Codeine: Addictive and Potentially Dangerous

Woman at home under codeine effect, paramedics arrived
Photo by Pavel Danilyuk/

Americans have come to understand in recent years that many pharmaceutical drugs they were told were safe and harmless are actually quite dangerous. Virtually all Americans are now aware of the opioid epidemic, kicked off in the late 1990s and early 2000s by the overprescribing of prescription opioid pain relievers.

While the opioid epidemic was the first harsh lesson that not all pharmaceutical drugs are safe and benign, it was not the last. More recently, Americans have begun to understand that codeine, initially thought to be a harmless cough medicine, is both addictive and dangerous.

What Is Codeine? Why Is It Dangerous?

Codeine is an opioid drug, though it differs in one key way from other opioids like hydrocodone, oxycodone, oxymorphone, morphine, and fentanyl. While most opioid drugs are prescribed to relieve pain, codeine is primarily used to reduce coughing. The drug does have a pain-relieving element, but the public does not perceive it as a pain reliever. It is perceived as a treatment for coughing. In fact, many people who are prescribed codeine do not even know it is an opioid drug.

Young man takes codeine

Codeine is dangerous because, when it is used for a long time, it may become habit-forming. It can cause mental and physical dependence.

Though codeine is typically perceived and used as a cough medicine, it is an opioid, and it acts on the opioid receptors in the brain. Because of that, people who use the drug may experience pain relief, relaxation, pleasure, and contentment. People may begin using the drug more for its psychological effects than its pain-relieving or cough-suppressing effects. However, as they use it, their body will build up a tolerance to it, meaning they will need to use more and more of the drug to experience the same effects from it.

People become addicted to codeine when they can no longer control how much of the drug they take or how often they take it. When the cravings for the drug dictate usage behavior (as opposed to what the doctor or prescription recommends), the individual is hooked on the drug and is in greater danger of experiencing harmful side effects.

How Has the FDA Changed its Monitoring of Codeine?

Codeine used to be readily available over the counter and was approved for treating pain and cough symptoms for all age demographics. However, that changed in 2018 when the Food and Drug Administration (FDA) began to reckon with the addictive and dangerous nature of the drug.

In 2018, the FDA updated its approval of codeine. On November 1st of that year, the agency put out this announcement: “The U.S. Food and Drug Administration (FDA) is requiring safety labeling changes for prescription cough and cold medicines containing codeine or hydrocodone to limit the use of these products to adults 18 years and older because the risks of these medicines outweigh their benefits in children younger than 18. We are also requiring the addition of safety information about the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing to the Boxed Warning, our most prominent warning, of the drug labels for prescription cough and cold medicines containing codeine or hydrocodone.” Perhaps most importantly, the FDA also removed its approval of the drug for over-the-counter sale. Today, codeine is only available via a prescription for adults 18 and older.

What are the Side Effects of Experimenting with Codeine?

young man under codeine effect

People who misuse codeine, and even some who take it as prescribed, put themselves at risk for unwanted side effects. Some of the side effects people experience when they use codeine include:

  • Seizures
  • Headaches
  • Stomach pain
  • Changes in vision
  • Difficulty urinating
  • Agitation and hallucinations
  • Skin rashes, itching, and hives
  • Nausea, vomiting, and loss of appetite
  • Weakness, dizziness, difficulties in coordination
  • Changes in libido, menstruation, and sexual function
  • Difficulty breathing or swallowing, including noisy, shallow breathing
  • Changes in heartbeat and cardiovascular function that can be very serious

Codeine can also depress respiratory function, as mentioned earlier. That is extremely dangerous and can lead to an overdose, which can be fatal when not treated. Signs and symptoms of a codeine overdose include:

  • Fainting
  • Dizziness
  • Slow heartbeat
  • Unconsciousness
  • Cold, clammy skin
  • Difficulty breathing
  • Loss of muscle control
  • Slow, shallow breathing
  • Inability to be awakened
  • Excessive drowsiness or sleepiness

If someone using codeine overdoses, witnesses should call 911 and administer naloxone (Narcan) if it is available to them.

Do People Hooked on Codeine Need to Go to Rehab?

People who use codeine and cannot stop or control their use, whether they have a legitimate prescription for it or not, are addicted to it and will require professional help. Such help must be obtained at qualified residential drug and alcohol addiction rehab centers.


  • FDA. “FDA Drug Safety Communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older.” Food and Drug Administration, 2018.


Editorial Staff