Codeine is one of the oldest drugs in modern medicine, having been discovered in 1832 by a French pharmacist and chemist Pierre Jean Robiquet.
It is the third most misused prescription opioid in the US with over 2.8 million Americans misusing it in 2017.
An important note: in January, 2018, the FDA issued a drug safety communication requiring safety labeling changes for prescription cough and cold medicines containing codeine to limit the use of these products to adults 18 years and older.
What is Codeine?
Codeine is a prescription opiate analgesic used to treat mild to moderate pain and to reduce coughing. Codeine is FDA-approved in two drug classes – as a narcotic analgesic (painkiller) and as an antitussive (cough suppressant).
Codeine is available as a single ingredient for analgesia and in cough syrups and other combination products containing acetaminophen, aspirin, caffeine, pseudoephedrine, phenylephrine, and chlorpheniramine. If you are prescribed a codeine combination product make sure that you know what other ingredients are included and for what purposes and talk to your doctor or pharmacist about it.
FDA-approved generic versions are widely available as are the branded products including:
- Fioricet with Codeine
- Fiorinal with Codeine
- Phenergan and Phenergan VC with Codeine
- Tuxarin ER
- Tuzistra XR
Is Codeine an Opiate or Opioid?
The distinction between an opiate versus an opioid is based on whether it is made from natural (opiate) or synthetic (opioid) ingredients. Codeine is obtained from the opium poppy plant’s seed pod and hence is categorized as a natural opiate. The terms opiate and opioid are currently used interchangeably and generally opiates are classified as a sub-group of opioids which includes natural, semi-synthetic, and synthetic products.
Codeine Side Effects
Side effects include:
- Abdominal pain
It is important to take this medication exactly as prescribed by a physician to avoid side effects and potential overdose. Misuse and abuse of this medication can lead to serious health effects as well as substance dependence and addiction. Taking codeine for longer than prescribed or at higher doses than recommended can lead to tolerance of the drug, which means that a person needs more of the drug to achieve the same pain-relieving effect.
Codeine is subject to high misuse and abuse leading to addiction. In the US, over 2.8 million people misused it in 2017 as noted earlier.
Codeine can be highly addictive, and recently the FDA ruled in January, 2018 that the risks of prescription cough and cold medicines containing codeine outweighed their benefits in children younger than 18. The FDA required the addition of safety information about the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing to the “black box warning” on the consumer drug labels for these products.
Codeine Withdrawal Symptoms
Some or all of the following can occur:
- Lacrimation (tearing)
- Rinorrhea (runny nose)
- Myalgia (muscle pain)
- Mydriasis (dilated pupils)
Other signs and symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.
It is best to have medical supervision with codeine withdrawal because it is very unpleasant and there is a high risk of relapse during detox. Physical withdrawal symptoms last for approximately 1 week but can be prolonged over several weeks/months if you have been taking the drug for a long period of time or in high amounts.
Withdrawal symptoms can be eased by undergoing a medically assisted tapering off regime designed by your doctor. A SAMHSA certified opioid treatment program is recommended.
How Long Does Codeine Stay in Your System
The length of time codeine stays in your system varies from person to person and is dependent on several personal factors. Body fat percentage, metabolism and other medications can all affect the rate that your body dispels this drug.
Codeine has a half-life of approximately 3 hours. The time the remaining half can be detected in your system falls within the following time frames, to be used as a broad guideline only:
- Urine: 2-4 days
- Saliva: 12 -24 hours
- Blood: 12 to 24 hours
- Sweat: 1 to 4 weeks
- Hair: 4 to 6 months
For analgesia, non-opioid options such as ibuprofen and acetaminophen should be considered along with non-medication therapies like physical therapy and acupuncture. To relieve a cough due to a cold or upper respiratory infection alternatives to consider include over-the-counter (OTC) cough syrups such as dextromethorphan as well as prescription benzonatate products. It is also important to recognize that trying to treat a cold or upper respiratory tract infection can be self-limiting and it might be best to let it run its course since medication won’t treat the underlying cause or shorten recovery time.