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Codeine addiction and you

Written by Drew Redd. Mina Draskovic, B.Psy., reviewed this content for accuracy.

Codeine addiction is a serious issue with far-reaching health consequences. Many people rely on codeine to treat mild to moderate pain, but this opioid painkiller has a high potential for abuse and addiction. In 2022, over 1.8 million Americans older than 12 abused codeine.

A qualitative study by Kinnaird et al. (2019) found that unsupervised and repeat prescribing of codeine, poor access to alternative pain treatments, and ineffective regulation of over-the-counter codeine sales all drive addiction rates up and fuel the growing plague of codeine dependence.

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If you’re struggling with an opioid use disorder, Ardu can help you break the addiction and reclaim sobriety. Our codeine rehab center is staffed by compassionate professionals who provide personalized treatment plans and support to guide you through the rehabilitation process and beyond.

What is codeine?

Codeine is an opioid medication used to treat mild to moderate pain and suppress coughing. The active ingredient or agent in codeine is morphine. As an opioid, codeine binds to opioid receptors in the brain and throughout the body, reducing pain sensations and inducing relaxation. For many, codeine induces euphoria alongside its analgesic effects, which is often what compels them to continue using after their pain subsides.

While codeine is effective for short-term pain relief, it does carry the potential for misuse, dependence, and addiction. People who continue to use codeine after the prescription period put themselves at risk.

How does codeine affect the brain?

Like other opioids, codeine affects the brain by interacting with proteins called opioid receptors. They are found in different brain regions, the spinal cord, and the digestive tract. There are three main types of opioid receptors: mu, delta, and kappa. Codeine primarily binds to the mu receptors, responsible for most of its pain-relieving and euphoric effects. Stimulation of these receptors leads to a decrease in the release of neurotransmitters that signal pain, effectively diminishing the perception of pain.

When opioids bind to these receptors, a series of intracellular events occur, resulting in…decreased neurotransmitter release. Within the nervous system, activation of mu receptors in the midbrain is the dominant mechanism of opioid-induced analgesia. The cough reflex is primarily mediated through the opioid receptors in the medulla. (Peechakara, et. al.)

Codeine also stimulates the release of dopamine, a neurotransmitter associated with pleasure and reward. This surge of dopamine in the brain’s reward centers creates a sense of euphoria and well-being, which contributes to the development of addiction.

As you continue to use codeine, your brain adapts to the presence of the drug. Over time, the brain may require increasingly larger doses of codeine to achieve the same desired effects, leading to tolerance. This often compels people to take more than prescribed or to continue using the drug even after their pain has subsided.

The longer you take codeine, the greater your chances of developing an addiction. If codeine use is abruptly stopped or significantly reduced, a dependent person may experience withdrawal symptoms such as anxiety, restlessness, muscle aches, and gastrointestinal distress.

Long-term codeine use can cause changes in brain structure and function, particularly in regions involved in decision-making, self-control, and stress response. These changes make it all the more difficult to stop using codeine and may increase the risk of relapse even after periods of abstinence.

Not everyone who uses codeine will develop an addiction. Factors such as genetic predisposition, mental health, and environment play an important role. The longer and more frequently one uses codeine, the greater the risk of developing dependence and addiction.

What is codeine used for?

Codeine is a pain reliever and cough suppressant. It is used for many chronic conditions and medical procedures, often in combination with other medications. A 2007 study found that codeine is ineffective in treating severe and chronic pain and that “its use is therefore restricted for mild-to-moderate pain relief and for cough.”

The primary uses of codeine include:

  • Pain relief
    • Injuries, such as fractures, sprains, or strains
    • Dental procedures, such as tooth extractions or root canals
    • Surgeries, during the post-operative recovery period
    • Chronic conditions, such as back pain or arthritis
    • Migraines and severe headaches
  • Cough suppression
    • Chronic bronchitis
    • Emphysema
    • Lung cancer
    • Other respiratory disorders

In some cases, codeine may also be prescribed to treat severe diarrhea that has not responded to other treatments. It works by slowing down gut motility and reducing intestinal secretions.

Codeine is offered in several forms, depending on the intended use and patient preference:

  • Oral tablets and capsules are the most common forms of codeine for pain relief. 
  • Liquid solutions and suspensions are used for cough suppression and pain relief. 
  • Injectable codeine solutions are given in hospital settings through intramuscular (IM) or subcutaneous (SC) injections for rapid pain relief or when oral administration is not possible.

Because of the potential for misuse and addiction, there are strict regulations around prescribing codeine. Some places have even made it prescription-only rather than available over-the-counter. When used carefully and as directed, codeine remains an effective opioid medication for managing pain. 

If you’re struggling with an addiction to codeine or other types of opioid drugs, our opioid rehab center can provide the support you need to break free from addiction and rebuild your life. Our experienced medical team offers personalized, evidence-based treatment programs tailored to your specific needs, equipping you for lasting recovery and a sober, fulfilling life.

How to recognize codeine addiction

It isn’t always easy to spot a codeine addiction, even in someone you know.The signs often start subtly, but after a while, some clear red flags show that codeine abuse has taken deeper roots. 

The most common physical symptoms of codeine addiction include:

  1. Constipation
  2. Drowsiness
  3. Constricted pupils
  4. Slurred speech
  5. Lack of coordination
  6. Nausea and vomiting
  7. Shallow breathing
  8. Sweating
  9. Irregular heart rate
  10. Frequent flu-like symptoms

Codeine addiction can manifest in several behavioral signs, such as:

  1. Inability to control codeine use
  2. Intense cravings
  3. Using despite negative consequences
  4. Obsession with obtaining codeine
  5. Mood swings and irritability when not using
  6. Poor decision-making
  7. Lying about codeine use
  8. Engaging in risky behaviors to obtain codeine
  9. Loss of interest in favorite activities
  10. Strained personal relationships

Why is codeine addiction so common?

Codeine addiction has become a growing concern in recent years in the United States, with abuse and dependence numbers showing a steady increase. Apart from the effects codeine produces in the brain, several other factors contribute to the prevalence of codeine addiction. 

Here are some of the key reasons why so many people find themselves battling codeine dependence:

  1. Easy access. Codeine is readily available through prescriptions for managing pain and suppressing coughs, and even in some over-the-counter cold medications. This widespread availability makes it simple for people to obtain and start using codeine regularly, increasing the risk of developing a substance use disorder (SUD).
  2. Perceived safety. Because it’s a prescription medication, many people mistakenly view codeine as a “safer” opioid. They tend to underestimate the potential for addiction and the severity of codeine side effects, making them more likely to misuse the drug.
  3. Lack of awareness. Despite the ongoing opioid epidemic, there’s still a lack of public knowledge about codeine’s addictive properties. Many people don’t realize that codeine use can lead to tolerance, cravings, and addiction.
  4. Progression from medical use. Most people begin taking codeine for legitimate medical reasons, but they may find themselves misusing and abusing the drug over time, developing a physical and psychological dependence.
  5. Polysubstance abuse. In combination with other substances, such as alcohol or illicit drugs, the effects of codeine are amplified. This increases the risk of addiction, overdose, and severe withdrawal symptoms. 
  6. Genetic factors. A family history of addiction and certain genetic predispositions can make some people more vulnerable to developing a codeine addiction. 
  7. Environmental factors. Environmental influences such as stress, trauma, and mental health conditions may lead people to self-medicate with codeine, escalating into a substance use disorder.
  8. Inadequate monitoring and limited access to treatment. Healthcare providers may not always closely monitor codeine use in patients or recognize the signs of developing addiction. Effective treatment for codeine addiction can be expensive and difficult to access, leaving many struggling to kick their habit.

Our codeine detox program provides a safe, medically supervised environment to help you overcome your physical dependence. Through a combination of counseling, therapy, and proven techniques, we’ll equip you with the tools to break free from codeine addiction for good. 

Contact Ardu today.

What are the health risks of codeine addiction?

Codeine addiction can wreak havoc on your physical and mental health. We highlight some of the health risks that can come with codeine abuse. 

Respiratory depression and breathing problems

As a central nervous system depressant, codeine can dangerously slow down breathing rates and reduce oxygen levels in the body. This respiratory depression can lead to shortness of breath, disrupted sleep patterns, and even life-threatening respiratory failure in severe cases. Long-term codeine abuse increases the risk of developing chronic respiratory issues like pulmonary complications.

One: constipation and gut dysfunction  

Codeine directly impacts the digestive system by reducing gastric motility and slowing down intestinal muscle contractions. This results in difficult, infrequent bowel movements and chronic constipation. Prolonged constipation can cause hemorrhoids, impacted bowels, and other gastrointestinal issues that may require medical intervention.

Two: increased risk of infections and illnesses

Codeine addiction directly hampers the immune system’s ability to fight off infections by suppressing the production and function of white blood cells and antibodies. The poor nutrition and lack of hygiene that often accompany addiction further compromise the body’s defenses, leaving users susceptible to viral, bacterial, and opportunistic infections.

Three: liver damage

The liver metabolizes codeine, and excessive strain from long-term abuse can impair its functioning. This can manifest as liver inflammation, cirrhosis, and even liver failure in the most severe cases of codeine addiction and overdose.

Four: kidney problems

Codeine and its metabolites can accumulate in the body and put undue stress on the kidneys over time. This buildup may lead to acute kidney injury or exacerbate existing kidney disease. Dehydration associated with opioid use also contributes to potential kidney damage.

Five: brain damage and cognitive impairment

Chronic codeine abuse disrupts normal brain chemistry and causes structural changes, including a reduction in gray matter volume. This often results in cognitive deficits such as impaired decision-making, memory issues, and difficulty regulating emotions. Overdose raises the risk of hypoxic brain injury (a lack of oxygen supply to the brain tissue).

Six: increased pain sensitivity

Long-term opioid use can cause hypersensitivity to pain stimuli in some people. This condition is known as opioid-induced hyperalgesia. This heightened pain perception can worsen discomfort and suffering, fueling further codeine abuse.

Seven: sleep disorders

While codeine may initially promote sleepiness, chronic use leads to poor sleep quality over time. Insomnia, sleep apnea, and other sleep-related breathing issues often accompany codeine addiction, contributing to fatigue, impaired cognitive function, and other consequences.

Eight: malnutrition and weight loss

Appetite suppression caused by codeine, combined with the drug-seeking behavior that overrides other priorities like eating, can result in rapid weight loss and malnutrition. People addicted to codeine and other opioids often suffer from vitamin and mineral deficiencies that further exacerbate negative health impacts.

Nine: deteriorated mental health

Codeine addiction frequently co-occurs with mental health disorders such as clinical depression, anxiety, and other mood disturbances. The drug can worsen these conditions, while the emotional turbulence of addiction may trigger or intensify psychological problems as well.

Many struggling with codeine addiction also battle co-occurring mental health disorders. Left untreated, combined substance use and mental illness—known as dual diagnosis—can exacerbate each other. 

At Ardu, we understand the complexities of dual diagnosis with codeine addiction. Our integrated approach tackles both the addiction and mental health aspects concurrently. We offer comprehensive, evidence-based co-occurring disorder treatment to support the healing of mind, body, and spirit.

Can codeine addiction be lethal?

Codeine addiction can be lethal, as it carries a high risk of overdose. Codeine is less potent than other opioids, but if you take too much or combine it with other depressants (such as alcohol), your breathing can dangerously slow and cause life-threatening respiratory depression. 

Codeine overdoses aren’t as common as overdoses involving stronger opioids, but they still require immediate medical attention. The following signs show someone is in danger of a codeine overdose:

  1. Slowed or irregular breathing
  2. Bluish tint to lips or fingernails (cyanosis)
  3. Extreme drowsiness or inability to wake up
  4. Cold, clammy skin
  5. Constricted (pinpoint) pupils
  6. Weak, faint pulse
  7. Nausea and vomiting
  8. Confusion and disorientation
  9. Muscle spasms
  10. Loss of consciousness
  11. Choking or gurgling sounds
  12. Limp body
  13. Comatose state

If you suspect someone has overdosed, call 911 right away.

What is the best treatment approach to codeine addiction?

Codeine addiction is a serious condition that should never be taken lightly. That’s why people need comprehensive professional treatment to help them break free from codeine’s physical and psychological hold.

At Ardu Recovery Center, we understand the complexities of opioid use disorders and offer evidence-based rehab programs tailored to treat codeine and other substance addictions. Our team of medical professionals provides robust clinical care, behavioral therapies, and holistic healing approaches to support you every step of the way as you reclaim your life. Depending on your specific needs, we offer:

…and more to help you ease into a healthy and sober new life. 

The first step in getting you clean is detox.

Codeine detox center at Ardu

Ardu offers comprehensive drug detox services to guide you through the challenges of withdrawal safely. Our experienced medical staff will develop an individualized treatment plan tailored to your unique codeine use and needs. That includes 24/7 clinical care and effective medications that alleviate the difficult withdrawal symptoms associated with codeine. We use appropriate prescription drugs as needed to make the detox process as comfortable and safe as possible.

We often combine this traditional medical approach with holistic methods. At our holistic detox, we offer nutritional therapy, yoga, IV amino acid therapy, and massage to help relax the nervous system and restore balance as your body adjusts to life without codeine.

With personalized medical oversight and supportive holistic therapies customized for you, our codeine detox program helps you transition into an effective addiction treatment program with the best chance of achieving lasting recovery.

Codeine rehab center at Ardu

At our codeine addiction rehab center, we help you overcome dependence and reclaim your health and happiness through evidence-based integrated care. We offer tailored inpatient and outpatient treatment programs to best suit your individual needs and circumstances.

Inpatient or residential treatment immerses you in a structured therapeutic environment with 24/7 support and intensive daily therapy. This allows you to step away from your routine and external triggers while focusing solely on your recovery. With round-the-clock medical care and counseling, our inpatient rehab program provides the highest level of support.

For those unable to step away from work or other responsibilities, outpatient treatment offers the flexibility to live at home while attending regular rehab programs and group therapy. Our intensive outpatient and partial hospitalization programs allow you to get help and develop crucial coping strategies while fulfilling commitments and maintaining your daily routines.

Whichever path you choose, our comprehensive approach combines evidence-based therapies such as cognitive-behavioral therapy (CBT), contingency management, family therapy, and medication-assisted treatment when appropriate. We incorporate holistic healing practices to promote complete mind-body healing from codeine addiction.

Our team will work closely with you to determine the ideal mix of therapies, treatments, and level of care to support long-term recovery.

We’re just a click away. Contact Ardu and start your journey towards lasting recovery.

Contact Ardu Recovery Center

Our recovery center welcomes anyone seeking help to overcome their codeine addiction. Our dedicated team of professionals is here to guide and support you through the addiction treatment process, laying the foundation for long-term sobriety and relapse prevention.

Our team will thoughtfully assess your needs and insurance coverage to determine which type of care will give you the best chance of success given your current situation. If you want to verify your health insurance coverage, gather more payment information, and pursue the Medicaid redetermination process in Utah, visit our insurance verification page.

Read our admissions process page for more information.

Drew Redd

Drew Redd is the executive director of Ardu Recovery Center and is dedicated to empowering people on their journey to sobriety.

Codeine addiction FAQ

Is codeine an opioid or an opiate?

Codeine is an opioid, which is a broader term that includes both natural opiates and synthetic or semi-synthetic drugs. Opiates refer specifically to natural substances derived from the opium poppy plant. All opiates are opioids, but not all opioids are opiates.

Natural opiates include:

Synthetic opioids are created in a lab to mimic the effects of natural opiates and they include:

Semi-synthetic opioids are a combination of natural opiates and synthetic substances. Examples include:

Codeine is a natural opiate because it is directly extracted from the poppy, but it is also classified under the wider umbrella term of opioids. 

What disease is caused by codeine?

Codeine itself does not directly cause a specific disease, but its prolonged abuse can lead to opioid use disorder or opioid addiction. Opioid use disorder is a chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences.

Codeine addiction also leads to many health conditions and disorders such as liver damage, kidney damage, respiratory depression, gastrointestinal issues, and so many more.

Is codeine a controlled drug?

Codeine is a controlled substance in most countries due to its potential for abuse and addiction. It is classified as a Schedule II drug under the United States Controlled Substances Act. As a prescription opioid, codeine has an accepted medical use for treating cough and pain, but it also has a high potential for misuse, dependence, and diversion to the illegal drug market.

Codeine’s controlled status means it can only be legally obtained with a valid prescription from a licensed healthcare professional. Possessing or distributing codeine without proper medical authorization can result in criminal charges for drug trafficking and substance abuse violations. Strict regulations also govern how codeine medications are manufactured, stored, and dispensed through legitimate pharmaceutical channels to help prevent their diversion to the illicit street drug market.

Does codeine cause constipation?

Constipation is a very common side effect of codeine use. Codeine slows down the movement of the digestive tract, leading to difficult and infrequent bowel movements. This opioid-induced constipation occurs because codeine binds to receptors in the gut and disrupts normal gastrointestinal motility. 

As a result, food and waste products move through the intestines more slowly, allowing too much water to be reabsorbed and producing hard, dry stools that are difficult to pass. Chronic constipation from prolonged codeine use can lead to painful complications like hemorrhoids, fecal impaction, and bowel obstructions if left untreated. 

What is the active agent of codeine?

The active ingredient or agent in codeine is morphine. Codeine is a naturally occurring opiate that is metabolized by the body into morphine, which binds to opioid receptors and produces analgesic (pain-relieving) effects. Approximately 10% of codeine gets converted to morphine after ingestion. This morphine metabolite is what allows codeine to mimic morphine’s actions, albeit in a less potent form. Other metabolites such as codeine-6-glucuronide and norcodeine also contribute minor analgesic and cough-suppressant effects. 

Does codeine help neurological pain?

Codeine can be effective in treating certain types of neurological or neuropathic pain, such as pain caused by nerve damage or diabetic neuropathy. Its ability to bind to opioid receptors in the brain and spinal cord can help reduce neuropathic pain signals. 

As an opioid analgesic, codeine works by mimicking the body’s natural painkillers (endorphins) to block the transmission of pain from the nerves to the brain. This disruption of neuropathic pain pathways can provide relief for symptoms such as burning, shooting, or stabbing nerve pain that responds poorly to other medications. 

Codeine tends to be less potent than other opioids for severe neuropathic pain. Its use requires careful medical supervision to balance pain control with side effect risks. 

Can codeine cause CNS depression?

Codeine can cause central nervous system (CNS) depression, which refers to the slowing down of brain activity and vital functions like breathing and heart rate. As an opioid, codeine suppresses the central nervous system, potentially leading to drowsiness, slowed respiration, low blood pressure, and other depressant effects in higher doses.


Kinnaird, E., Kimergård, A., Jennings, S., Drummond, C., & Deluca, P. (2019). From pain treatment to opioid dependence: A qualitative study of the environmental influence on codeine use in UK adults. BMJ Open, 9(4). https://doi.org/10.1136/bmjopen-2018-025331

Peechakara, B. V., Tharp, J. G., & Gupta, M. (2023, February 13). Codeine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK526029/

Bowery, N. G. (2007, January 1). Codeine. Elsevier eBooks. https://doi.org/10.1016/b978-008055232-3.61504-1

Further reading

Learn about the different types of illegal drugs

Understanding cross addiction

What are the most damaging drugs to your body?

What are the signs that your body is detoxifying?

What is post-acute withdrawal syndrome?

How to recognize morphine addiction

What are some common symptoms of heroin withdrawal?

Will my addiction go away?

Why should you never detox alone?

What to look for in teen addiction