A Guide to Codeine

By The Fix staff 07/10/14

Codeine is a widely-used short-acting narcotic that is highly addictive and provides the user with an overall sense of calm and feelings of pleasure. It is a chemical found in small amounts (0.7%-2.5%) in a type of poppy flower, Opium (papaver somniferum), and is more often synthetically made from morphine without being as strong as morphine.

Popular legal forms that include codeine are Fioricet with codeine, Phrenillin with caffeine and codeine, Cotabflue, Colrex Compound, Tylenol with Codeine (#1-4), Phenflu CD, Maxiflu CD, Fiorinal with Codeine, Soma Compound with Codeine (for muscle pain), Empirin with Codeine, Nalex AC, Mar-cof BP, Nowuss-NX, CapCof, T-Koff and Pediatuss, among other mixtures with ibuprofen and aspirin. Street names of codeine and codeine mixtures include: T-three’s (Tylenol #3 w/codeine), cough syrup, sizzurp, purple, lean and or drank. It can be taken orally, rectally, applied under the skin or injected into the muscles.

How is Codeine Used?

Codeine is typically prescribed for symptomatic relief of mild to moderate pain, relief of difficult or labored breathing, suppression of severe cough or diarrhea. It also carries anti-anxiety, antidepressant, and anti-hypertensive properties. When used, it causes the release of neurotransmitters that stimulate the reward center of the brain, leaving the user feeling mildly euphoric, which can lead to both psychological and physical dependence. Codeine abusers, often teens and youth with easy access to it, can become addicted by using large quantities of it to get high. Many adults become addicted to it by relying on it as a seemingly harmless painkiller. 

How Codeine Affects the Brain

Codeine changes how the brain and the nervous system respond to pain by blocking certain transmissions of pain so that the brain perceives them differently. Codeine carries anti-tussive effects and it is also believed that it inhibits an area of the brain called the medullary cough center. Chemicals produced by the mammal brain such as endorphins, enkephalins, and dynorphins resemble codeine, and the brain actually contains opioid receptors and creates small amounts of it in its normal responses and binding combinations with endorphins.

Signs of Abuse

Symptoms of codeine abuse vary according to amount used and length of abuse. Mood swings will range from euphoria to calm, depression, and anxiety. Behavioral symptoms may include drowsiness, decreased appetite, apathy, increased visits to doctor/hospital, lying, and stealing. Physical symptoms include constipation, blue tinge to lips, skin, and fingernails, muscle twitches, dizziness, fainting, nausea and vomiting, dry mouth, itching, rashes, urinary retention and infection, hypotension, respiratory depression, decreased libido, and seizures. Psychological symptoms may include hallucinations, delusions, memory loss, and/or lack of emotions.

Long Term Effects of Use

Long term abuse of codeine can lead to acute pancreatitis, liver/kidney damage, seizures, uncontrollable muscle twitches and loss of muscle tone, spasms, cramps, and pain. Abuse can also cause physical disorders, including to the immune system, eyes, heart and respiratory track. Other damage may be thoracic, mediastinal, gastrointestinal, musculoskeletal, renal and urinary, reproductive and breast disorders, not to mention dependence and increased risk of overdose. Legal issues, financial and domestic problems, job loss, impaired social relationships, incarceration, and loss of productivity are all potential consequences of long term use.

Mixing with Other Drugs

Using codeine with alcohol is highly addictive as well as life threatening; it may cause one to stop breathing. The use of other opioids, antihistamines, antipsychotics, antianxiety, or other CNS depressants concurrently with codeine may result in respiratory depression, hypotension, profound sedation or coma. Use with anticholinergics leads to increased risk of urinary retention, and/or severe constipation, which may lead to paralytic ileus.

Be careful also of mixing with MAO inhibitors or tricyclic antidepressants. These potentiate the action of morphine sulfate, the major metabolite of codeine.


Detox from codeine should be done gradually and usually last around seven days. It is recommended that anyone who is physically dependent on codeine seek medical assistance when attempting to quit. Immediate cessation may cause a number of withdrawal effects ranging from intense sweating, chills, stomach cramps, nausea/vomiting, muscle spasms, agitation and irritability, psychosis, suicidal/homicidal thoughts, and/or hallucinations. 


Symptoms of a codeine overdose include bluish lips or skin, change or loss in consciousness, chest pain or discomfort, constricted pupils, decreased awareness, unusual drowsiness, slow or irregular heartbeat as well as dramatic changes in pulse activity. There is also risk of psychosis, cardiac arrest, and/or coma.

Drug Tests

The timetable for detecting codeine in the system is dependent on many variables including body mass, age, hydration level, physical activity, health conditions, and each individual's metabolism. It also depends on which test is being used. It can be detected in urine for 2-4 days, blood for 12 hours, saliva for 1-4 days, and in the hair follicle for up to three months.

Legal Status

As a single product codeine is a Schedule II controlled substance in the U.S. When combined with other non-controlled substances and depending on amount per dose unit, codeine combined products range from schedule III to V. 

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