Codeine Withdrawal: What It Is and How to Cope

Tolerance

Over time, you may develop tolerance to the effects of codeine. This means that your body needs more and more of the drug to feel the same pain relief or other desired effects.

In other words, tolerance makes the drug seem less effective to your body.

How quickly you develop codeine tolerance depends on factors such as:

• your genetics
• how long you’ve been taking the drug
• how much of the drug you’ve been taking
• your behavior and perceived need for the drug

Dependence

As your body becomes more tolerant of codeine, your cells begin relying on the drug to prevent withdrawal symptoms.

This is dependence. It’s what leads to intense withdrawal side effects if codeine use is stopped suddenly. One sign of dependence is feeling that you must take codeine to prevent withdrawal symptoms.

Dependence can occur if you take codeine for more than a few weeks or if you take more than the prescribed dosage.

It’s also possible to develop codeine dependence even if you take the drug exactly as your doctor prescribes.

Dependence is often a part of addiction, but they’re not the same.

Dependence vs. addiction

Dependence and addiction both cause withdrawal when the drug is stopped, but they’re not the same thing.

Dependence stems from long-term exposure to a drug, and people dependent on a drug will experience mild or severe withdrawal symptoms when they abruptly stop taking the drug.

Physical dependence on a prescribed opiate is a typical response to treatment and can be managed with help from your doctor.

Addiction, on the other hand, may follow dependence. It involves craving and compulsively seeking the drug. Addiction can change your brain circuitry, leading you to use a drug despite negative consequences and eventually to lose control over your usage. It often requires more support to get through.

Withdrawal symptoms may come in two phases. The early phase occurs within a few hours of your last dose. Other symptoms may occur later as your body readjusts to working without codeine.

Early symptoms of withdrawal may include:

• feeling irritable or anxious
• trouble sleeping
• teary eyes
• runny nose
• sweating
• yawning
• muscle aches
• faster heart rate

Later symptoms may include:

• loss of appetite
• nausea and vomiting
• stomach cramps
• diarrhea
• enlarged pupils
• chills or goosebumps

Many withdrawal symptoms are a reversal of codeine side effects.

For instance, codeine use can cause constipation. But if you’re going through withdrawal, you may develop diarrhea. Likewise, codeine often causes sleepiness, and withdrawal may lead to trouble sleeping.

How long withdrawal lasts

Symptoms may last for a week, or they may persist for months after stopping codeine use.

Physical withdrawal symptoms are strongest in the first few days after you stop codeine use. Most symptoms are gone within 2 weeks.

However, behavioral symptoms and cravings for the drug can last months. In rare cases, they can even last years. Everyone’s experience with codeine withdrawal is different.

With a doctor’s guidance, you can typically avoid severe withdrawal side effects. Your doctor will likely advise you to taper off your codeine use slowly rather than suddenly stopping the drug.

Gradually reducing your use allows your body to adjust to less and less codeine until your body no longer needs it to function normally.

Your doctor can help you through this process or refer you to a treatment center. They may also suggest behavioral therapy and counseling to help you avoid relapse.

Your doctor may also suggest certain medications depending on whether you have mild, moderate, or advanced withdrawal symptoms.

For mild pain and other symptoms

Your doctor may suggest non-narcotic medications to ease more mild withdrawal symptoms. These medications may include:

• pain medications such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) to help reduce mild pain
• loperamide (Imodium) to help stop diarrhea
• hydroxyzine (Vistaril, Atarax) to help ease nausea and mild anxiety

For moderate withdrawal symptoms

Your doctor may prescribe stronger medications. Clonidine (Catapres, Kapvay) is often used to reduce anxiety and treat high blood pressure. It can also help ease:

• muscle aches
• sweating
• runny nose
• cramps
• agitation

Your doctor may also prescribe a long-acting benzodiazepine such as diazepam (Valium). This drug can help treat muscle cramps and help you sleep.

For advanced withdrawal symptoms

If you have severe withdrawal, your doctor may try different options.

For instance, they may switch you from codeine to a different medication, such as a different opiate. Or they may prescribe one of three medications that are commonly used to treat opiate addiction and severe withdrawal symptoms:

• Naltrexone: This blocks opioids from acting on the brain. This action takes away the pleasurable effects of the drug, which helps prevent relapse of misuse. However, naltrexone may not stop drug cravings due to addiction.
• Methadone: This helps prevent withdrawal symptoms and cravings. It allows your body’s function to return to its natural state and makes withdrawal easier.
• Buprenorphine: This produces weak opiate-like effects, such as euphoria (a feeling of intense happiness). Over time, this drug can reduce your risk of misuse, dependence, and side effects from codeine.

Codeine is milder than other opiates (such as heroin or morphine), but it can still cause dependence and addiction.

Your doctor can support you through withdrawal and recovery. If you’re concerned about codeine withdrawal, talk with your doctor and ask for help. Here are a few questions you might ask:

• How can I avoid addiction to codeine?
• Are there better alternatives to codeine use for me?
• How should I stop taking codeine?
• What signs of codeine tolerance and dependence should I watch for?
• Will I go through withdrawal if I quit using codeine? What symptoms should I expect?
• How long will my withdrawal and recovery take?