Though less potent than other opioids, codeine still results in highly unpleasant withdrawal symptoms when stopped abruptly.
Codeine is an opiate used in pain relievers and cough medicines. While it’s sometimes available as a single-ingredient medication, codeine is typically combined with other drugs, such as acetaminophen (Tylenol) or guaifenesin (a cough expectorant).
While codeine is relatively less potent than other opioid medications — such as oxycodone — withdrawal can still occur if you suddenly stop taking it or cut back too quickly after prolonged use.
Like other opioids, codeine withdrawal involves a set of very unpleasant symptoms, including nausea, anxiety, sweating, and restless legs.
The Department of Health and Human Services says that in the United States, approximately 9.9 million people (12 and older) misused prescription pain relievers from 2017 to 2018. Of these, 9.4 percent of people misused products containing codeine.
Let’s look at how codeine affects the body, what its withdrawal looks like, and how it’s managed.
Codeine is an opiate pain reliever derived from the poppy plant. It has long been used to treat mild to moderately-severe pain, cough, and occasionally gastrointestinal health concerns.
As a pain reliever, codeine is available by prescription as a single-ingredient product or in combination with acetaminophen (Tylenol) or aspirin. Tylenol 3, for example, is codeine combined with acetaminophen. Codeine is also used as a cough suppressant in some cough and cold medications.
Codeine is a relatively short-acting pain reliever, with effects lasting only a few hours. Though less potent, codeine produces similar effects to morphine.
Codeine is less commonly prescribed than other opioids. The Department of Health and Human Services says that while about 24% (26.8 million) of outpatient opioid prescriptions in 2017 in the United States were for oxycodone, codeine only accounted for about 6% (6.1 million) of those.
According to the Drug Enforcement Association, codeine medications range from Schedule II to Schedule V, depending on the ingredients in the product and the amount of those ingredients. The higher the schedule number, the lower the chance of misuse, dependence, and addiction.
- Schedule II: Codeine products in which codeine is the only ingredient.
- Schedule III: Codeine products with acetaminophen (Tylenol), aspirin, butalbital, carisoprodol, papaverine, and/or noscapine. These products contain no more than 90 milligrams of codeine.
- Schedule V: Codeine products with promethazine (Phenergan), chlorpheniramine and/or guaifenesin. These products contain no more than 200 milligrams per 100 milliliters, or 100 grams.
Even though codeine is relatively less potent and less commonly prescribed than other opioids, it still carries a chance for physical dependence.
The longer you take the medication, the more your body can become dependent on it. So, abruptly stopping or lowering the dose you’re taking can cause a reaction.
Since codeine is considered an opioid, the
Withdrawal occurs when a person who’s been taking codeine products on a regular basis suddenly stops or cuts back too quickly. This leads to unpleasant withdrawal symptoms as the brain has “forgotten” how to function without the substance.
Though relatively less potent, codeine can cause the same effects as other opioids. This class of drugs works by attaching to the body’s opioid receptors in the spinal cord and brain. This in turn reduces your perception of pain.
But although opioid medications are technically prescribed to treat physical pain, they can also cause a sense of euphoria. Because of this, they can cause physical dependence in some people.
Opioids activate endorphins and other neurotransmitters, such as dopamine, to produce enjoyable feelings. This reduces any feelings of stress, fatigue, and anxiety. This causes your brain’s reward center to “light up” when you see or think about the drug, leading to cravings.
Codeine, in particular, has the additional action of attaching to neurons in the brainstem that manage the cough reflex. This gives it cough suppressant qualities.
Symptoms of codeine withdrawal are similar to the same ones seen with any other opioid withdrawal. They can include:
- muscle and body aches
- fever and chills
- vomiting or diarrhea
- problems with digestion
- restless legs
Codeine withdrawal can also cause psychological symptoms that can last for years or longer. Over time, these symptoms can decrease in severity. These can include:
Codeine withdrawal varies from person to person, and severity may depend on a number of factors, including:
- length of use
- typical dose
- time between doses
- mental health history
- medical history
- body weight
- how codeine is taken (nasally, orally, injection, or mixed with alcohol or other substances)
Timeline of codeine withdrawal:
- Days 1 to 4: Physical symptoms peak and may be particularly intense the first few days. Symptoms may include nausea, insomnia, restless legs, sweating, diarrhea, and vomiting.
- Days 5 to 7: Most physical symptoms start to decrease, but psychological symptoms, such as depression, may set in. Some people might feel dehydrated due to excessive sweating, diarrhea, or lack of fluid intake.
- Days 8 +: Most physical withdrawal symptoms have subsided by this point, but depression may remain. Depression and cravings can sometimes last for months after a person quits.
A diagnosis of codeine withdrawal can be given if an individual reports they have:
- reduced or stopped codeine after heavy or prolonged use
- taken an opioid antagonist after a period of codeine use
Since codeine is considered an opioid, the Subjective Opiate Withdrawal Scale (SOWS) can be used to diagnose codeine withdrawal. They can help assess the presence or severity of withdrawal. The SOWS is scored on a point system.
The criteria assessed in the SOWS include:
- muscle and body aches
- stomach upset (diarrhea, nausea, or vomiting)
- runny nose or leaky tear ducts
- sweating, dilated pupils, or piloerection (body hairs standing on end)
- low mood
Detoxing (getting the drug out of your system) is the first step to overcoming a codeine dependence or addiction. This can be challenging so try to have a solid support system around you — either a trained counselor or therapist or family and friends you trust.
If you’ve been taking codeine for a long time, before you stop or lower your dosage on your own, consider discussing this with a healthcare or mental health professional. They may help you come up with a plan to taper off slowly and safely.
By slowly tapering off, your body may experience fewer withdrawal symptoms and your cravings may be reduced.
You can do withdrawal:
- at home surrounded by family and friends
- in a treatment center for close monitoring
- at a hospital, if symptoms become severe
Because codeine is considered an opioid, many of the same medications can be used for withdrawal symptoms.
Methadone (mu-opioid receptor agonist) or buprenorphine (partial agonist) can be taken to help relieve cravings and other withdrawal symptoms.
Lofexidine hydrochloride — approved in 2018 by the Food and Drug Administration (FDA) for managing opioid withdrawal symptoms — may also be used. This medication is similar to clonidine — a commonly used medication for opioid withdrawal.
Medications can be given either inpatient or outpatient by healthcare professionals who’ve completed a specialized training course.
Other medications may be taken for specific symptoms:
- clonidine (Catapres) to reduce blood pressure
- loperamide (Diamode or Imodium A-D) for diarrhea
- ibuprofen (Advil or Motrin) for muscle pain
- promethazine (Phenergan) for nausea/vomiting
- Benadryl for insomnia, anxiety, and runny nose
A healthcare or mental health professional can help you determine the best treatment plan for you based on your symptoms and medical history.
If you or a loved one is experiencing withdrawal from codeine or another opioid, you’re not alone. Reach out to a trusted healthcare professional who can direct you to the proper treatment, if necessary.
Medications can be taken to help ease your withdrawal symptoms.
If you’re going through withdrawal at home, get as comfortable as possible and make sure you stay hydrated. It’s also helpful to take vitamins, particularly vitamins B and C, to help you recover from the stress your body is experiencing.
If possible, you can ask a family member or friend to keep in touch and check in on you throughout the withdrawal process.
There are many resources and support groups available to help. American Addiction Centers offers several relief tips and tricks to help you through withdrawal. You can also find more helpful information on the following pages:
- Treating Opioid Withdrawal: What Are My Options?
- What Are the Symptoms of Opioid Withdrawal?
- What Are the Signs and Symptoms of Opioid Use Disorder?
If you don’t have access to a mental health professional, you can check out our Find a Therapist page for help.