Codeine Withdrawal and Treatment Options

What is Codeine?

Codeine is a prescription opioid analgesic and antitussive used for pain relief as well as to treat severe coughing. It is available in combination with other medications (e.g., decongestants, antihistamines, expectorants) in several prescription cold and cough formulations. ¹

For most people, codeine is not addictive or dangerous. However, a minority of codeine users misuse it to obtain a “high” or a feeling of pleasure. One relatively recent method of illicit use involves combining codeine with soda, alcohol, or hard candies in a mixture sometimes referred to as “purple drank” or “sizzurp.”

Codeine Withdrawal Symptoms

Once narcotic abuse occurs on a regular basis, tolerance, and dependence set in. The person may not feel as strong of an effect from the drug as they once did. Over time, they will begin to notice that they experience unpleasant codeine withdrawal symptoms if they stop using or reduce the dose. They may have trouble functioning without codeine.

• Restlessness.
• Tearing.
• Rhinorrhea or runny nose.
• Sweating.
• Chills.
• Body aches.
• Irritability.
• Abdominal cramps.
• Racing heart.
• Nausea and vomiting. ²

The symptoms usually start 8-12 hours after the last dose and last about 4-10 days.^4,5,6

How Long Does Codeine Withdrawal Last?

The length of codeine withdrawal is dependent on many factors, including the length of use and dose taken. The timeline can last anywhere from 4-10 days. ^4,5,6

Codeine Withdrawal Timeline

Like many opioids, the withdrawal timeline for codeine can vary greatly depending on the individual. In general, one can expect the withdrawal to last roughly 4-10 days, although it may take longer.^{4,5,6, 7} 

Withdrawal symptoms can appear as early as 6 – 12 hours after the last dose of an opioid substance, although for longer acting opioids symptoms may take 2-4 days to appear. ⁷ As the detox process progresses, symptoms will gradually begin to subside, and are usually concluded after 5-7 days, though it’s not uncommon to have lingering withdrawal symptoms for as long as 10 days.⁷  Further, it’s worth noting that some withdrawal symptoms may persist for months after the initial detox is complete.⁷ 

Codeine Withdrawal Treatment

Codeine withdrawal treatment can occur on an inpatient or outpatient basis. Inpatient means you live at the facility, while outpatient means you visit the facility at certain times.

Treatment often includes:

• Tapering down the dose of codeine to prevent or eliminate withdrawal symptoms.²
• Prescribing another medication, such as methadone or buprenorphine, to help the person stop using codeine. These medications prevent or lessen the severity of codeine withdrawal symptoms, with less risk of addiction than codeine and other opioids. They are best administered by experienced addiction treatment physicians.
• Other supportive medications to treat individual symptoms, such as diarrhea.

Once the acute effects of codeine withdrawal are under control, the focus of treatment shifts to helping the person overcome future temptation by addressing lifestyle and emotional issues.

Treatment for Codeine Addiction and Withdrawal

Detoxification deals primarily with the physical effects of withdrawal. Proper medical treatment for codeine withdrawal should be followed up with addiction treatment that helps people in recovery find healthy ways to deal with stress, physical pain, and other issues in their everyday lives.

Types of addiction treatment include:

• Inpatient or residential programs.
• Executive and luxury programs.
• Outpatient programs – standard, intensive, partial hospitalization.
• 12-step programs, such as Narcotics Anonymous or Pills Anonymous.

Rehabilitation programs provide individual and group counseling, as well as behavior modification techniques such as cognitive-behavioral therapy. These treatments help people in recovery from codeine addiction identify and deal with the issues that contributed to their addiction.

Relapse is common with many types of drug addictions, even after the person has completed a treatment program. For this reason, the person in recovery should continue on with some form of therapy or support group after they finish treatment. A carefully devised aftercare plan can enable those in recovery to keep practicing relapse prevention skills and reaffirm their commitment to sobriety.

Can I Detox from Codeine at Home?

Medically assisted detox centers provide supervision and support, while shielding those in recovery from their previous using environment. Many home remedies and alternative or natural forms of detoxification are largely untested and may even be unsafe. Some people believe that drinking more than a gallon of water or tea a day will help relieve withdrawal symptoms. This method is not medically proven.

In addition to uncomfortable symptoms such as nausea, vomiting, and stomach cramps, users in withdrawal are at heightened risk of relapse and overdose. They may take the same dose they took before, not aware that their tolerance has been lowered, and their body cannot handle the dose it once could.

Medically assisted detox centers provide supervision and support while shielding those in recovery from their previous using environment. In these ways, professional detox is able to offer safe, effective withdrawal management.

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Codeine Information at a Glance
Medication Name, Costs	Class of Medicine
Generic Name: Codeine Cost/Price: $1 – $9 1	Type of Drug: Opioid analgesic 4
Form, Intake, and Dose	Interactions and Complications
Drug Forms: tablet, capsule, syrup, solution Administration Routes: oral/swallowed Dose: tabs:15, 30, 60 mg; oral solution: 30 mg/5mL 2 Maximum Dose: max dose is 360 mg in 24 hours for mild to moderate pain, 120 mg in 24 hours for coughing 2 Dosing Schedule/Duration of Action: 4-6 hours 2 Overdose Symptoms: respiratory depression, sedation, nausea, vomiting, slowed heart rate, low blood pressure, apnea, death 1	Alcohol Interaction: may cause life-threatening respiratory depression, drowsiness, and/or sedation 2 Illicit Drugs: can have fatal effects when mixed with codeine 3.4 Prescription Medications: combining codeine with benzodiazepines or other CNS depressants such as alcohol or opioids can be deadly 3,4 Contraindications: hypersensitivity to codeine, respiratory depression, acute or severe asthma or hypercarbia, paralytic ileus 4
Effects and Adverse Reactions	Substance Abuse
Short-Term: lightheadedness, headache, drowsiness, mood changes, constipation, stomach pain, difficulty urinating 3 Long-Term: tolerance, dependence, addiction, overdose, death 4	Risk of Substance Abuse: High Signs of Abuse: secrecy around drug use, cravings, preoccupation with getting more of the drug
Physiological Problem Signs and Symptoms	Dependence and Addiction Issues
Withdrawal Syndrome Onset: 6-12 hours from last dose 5 Withdrawal Symptoms: restlessness, dilated pupils, teary eyes, irritability, anxiety, runny nose, difficulty falling asleep, fast heartbeat and breathing, chills, vomiting, muscle aches 3 Tolerance: Yes 4	Physical Dependence: High Psychological Dependence: High
Legal Schedules and Ratings
Controlled Substances Act Rating: Schedule II 4