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Codeine Addiction: Some Important Facts

Codeine is a opioid painkiller often prescribed for the treatment of pain that is not severe. It is a mild painkiller with high potential of development of addiction. It is similar in structure to morphine but far less potent. It is frequently used for the treatment of mild to moderate pain and is often used without a prescription in many countries. Sometimes, codeine is mixed with other pain killers such as aspirin and acetaminophen to increase its potency. Some cough suppressants medications may also contain codeine.


Table of Contents

  • What Is Codeine?
  • What Does Codeine Look Like?
  • Is Codeine Addictive?
  • Effects of Codeine Abuse
  • Common Codeine Drug Combinations / Lean
  • Codeine Overdose and Statistics

What Is Codeine?

Doctors prescribe codeine to help patients manage mild, moderate, and severe pain. Codeine is an opioid, a class of drugs that interact with opioid receptors on nerve cells to essentially slow down how messages travel between the brain and the body. Codeine is typically safe to use as long as it’s prescribed for short-term use; unfortunately, nonmedical codeine abuse can produce physical dependence and even fatal overdoses.

Codeine Addiction: Some Important Facts

In 2005, as studies began to corroborate the addictive potential of the drug, drug manufacturers — and the pharmaceuticals industry — added warnings to the labels of over-the-counter medications containing codeine. Specifically, instructions were intended to differentiate safe, doctor-recommended use of the drug versus unsafe, nonmedical use of the drug. Currently, codeine products carry a black-box warning — mandated by the FDA — because the drug has severe and fatal risks for some children and

What Does Codeine Look Like?

Codeine is commonly available in three forms: tablet, syrup, and injection solution. Doctors often prescribe the drug to treat pain and to suppress a cough. However, low doses of the drug are available for purchase over-the-counter (OTC) in some parts of the country, making codeine one of the most commonly abused OTC drugs. Codeine is also a major ingredient in cough syrup, typically in a promethazine/codeine combination. Codeine is often found in multi-ingredient medications — especially cough syrups. Some common brand names include:


  • Robitussin
  • Maxiflu CD
  • Maxiflu CDX

You may hear people discuss codeine and codeine combinations by using street names or slang names, including:

  • Cody
  • Schoolboy
  • Loads
  • Pancakes
  • Syrup
  • Fours
  • Doors
  • Purple Drank
  • Sizzurp

Physicians prescribe codeine to manage severe pain — especially in cases of recovery following a surgical procedure. Physicians may also give this drug to those suffering from a persistent cough. Codeine’s potential for dependence often warps how patients use the drug. Once an opiate addiction has developed, users often fuel their addictions by expanding recommended dosages or extending recommended usages. In some cases, those addicted to codeine may even pressure friends and family to divert prescriptions to them. In such cases, medical detox and rehab may be necessary.


The proper dosages of codeine vary on several factors, the primary one being pain management needs, which are unique to each patient. Typically, for a cough, the usual prescribed dose is 15–30 mg every four to six hours — not to exceed 120 mg in 24 hours. For pain, the usual prescribed dose is 15–60 mg every four hours — not to exceed 360 mg in 24 hours.

Is Codeine Addictive?

Yes, codeine is addictive, as is the case with other opioid medications. Codeine impacts the user by slowing down how messages are sent between the brain and the body, relieving pain symptoms and suppressing dry coughs.

When taking this drug at high dosages, a person can achieve a codeine high that is similar to the effects of heroin and other opioids. This addictive high is what leads users to resort to nonmedical use of the drug — the addicted brain demands that a person maintains their euphoric state by continuing to use codeine.

Drug companies usually make codeine in tablet form, but the medicine is also an ingredient in promethazine-codeine cough syrups. The combination of codeine’s euphoria and promethazine HCl’s (an antihistamine) sedation makes it a popular drug of abuse, exploits of which litter popular music lyrics and tabloid headlines.

Codeine addiction can happen slowly for some people and quickly for others — a mental addiction may ignite upon the initial use of the drug. Because it is less potent than some other opioids, it is sometimes considered a “safer” opioid. However, at high dosages, its addictive potential is every bit as strong as that of other drugs that can lead to opiate addiction.

The Drug Enforcement Administration (DEA) considers standalone codeine — prescribed exclusively for pain — a Schedule II controlled substance, a classification reserved for drugs that are deemed to have a high potential for abuse and could lead to addiction. Other examples of drugs classified this way include opioids like hydrocodone, fentanyl, and oxycodone.

Further classifications of codeine depend on the drugs with which it is combined or interacting. For example, pain-relieving tablets containing codeine and aspirin or acetaminophen are considered Schedule III drugs — indicating a slightly lower potential for abuse. Other syrups that include codeine in combination with other drugs can fall between the DEA’s Schedule III and Schedule V.

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Effects of Codeine Abuse

When taken as prescribed and intended, codeine-based drugs can safely treat mild to moderate pain and suppress a cough brought on by a cold or flu. At higher dosages, the drug’s effects can mirror those of illicit drugs, critically altering the brain. Common side effects of codeine abuse include:

  • Prolonged euphoria
  • Breathing problems
  • Decreased heart rate
  • Heart palpitations
  • Detox side effects when the drug is ceased

When abused non-medically over an extended period, codeine can cause symptoms such as include involuntary muscle twitches and dependence. However, the long-term effects of codeine abuse extend past physical manifestations. Many who get hooked on codeine and other opioids eventually harm relationships with family and friends and struggle to manage work and other responsibilities. A codeine addiction can be devastating, but recovery is possible — even in the face of an addiction relapse. Treatment can help keep a person on the long-but-worthwhile road to sobriety.

Common Codeine Drug Combinations

If a patient is suffering, their doctor may prescribe codeine alongside another medication to better alleviate their pain. However, codeine and codeine-based medications are often mixed illicitly with other substances to accentuate the codeine high — a simultaneously popular, dangerous, and addictive practice. Especially in the case of promethazine-codeine cough syrups, popular combinations include:

  • Cough syrup and alcohol
  • Cough syrup and marijuana
  • Cough syrup and soda (colloquially called “sizzurp”, “lean”, or “purple drank”)
Codeine Overdose

Codeine use often begins at safe and low dosages, but people tend to “up the ante” by pushing their usage past their prescribed limits. Codeine overdose is a dangerous possibility. Though you may think of overdose as something that only occurs in cases of uncontrolled “hard” drug addiction, it can happen even when a person is casually abusing codeine. Overdosing on painkillers can be fatal, so recognizing signs can be critical in saving a drug user’s life. Signs and symptoms of a codeine overdose include:

  • Severe constipation
  • Cold, clammy, blue-tinged skin
  • Slowed breathing
  • Slowed brain activity
  • Hallucinations
  • Seizures

How common is narcotic abuse? Here are some facts on the prevalence of prescription painkiller abuse:

  • 50.5% of people who misused opioid drugs received them from friends or family.
  • On average, first-time users of opioid drugs are around 21 years of age.
  • Many users turn to the black market or cheaper alternatives like heroin to fuel their addictions.

The popularity of codeine-based drugs — especially cough syrup-derived “lean” and “sizzurp” concoctions — has increased over the last decade, evolving from a drink for partiers in pockets of the United States to a mixture that receives major facetime in music videos and pop culture.


As of 2013, lyrical references to lean/sizzurp/drank trailed only weed and cocaine references. Artists — rappers in particular — have even gone so far as to wax poetic on how critical codeine’s euphoria is on their own creative abilities. These artists are influencing a generation of entertainment consumers — and whether or not they realize it, harming their audience by glorifying addiction and even drug rehab.


Road to drug and alcohol recovery is easy if you follow our extensive addiction recovery guide.