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Every day, countless lives are caught in a cycle of abuse and addiction with the most highly addictive class of drugs, opioids. This dangerous family of drugs comes in various forms, strengths, and legal statuses. This means that even the prescription opioids doctors give have the same addiction and suffering potential as heroin or fentanyl.

Opioids are the most frequently abused class of prescription drugs overall. Some of the most well-known opioids include OxyContin, Percocet, and Vicodin, but there is another common opioid that is often overlooked. Codeine is relatively easy to obtain compared to other prescription opioids and has a following in pop culture.

Codeine is a prescription opioid placed in the Drug Enforcement Agency’s federal drug scheduling classes depending on the dosage. Any products containing codeine in less than 90 mg are only bound by the Schedule III category. Those substances or products containing 90 mg or more per dose are subject to the restrictions of Class II controlled substances. 

Scheduling codeine in Schedule II or III means that codeine can only be obtained from a physician through prescriptions. This is often because they are recognized for having a moderately high potential for being abused and generating dependency. The development of physical dependency can depend on the drug concentration’s potency as well as the duration of use.

Codeine’s Legitimate Uses

Since it is a legitimate medication used to manage pain, codeine has become a relatively common medication prescribed to those who may be recovering from surgery or injury. However, the most frequent application of codeine is by including it in the nighttime formulation of cough medicine. For situations like this, it is commonly seen in liquid form or pills.

Just as with any narcotic pain reliever, and opioids are a prime example, using the drug regularly or consistently will result in dependency. With codeine, this dependence will develop even when legitimately prescribed medication and taking it as directed. 

How Codeine Works

At its core, codeine is an opioid or simply: any drug that is derived from the opium poppy. This means that codeine changes how the body senses pain and how the brain and central nervous system respond chemically to pain.

The opioid compounds in the drug attach to specific opioid “receptors,” which are nerve cells already in the brain. Once attached to these receptors, they are busy and cannot accept their primary input, including pain signals from other nerves. 

This makes codeine an incredibly effective pain management medication, but it is also very likely to become abused even when taken as directed. In addition, the release of dopamine that it causes helps to reinforce the use-reward cycle, which builds a stronger dependence and more severe withdrawal symptoms. 

Codeine Withdrawal Symptoms

Withdrawing from codeine can cause a myriad of symptoms, and while these symptoms will vary from person to person, there are several common ones that you can generally expect.

Physical Withdrawal Symptoms

Some of the first symptoms to appear will be those that generally resemble cold or flu symptoms. Most individuals will experience strong stomach or abdominal cramping that will evolve beyond simple nausea. 

There will also be noticeable intestinal distress, nausea, and cramping, resulting in vomiting, diarrhea, and extreme dehydration. These uncomfortable and painful symptoms will frequently accompany chills, jitters & tremors, and uncontrollable sweating. 

Additionally, many individuals will experience decreased coordination in the extremities, dilated pupils, and even a rash or hives. Some individuals may only experience a few symptoms from this category, but generally, most users need to weather the majority of them. 

Since codeine, like all opioids, is a potent respiratory depressant, this can result in a significant increase in respiration when going through codeine withdrawal. In some heavy users, or those with co-occurring medical conditions, this increase in respiration may be medically significant. 

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Rapid respiration may exacerbate psychological symptoms like anxiety or panic, leading to a snowball effect. This can also present other potential complications, such as headache, restlessness, and early seizure activity. 

Additionally, allowing the body to metabolize the remaining codeine without replacing it will also result in many people seeing dramatic changes in their cardiovascular system while undergoing the codeine withdrawal process.  The powerful effect codeine has on the body when addicted leads to a marked drop in blood pressure and heart rate. However, going through codeine withdrawal can result in dangerous increases for both. This increase can be a factor in cardiac arrest, stroke, seizure, or even death in many people.

Psychological Withdrawal Symptoms

An individual going through codeine withdrawal can expect to experience one or more challenges to mental health such as mood swings & emotional instability, irritability, depressive episodes, disruption to their sleep cycles, difficulties concentrating or focusing, and diminished appetite.

The constant, occasionally surging, intense cravings to use more codeine will likely be the most challenging part of the codeine withdrawal.  The chemical leverage the brain and body use to try to get the individual to use again can be incredibly powerful and frequently cause relapse by those attempting recovery alone. 

Factors That May Influence Withdrawal Symptom Severity

Many factors will play a role in an individual’s codeine withdrawal and recovery process. The individual’s age, sex, current health, and medical history will all have relatively significant roles. 

The addiction profile is important because of factors like the dosage and frequency influence withdrawals. Those that used larger doses or dosed more frequently will almost certainly experience a more difficult withdrawal process than light or occasional users.

What Is Tolerance?

Tolerance is the tendency for your body to grow used to the effects of a particular drug. This often happens during chronic use, and the individual suddenly finds that they are starting to need larger and larger quantities of the drug to feel the same sensations. 

Tolerance is shown to build faster in individuals who use or abuse multiple substances and is somewhat common in some user groups. Those living with a diagnosis of polysubstance abuse disorder and those who have been prescribed a range of medications tend to have a much higher occurrence of tolerance overall. 

Tolerance isn’t directly linked to higher levels of dependence. However, people with a tolerance tend to take larger doses or doses more frequently. The increased dosage or frequency will directly impact the severity of the dependency issue by reinforcing it and building a deeper and deeper reliance on the drug.

Timeline For Codeine Withdrawal

The timeline of a typical withdrawal from codeine can be broken down into three main stages.

Initial Stage

The first signs for most people will develop about 12 hours following the last dose. This is due to codeine’s relatively short half-life. Many people do not begin to feel the first stages for nearly 40 hours after the last use, but those who use large amounts or consistently can expect to feel them much sooner.

The first symptoms experienced during this initial 12-48 hour period will be the earliest and most common physical symptoms. The flu-like symptoms will often begin here, starting with headache and nausea in most cases.

Acute Withdrawal Stage

The acute stage often begins within 48 hours and is when the physical withdrawal symptoms peak in severity, often approximately 3-5 days in. This is also the stage when the psychological withdrawal symptoms begin to present. The acute stage can last for 2-3 weeks in some cases. 

This is the period when the most intense cravings to use codeine will occur, and it is often what causes a relapse for those attempting recovery alone or with limited support. Completing a codeine withdrawal and detox program in a safe environment with medical supervision can also help prevent other complications. 

During this stage, the physical symptoms will continue until the peak, when they begin to fade rapidly. The disruption to the individual’s sleep cycle and changes to the breathing, heart rate, and blood pressure should have lessened greatly by the end of this stage. 

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Post-Acute Withdrawal Stage

By about one month from the last dose, the majority of the physical symptoms should have faded away or at least greatly diminished. However, there will be some lingering psychological symptoms for some time, particularly for heavy or long-term users, who may experience symptoms like sporadic cravings or bouts of depression months or even years into recovery.

How To Recover Safely From a Codeine Withdrawal

If you or someone you love may be living with an addiction to codeine, they may need significant help getting through the detox process. Contact us for more information on how to get on the path to recovery. We are here to help.

Sources:

Infinite Recovery has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations for our references. We avoid using tertiary references as our sources. You can learn more about how we source our references by reading our editorial guidelines and medical review policy.

  1. RxList. Codeine Sulfate (Codeine): Uses, Dosage, Side Effects, Interactions, Warning. RxList. Published August 6, 2020. Accessed June 29, 2022. https://www.rxlist.com/codeine-sulfate-drug.htm
  2. Drug Enforcement Administration. Controlled Substance Schedules. Accessed June 29, 2022. https://www.deadiversion.usdoj.gov/schedules/
Amanda Stevens, BS

Medical Content Writer

Amanda Stevens, BS

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magnum Cum Laude from Purdue University with a B.S. in Social Work. As a person in recovery from disordered eating, she is passionate about seeing people heal and transform. She writes for popular treatment centers such as Ocean Recovery, Ascendant NY, The Heights Treatment, Epiphany Wellness, New Waters Recovery and adolescent mental health treatment center BasePoint Academy. In her spare time she loves learning about health, nutrition, meditation, spiritual practices, and enjoys being the a mother of a beautiful daughter.

Last medically reviewed June 29, 2022

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