for accepting and dealing with your emotions effectively. Therapy can help you beyond getting clean and sober, it is designed to help you become healthier in every area of your life.

Counselling setting has proven to be effective in treating addiction. One of the reasons counselling is so useful for such a range of problems is that it can be used to teach you to manage distressing feelings effectively, without the use of drugs and alcohol.

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