Codeine is an opioid medicine used to relieve pain and calm coughing. It is sold alone and in combination products such as acetaminophen with codeine and some prescription cough medicines. Codeine can be habit-forming, can slow or stop breathing, and is especially dangerous for children and when mixed with alcohol, benzodiazepines or other sedatives.
Premier spot available
Feature your facility right under the search bar on county, city and treatment pages.
Advertise hereWhat Codeine Is and Its Approved Uses
Codeine belongs to a class of medicines called opioid analgesics. According to MedlinePlus, it is used to:
- Relieve pain
- Calm coughing
Codeine comes as a single-ingredient medicine and in combination with other ingredients, such as acetaminophen (Tylenol with codeine), aspirin, and antihistamines or decongestants in some prescription cough and cold medicines. In the U.S., codeine cough products are controlled substances, and in 2018 the FDA limited prescription opioid cough and cold medicines, including those with codeine, to adults 18 and older.
How Codeine Affects the Body and Brain
For pain, codeine changes the way the brain and nervous system respond to pain. For cough, it reduces activity in the part of the brain that triggers coughing. The liver converts part of each dose of codeine into morphine.
Like other opioids, codeine attaches to opioid receptors in the brain, spinal cord and body. NIDA explains that opioids block pain signals and also release large amounts of dopamine, a brain chemical tied to reward. That reward effect is part of why opioids can lead to repeated use.
Common side effects include nausea, vomiting, sweating, constipation, dizziness when standing up and sexual problems.
Short- and Long-Term Risks
- Breathing problems. Codeine can cause serious or life-threatening breathing problems, especially in the first 24 to 72 hours of treatment and any time the dose is increased.
- Addiction. Codeine can be habit-forming. FDA labels warn that it exposes people to the risks of addiction, abuse and misuse, which can lead to overdose and death.
- Accidental use. If a child or anyone else takes codeine that was not prescribed to them, it can cause a fatal overdose. Keep it locked away.
- Pregnancy. Regular use during pregnancy can cause life-threatening withdrawal symptoms in the newborn.
- Serious side effects. Get medical help right away for confusion, hallucinations, seizures, extreme drowsiness, a fast heartbeat, allergic reactions, or unusual snoring or pauses in breathing during sleep.
Why codeine is dangerous for children
Some people inherit a trait that makes their liver convert codeine into morphine much faster than usual. In children, this has led to life-threatening breathing problems and deaths, many of them after surgery to remove the tonsils or adenoids. Because it is hard to know in advance who processes codeine this way, FDA labeling says codeine must not be used in children younger than 12, or for anyone younger than 18 after tonsil or adenoid surgery. It should also be avoided in teens 12 to 18 who have other risk factors for breathing problems. Parents who notice unusual sleepiness, confusion, or difficult or noisy breathing in a child taking codeine should get medical help right away.
Codeine with Alcohol, Benzodiazepines and Other Sedatives
The boxed warning on codeine labels says that taking opioids with benzodiazepines (such as Xanax or Valium) or other CNS depressants, including alcohol, can cause profound sedation, slowed breathing, coma and death. Sleeping pills, some muscle relaxants and street drugs can add to the risk. Tell your doctor and pharmacist about every medicine and substance you use before you take codeine.
Overdose: Signs and What to Do
Signs of a codeine overdose include:
- Slow or shallow breathing
- Being unable to wake up or respond
- Limp or weak muscles
- Cold, clammy skin
- Changes in pupil size
- A slow heartbeat
Call 911 right away. Naloxone (Narcan) can reverse an opioid overdose if it is given quickly. In 2023, the FDA approved Narcan nasal spray for sale without a prescription, so it is now sold in pharmacies and other stores. If you have naloxone, give the first dose, call 911 and stay with the person. If symptoms come back before help arrives, another dose may be given every 2 to 3 minutes. If you or someone you live with takes an opioid, keep naloxone at home and make sure others know where it is.
Is Codeine Addictive? Dependence and Withdrawal
Yes. With regular use, the body builds tolerance, meaning it takes more codeine to get the same effect. It can also become physically dependent, meaning withdrawal appears when the drug is cut back. Opioid use disorder, or addiction, is a long-term condition marked by uncontrollable drug seeking and use despite harm.
If you have taken codeine for several weeks or longer, do not stop suddenly. Withdrawal can include restlessness, anxiety, sweating, runny nose, yawning, nausea, vomiting, diarrhea, muscle aches and strong cravings. NIDA notes that symptoms can start within a few hours of the last dose. Your doctor can lower the dose gradually. If you are dependent on codeine or have been using it in ways other than prescribed, a medically supervised detox makes stopping safer and more comfortable.
Codeine and the Law
Federal scheduling depends on the product. Codeine by itself is a Schedule II controlled substance. Combination products with limited amounts of codeine, such as acetaminophen with codeine, are Schedule III. Certain cough preparations with small amounts of codeine are Schedule V. All of them are controlled substances, and having or sharing codeine without a valid prescription is illegal.
Treatment for Codeine Use in Florida
Opioid use disorder is a treatable medical condition. The most effective approach combines medication with counseling and support. SAMHSA lists three FDA-approved medications for opioid use disorder:
- Methadone fully activates opioid receptors in a controlled way to ease withdrawal and cravings.
- Buprenorphine partly activates the same receptors, which also eases withdrawal and cravings.
- Naltrexone blocks opioids from attaching to the receptors. People usually need to be off opioids for about 7 to 10 days before starting it.
According to NIDA, people with opioid use disorder who receive methadone or buprenorphine are less likely to overdose or die than people who do not get treatment, and both medicines help people stay in treatment. SAMHSA describes these medicines as safe for long-term use, and they work for prescription opioids as well as for heroin. Talk with your doctor before stopping any of them.
Florida has programs at every level of care, from detox and residential treatment to outpatient counseling. Many offer medication alongside therapy. Start with our Florida medication-assisted treatment page, or search licensed Florida rehabs near you. Our directory lists facilities using SAMHSA FindTreatment.gov data.
Getting Help Now
- Emergency or possible overdose: call 911.
- SAMHSA National Helpline: 1-800-662-4357. It is free, confidential, open 24/7 and available in English and Spanish. They can help you find treatment and support near you.
- Crisis or thoughts of suicide: call or text 988 to reach the Suicide & Crisis Lifeline.
- Poison Control: 1-800-222-1222 for questions about a possible overdose or a medicine taken by mistake.
Sources
- MedlinePlus: Codeine
- FDA: Codeine Sulfate Tablets prescribing information
- FDA: Tuzistra XR (codeine and chlorpheniramine) prescribing information
- FDA: Safety review update of codeine use in children; new Boxed Warning and Contraindication on use after tonsillectomy and/or adenoidectomy
- FDA: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older
- FDA: FDA Approves First Over-the-Counter Naloxone Nasal Spray
- NIDA: Prescription Opioids DrugFacts
- NIDA: Medications for Opioid Use Disorder
- SAMHSA: Treatment Options for Substance Use Disorder
- DEA Diversion Control Division: Controlled Substances – Alphabetical Order
Frequently Asked Questions About Codeine: Uses, Risks and Opioid Addiction
What is codeine?
Codeine is an opioid medicine used to relieve pain and to calm coughing. It is sold alone and in combination products, such as acetaminophen with codeine (Tylenol with codeine) and some prescription cough syrups. Federal scheduling depends on the product: codeine alone is Schedule II, combinations like Tylenol with codeine are Schedule III, and certain cough preparations are Schedule V.
Is codeine addictive?
Yes, codeine is habit-forming and can lead to tolerance, physical dependence and opioid use disorder, especially when taken in larger amounts, more often or for longer than prescribed. Mixing prescription cough syrup with other substances to get high is a form of misuse that carries real overdose risk. Take codeine only as directed and keep it locked away.
Can children take codeine?
No, codeine is not approved for children under 12, and it should not be used for pain after tonsil or adenoid surgery in anyone under 18. Some people, including children, convert codeine to morphine unusually fast, which has caused life-threatening breathing problems and deaths. Prescription opioid cough and cold medicines are limited to adults 18 and older.
What are the signs of a codeine overdose?
Signs of a codeine overdose include slow or shallow breathing, being unable to wake up or respond, limp muscles, cold and clammy skin, changes in pupil size and a slow heartbeat. Call 911 immediately. Naloxone (Narcan) can reverse an opioid overdose and is available over the counter, so give it if you have it and stay with the person.
Is it safe to take codeine with alcohol or sleeping pills?
No, combining codeine with alcohol, benzodiazepines, sleeping pills or other sedatives raises the risk of dangerously slowed breathing, deep sedation and coma. This risk is greatest in the first 24 to 72 hours of treatment and after a dose increase. Tell your doctor and pharmacist about every medicine and substance you use before taking codeine.
What happens if you stop codeine suddenly?
If you have taken codeine for several weeks or longer, stopping suddenly can cause withdrawal symptoms such as restlessness, sweating, runny nose, nausea, vomiting, diarrhea and muscle aches. Talk with your doctor before stopping so the dose can be lowered gradually. If you are dependent on codeine, medical support makes stopping safer and more comfortable.
How do I find opioid addiction treatment in Florida?
You can find licensed opioid addiction treatment across Florida, including programs that combine medication with counseling. Buprenorphine, methadone and naltrexone are the FDA-approved medications for opioid use disorder, and they can help with cravings and lower overdose risk. Start with our Florida medication-assisted treatment page, or call SAMHSA's free helpline at 1-800-662-4357.
