Substance Use

Codeine Withdrawal

codeine cough medicine pouring from bottle onto spoon

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Codeine Withdrawal Symptoms, Timeline & Detox Treatment Options

Codeine is prescribed to manage chronic pain, falling under the opioid class of medications. It is the most commonly taken opioid medication, and although it offers medical value, it is at the center of the current opioid crisis. Not since the HIV/AIDS epidemic has the United States faced such a lethal and devastating medical problem, with approximately 90 Americans dying prematurely from an opioid overdose daily.  

There are concerns that prolonged codeine use may lead to misuse, dependence, and addiction for some individuals, particularly those with a history of drug abuse. If you have been taking high doses of codeine or have been taking this opioid for extended periods, you will likely develop significant codeine withdrawal symptoms once you stop using this drug.

Although these symptoms often act as a barrier to treatment, it’s crucial to weigh the risks of continued use. If you have tried to stop using codeine in the past, you may have relapsed because withdrawal symptoms were too much to handle. 

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What Are the Symptoms of Codeine Withdrawal?

Since codeine is an opioid, it shares withdrawal symptoms with other opioids. The opioid withdrawal process is known to be highly uncomfortable. However, the severity of your symptoms will depend on several factors. 

For example, how long have you been using codeine, and what dose do you regularly take? How do you administer codeine? Have you been taking it as prescribed for years and have now developed a dependence?

Or do you crush codeine tablets to snort them? This route of administration brings codeine directly into the bloodstream as it bypasses the digestive system. The effect will be more substantial, which means you will likely have a higher tolerance with continued use. 

If you are currently snorting or injecting opioids, this is a major red flag concerning abuse and addiction. These methods are also hazardous, especially if you often combine codeine with other substances of abuse, such as alcohol

Regardless of how you use codeine, if you have developed dependence, codeine withdrawal symptoms will surface if you stop using. These symptoms will affect both your physical and mental health. 

Codeine withdrawal symptoms vary from one person to the next but typically include the following.

  • The earliest codeine withdrawal symptoms include:
    • Runny nose and eyes
    • Sneezing 
    • Sweating 
    • Goosebumps
    • Poor appetite 
  • During the peak phase, symptoms include:
    • Cravings 
    • Stomach cramps
    • Vomiting
    • Body aches
    • Irritability 
    • Fatigue
    • Poor concentration 
    • Hot and cold flushes 
    • Increased sweating 
  • Once physical symptoms subside, the late-phase symptoms include:
    • Insomnia
    • Lethargy 
    • Cravings 
    • Mood changes and irritability 

When you withdraw from an opioid, you can expect flu-like symptoms. Changes in blood pressure and heart rate are also common, which is why preexisting medical conditions need to be considered throughout the codeine withdrawal process. The psychological symptoms of codeine withdrawal vary, and although rare, hallucinations can develop. 

One of the most critical factors to consider during the withdrawal process is whether you combine codeine with other substances. If so, this increases your risk of seizure-like activity.

Certain combinations can be deadly, such as mixing codeine and alcohol. This combination increases your risk of overdose. That is why you should not allow the fear of codeine withdrawal symptoms to act as a barrier to treatment. Continued use can be dangerous, even fatal.

Post-acute withdrawal syndrome (PAWS) is discussed in greater detail below.

This syndrome can cause long-lasting symptoms following codeine withdrawal, including:

  • Irritability 
  • Depressed mood
  • Anxiety or panic attacks 
  • Poor cognitive function 
  • Cravings 
  • Disturbances in sleep patterns 
  • Increased sensitivity to stress

What Causes Codeine Withdrawal?

The cause of codeine withdrawal is complex. 

The development of codeine withdrawal symptoms often begins with tolerance. With continued use, the physiological effects decrease over time. To experience the same effect, you need to increase your dose.

Next, you may develop physical dependence, which causes a physiological adaptation to codeine, leading to codeine withdrawal syndrome following cessation. Once severe psychological dependence develops, it can lead to codeine addiction

For example, do you compulsively seek codeine? Do you crave codeine during periods of abstinence, and if you do not have access to it, do you develop a negative emotional state? If so, this is considered dependence.

There is often a fine line between dependence and opioid use disorder, which is why you need to be aware of your level of control, social impairment, risk use, and pharmacology. 

To better understand codeine withdrawal, you must know its mechanism of action. Although several subtypes exist, the three primary opioid receptors are mu, kappa, and delta. The activation of mu receptors within the central nervous system induces analgesia or pain relief. The mu receptor is also critical for reinforcing the actions of opioids. 

The main site in the brain that triggers opioid withdrawal syndrome is the locus coeruleus. This area of the brain is the primary source of norepinephrine, hosting neurons with an increased number of opioid receptors.

The mesolimbic system—your brain’s reward system—is also involved. When your brain continuously releases dopamine in response to codeine use, feelings of pleasure can reinforce cravings and resulting drug use. 

Like any drug you continue to use, codeine can start to cause changes in your brain. Prolonged use changes the way nerve receptors work, creating a dependency in your brain. This psychological dependency can drive continued use following the detoxification period. 

Following the codeine withdrawal process, there are many things you must consider to reduce the risk of relapse. You must address your triggers, but uncovering what those triggers are can be a complex process.

Key variables typically include rising stress levels, psychological conditioning, genetic predisposition, and the social context of codeine use. The goal is to target your triggers so that you can avoid relapse and maintain long-term recovery.

How Long Does Codeine Withdrawal Take?

The initial onset of codeine withdrawal symptoms will depend on several factors, including the formulation you take. There is an oral solution, an injectable, controlled-release tablets, and immediate-release tablets. These formulations are offered in varying doses.

There are also various codeine use patterns that influence how severe codeine withdrawal symptoms are.

  • Therapeutic dependence develops following long-term over-the-counter use. For example, you may have taken the recommended dose for years, but with the intent to better manage pain, you continued to increase your dosage slightly.

    You now experience elevated mood, reduced anxiety, or numbing of emotions when taking codeine. This prolonged use can complicate the codeine withdrawal process depending on your current mental health. For example, an increase in anxiety levels when aiming to discontinue use may make you avoid detoxification and ongoing treatment.
  • Recreational or non-medical use means you take codeine purely to achieve euphoria. In many cases, users start taking codeine to treat legitimate pain but then transition to non-medical use. 
  • High-dose dependence means you take very high doses daily. Some take more than 100 tablets in a single day. In these cases, the opioid withdrawal process will be severe and potentially dangerous when attempted unsupervised. However, the dangers of continued use at such high doses can be fatal. 

Codeine’s half-life is 2-4 hours. This timeline means it takes 2-4 hours to decrease the amount of codeine in your body by half. The final half-life takes between 9 and 11 hours. 

On average, codeine withdrawal symptoms appear approximately 12 hours after your last dose. However, some users may not experience significant symptoms until more than 24 hours have passed. Initially, you’ll experience flu-like symptoms and cravings. 

Most users experience a peak in their symptoms within 3-5 days following cessation. After this period, symptoms begin to subside. Depending on the circumstances, you may continue to experience insomnia, headaches, shakiness, cravings, and general discomfort. On average, symptoms generally resolve within a week. 

At this point, the physical symptoms generally end. However, psychological symptoms of codeine withdrawal can continue for weeks or months. Prolonged symptoms associated with post-acute withdrawal syndrome (PAWS) can even last years.

This condition is marked by symptoms similar to mood and anxiety disorders. This syndrome is most commonly associated with opioid, alcohol, or benzodiazepine withdrawal. Data shows that approximately 90% of recovering opioid users experience PAWS.

Is Codeine Dangerous?

Codeine is one of the drugs causing a spike in overdose complications and fatalities. One of the reasons it is so dangerous is it depresses the central nervous system, which is often the cause of complications related to “lean.”

Codeine is the main ingredient in lean, a beverage that combines prescription-strength codeine cough syrup and soda. In 2018, a story was published that showcased the severity of this drug. A young man overdosed on lean before spending 40 days in a coma.

When he awoke, he needed to learn to walk and talk again. This story is just one example showcasing the dangers of codeine misuse and how devastating the effects can be when you continue to use. 

It’s vital to seek the assistance of a professional treatment facility to address codeine withdrawal symptoms. It is not recommended that you attempt to withdraw from codeine unsupervised, especially if you have any underlying medical or mental health conditions. 

How to Safely Manage Codeine Detox

Like other opioids, codeine withdrawal can be incredibly uncomfortable. Unfortunately, the symptoms of codeine withdrawal often hinder users from seeking the help they need, which leads to relapse. 

Withdrawal management refers to the psychological and medical care of users experiencing withdrawal symptoms due to ceasing the use of a drug they are dependent on. The goal of withdrawal management is to reduce the discomfort associated with detoxification while providing ongoing support and care. 

The standard of care for withdrawal management typically involves 24-hour care. Recovering users should have access to a doctor during the admission process and nurses responsible for monitoring patients and dispensing medications when needed. 

Opioid withdrawal, including codeine withdrawal, can be very uncomfortable. However, during this process, your life is not generally at risk unless, of course, other variables are involved, such as co-occurring alcohol dependence. In this case, codeine withdrawal can become more complicated.

There are several approaches to evaluation. However, the COWS (Clinical Opioid Withdrawal Scale) assessment is commonly used to judge the severity of symptoms during codeine withdrawal. This evaluation is independent of the individual assessment you’ll receive when you seek the support of a professional treatment facility.

The individual assessment aims to ensure your individual needs are met concerning your current health status, medical history, and mental health. 

During this process, having a professional care team can make all the difference concerning success rates, especially when that team understands the value of holistic treatment. Codeine withdrawal is just the first step of many to achieve wellness and a higher quality of life.

In addition to treating substance use disorders and mental health conditions, many evidence-based treatment programs also implement wellness plans, including nutrition and medication practices. This approach often applies during the codeine withdrawal process to support optimal wellness from day one. For example, patients should drink at least 2-3 liters of water daily during the opioid withdrawal process.

When you have a care team alongside you supporting you through this process, you are given everything you need to remain as safe and comfortable as possible. The goal is to set you up for ongoing success.

It’s critical to understand that completing the codeine withdrawal process does not automatically lead to sustained abstinence. Codeine withdrawal is the first step before beginning a more comprehensive treatment plan.

For example, if you have an underlying mental health condition, it must be addressed to ensure your ongoing safety. In some cases, users began taking codeine to help mask symptoms of poor mental health. In other cases, long-term codeine use may lead to depressive symptoms

To ensure your greatest chance of success, it’s essential to partner with a substance abuse and mental health facility that understands the value of holistic treatment

When to Contact a Medical Professional

Prolonged codeine use is dangerous, and if you are currently struggling with misuse, it’s important to take the next critical step. Codeine withdrawal symptoms are uncomfortable, but with the support of an expert multidisciplinary team, you can overcome the withdrawal process as safely and comfortably as possible. 

A professional substance abuse and mental health treatment facility will help you develop a personalized treatment plan that focuses on more than codeine withdrawal. The idea is to identify the factors that hinder your ability to remain sober outside of physical dependence to develop a treatment plan that ensures ongoing success.

Ready to experience the freedom of sobriety? Seek the assistance of a professional treatment facility today.

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