Codeine is an opioid medication that is prescribed to help patients manage mild-to-moderately severe pain. It is used for short-term treatment because of its potency and high abuse potential. This still doesn’t stop people from misusing it and abusing it, a problem that health officials say has gotten out of control.
The U.S. government has listed codeine as a Schedule II narcotic, which puts it in the same class of drugs with OxyContin (oxycodone), and other opioid pain relievers. Users can take codeine as a pill (often combined with acetaminophen) or as a cough syrup. The drug’s classification also changes depending on the makeup of the drug it’s used in, so it can also be a Schedule III or Schedule V drug.
In the U.S. and abroad, a codeine-based cough syrup drink called “lean” or “purple drank” is leading teens and young people to consume the drug in unsafe amounts. The 2018 Monitoring the Future Report states that 2.8 percent of eighth-graders, 3.3 percent of 10th-graders, and 3.4 percent of 12th-graders, abuse cough and cold medication to get high.
One of these medications is codeine, a primary ingredient in “sizzurp.” The drink, typically served in a plastic foam cup, is laced with the opioid along with promethazine-based cough medicine, an antihistamine, soda, and hard candies, likely Jolly Ranchers, which make the drink sweeter. This lethal cocktail hooks people from all walks of life, including rappers, singers, and athletes. VeryWell Mind writes, “Purple drank is like an anesthetic but without life support.”
As with all medications, codeine should be used with care. The drug is available legally only through a doctor’s prescription. Any use of it outside of that is illegal. Even people who have a proper prescription for codeine from a health care provider can develop a high tolerance for the medication. The mind-altering effects of codeine, particularly at higher doses, makes the drug easy to abuse.
Recreational codeine users seek out the drug’s euphoric and calming effects. Pain in the spinal cord also decreases when it is taken. Users can feel the medication’s effects anywhere from 10 minutes to half an hour after it is taken. These effects can last about four to six hours, depending on how large the dose is.
Like other drugs in its class, codeine binds to opioid receptors in the brain and central nervous system, stimulating different parts of the body. As the drug stimulates the brain, users feel pleasurable sensations, relaxation, and a state of contentment in the limbic system, the part of the brain that affects emotional and behavioral responses.
When abused for too long, codeine is addictive, and people who want to come off the drug may require professional help to be successful in doing so.
People who use codeine regularly are likely to go into drug withdrawal if they suddenly stop using the medication or cut back on it. If noticeable changes appear after routine codeine use is interrupted, withdrawal is likely happening. Harrowing symptoms appear as the body and the brain attempt to adjust to the absence of the chemical in the amounts they had become used to having present.
Codeine withdrawal is uncomfortable, and symptoms can affect a person’s mind, body, and emotional state.
Some codeine withdrawal symptoms can lead to serious health complications and should not be ignored. If you or someone you know is experiencing the following, seek medical attention now by calling 911 or visiting your nearest hospital emergency room or urgent care center:
These severe psychological symptoms also require emergency medical attention:
Drug withdrawal will not look or feel the same for everyone. Factors unique to each individual will shape what the timeline will look like and how the symptoms will feel. These factors include:
People who are trying to stop their use of codeine may wonder about what happens during withdrawal from the drug. You should expect codeine withdrawal symptoms to emerge within the first few hours after the last dose. According to HealthLine, codeine withdrawal symptoms take place in two phases. In the first phase, certain symptoms appear within a few hours of the last dose taken. In the second phase, other symptoms appear as the body attempts to heal itself and resume functioning as normal.
Codeine withdrawal can take at least five to 10 days, though length and intensity depend on several factors, as noted above. Here’s a general outline of what codeine withdrawal could look like:
Days 1-4: A few hours after the last codeine dose is taken, users may start feeling flu-like symptoms. These include nausea, insomnia, diarrhea, and cramps. They also may have headaches and dilated pupils and sweat a lot. Goosebumps and restless legs syndrome are also common during this period. Users may also feel depressed.
Days 5-7: At this stage, physical symptoms start to wear off, but users will need to boost their water intake to avoid dehydration. In addition to depression, other mental and/or emotional disturbances may be experienced, including anxiety, irritability, and insomnia.
Day 8 and later: Physical symptoms likely will have subsided during this stage, but the mental and emotional challenges of codeine withdrawal linger. Codeine cravings may continue in the coming months or years. Post-Acute Withdrawal Syndrome (PAWS) is common after substance abuse ends. It brings on anxiety, low confidence, fatigue, guilt, shame, and, in severe cases, thoughts of suicide. Recovering users who are finding it hard to manage PAWS are advised to seek medical help or advice before, during, and after substance abuse treatment.
Some people will want to stop abusing codeine, and they may try to do it by quitting the drug abruptly with no medical help. This is not advised as it is not safe and can lead someone to relapse and use the drug again with harmful or deadly results.
Medical detox at a facility that specializes in treating substance abuse with evidence-based techniques and guidance is viewed as the safest way to manage withdrawal symptoms and ensuring that users come off the drug properly and with desired results.
In the case of opiate withdrawal, medical care professionals may use intravenous therapy (IV) to gradually lower the dosage of a drug to help users ease off it. This process is called tapering. Professional guidance in this area is critical. Tapering too quickly has its own risks, among them uncomfortable withdrawal symptoms and relapse. Physicians can help set the proper tapering schedule.
During the process, medical professionals may give patients medications to make the process easier to withstand while monitoring the person’s vital signs and overall health. These professionals also are available around the clock to ensure the needs of patients are met. Users don’t have to wait for their condition to worsen before seeking help at a facility. The sooner detox starts, the better the chance for recovery.
At-home detox treatments are discouraged because of the increased risk of the dangerous withdrawals or relapse that could result, as mentioned earlier. If you are experiencing codeine withdrawal and are going through the symptoms after stopping long-term use of the drug, please consider seeking treatment from a facility that is equipped to help you properly end codeine use.
Detox is the start of the recovery process. As the National Institute on Drug Abuse (NIDA) says, the process by itself is not enough to treat long-term or frequent codeine abuse. Depending on how severe the person’s situation is, treatment could run from 30 days to 90 days. NIDA says 90 days of treatment in a residential or inpatient setting is ideal because it gives the person the best chance at a successful recovery.
Medical professionals will conduct an assessment of your physical and mental needs, which will help determine your placement. Residential care involves 24-hour monitoring and a distraction-free environment that encourages understanding and addressing your addiction with the appropriate therapies.
Other treatments on the addiction continuum of care include partial hospitalization and intensive outpatient programs. Both options allow people in recovery to receive intensive treatment while living off-site. An outpatient program provides therapy for nine or fewer hours, while intensive outpatient treatment provides a minimum of nine hours and up.
Once treatment is complete, people in recovery can join alumni programs with other like-minded individuals who understand their journey and encourage them to pursue and reach their goals and dreams. They also can use post-treatment services that can help them rebuild their lives. These services may help them find employment, housing, therapies, and medical services that can help them stay on the path to full-time sobriety.
(June, 28, 2019). Serious Health Risks of Purple Drank. Verywell Mind. from https://www.verywellmind.com/is-purple-drank-going-down-1123889
National Institute on Drug Abuse. “Monitoring the Future 2018 Survey Results.” NIDA, 17 Dec. 2018. from https://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2018-survey-results
(December 2016). Codeine Withdrawal: What It Is and How to Cope. Healthline. from https://www.healthline.com/health/codeine-withdrawal#symptoms
NIDA. (January, 2018). “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment