Codeine Addiction and Abuse in Ohio

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Last Updated - 1/17/2023

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Updated 01/17/2023

Codeine is an opiate derived from the naturally occurring poppy plant. In contrast to other prescription opioids, codeine occurs naturally. It is not as potent as many other opioids, so it does not have the same addictive potential as oxycodone, heroin or fentanyl. However, just because codeine has a lower addiction potential does not mean it cannot lead to addiction. 

Codeine is available in various forms, including oral tablets and oral solutions. By itself, codeine is a Schedule II controlled substance according to the Drug Enforcement Agency (DEA). When mixed into a formulation with other products, the schedule of the drug is typically lower, meaning there is less risk of addiction. For example, when formulated with acetaminophen (Tylenol), it is a Schedule V drug.

Codeine Abuse in Ohio

Codeine and opiate abuse are major public health issues in Ohio. In 2007, unintentional drug poisoning became the leading cause of death. By 2019, the number of overdoses continued to increase.

In 2019, the age group with the highest rate of unintentional drug overdoses was those in the 35–44-year-old age group. Black non-Hispanic males had the greatest overdose rate, while Black non-Hispanic females had the lowest. However, this group saw the largest increase in overdose deaths of any group, increasing 21%.

About 84% of drug overdoses in Ohio were attributable to opioids, with fentanyl alone the cause of 76% of them. Since codeine is less potent than other opioids, it tends to be involved in fewer overdose deaths. However, it is important to understand that codeine can be laced with other drugs like fentanyl, so it shouldn’t be considered safer.

You might also be interested in: Mixing Codeine and Alcohol: Dangers, Effects & Interactions

How Codeine Addiction Happens

Codeine is a naturally occurring opiate that can be used to treat short- and long-term pain. It is also prescribed to treat cough. When ingested, codeine is converted by the liver into morphine, and they attach to opioid receptors, causing a reduction in pain and increased feelings of euphoria and well-being.

Codeine is available under several brand names:

  • Cheratussin
  • Codeine sulfate
  • Guaifen AC
  • Guiatussin with codeine
  • Phenergan with codeine
  • Robitussin AC
  • Tylenol #2, Tylenol #3, and Tylenol #4

 A full list of codeine brand names can be found on MedlinePlus.

If you are prescribed codeine for cough or pain, it will likely be administered at the lowest dose for the shortest time possible. Doctors in Ohio recognize this and are required by the Ohio Pharmacy Board to take this into consideration.

Using it in a way that’s not prescribed is considered codeine abuse. This includes using codeine too often, in too high a dose or without a prescription. Codeine abuse can lead to dependence, which greatly increases the risk of addiction. If the brain becomes dependent on codeine, withdrawal symptoms will occur when the person attempts to stop taking it.

Codeine addiction can happen even if the drug is taken exactly as prescribed. If you are taking codeine as prescribed, it’s important to speak with your doctor if you are experiencing cravings or withdrawal.

Common Signs of Codeine Addiction

A person addicted to codeine is likely to show signs and symptoms of withdrawal, which can include:

  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Lacrimation, or tearing up
  • Nausea
  • Rhinorrhea, or head cold
  • Vomiting
  • Yawning

All opioids have a similar set of withdrawal symptoms, so it is challenging to identify a codeine use disorder based on symptoms alone.

Long-term use of opioids is associated with mood deficits like depression and dysphoria. It can also lead to health consequences, including constipation and the inability to absorb nutrients from food.

Why Is Codeine Addictive?

Codeine works in the central nervous system (CNS), which includes the cells of the brain and the spinal cord. Neurons in the brain use chemical signals called neurotransmitters to communicate with each other, and this facilitates the functioning of the body.

Neurons use many neurotransmitters, including serotonin, norepinephrine, dopamine and endorphins. Codeine mimics the effects of endorphins, causing an increase in dopamine levels. Dopamine is responsible for generating pleasure, reward and motivation. Codeine activates this pathway, which can eventually lead to addiction as the brain begins to crave the substance.

Codeine Addiction Treatment in Columbus, Ohio

A codeine use disorder is challenging to treat. Prolonged codeine use often leads to dependence because of the withdrawal symptoms, which increase the risk of relapse.

When choosing an addiction treatment center, consider the location, the staff’s accreditation and training, and the types of treatment offered. A good-quality treatment center will include medical detox as well as facilities that provide both inpatient and outpatient treatment options.

For those with more severe addiction, inpatient treatment helps remove outside influences that may trigger a relapse. When it comes to a less severe addiction, outpatient treatment allows someone to continue fulfilling their obligations like work and school during treatment.

Ohio Resources for Opiate Addiction

The Recovery Village Columbus is available as a treatment resource for those who live in the Columbus, Ohio area and beyond. The addiction specialists are trained to manage codeine and other substance use disorders.

View Sources

Food and Drug Administration (FDA). “Codeine Package Insert.” October 2019. Accessed December 27, 2021.

Kosten, Thomas R; George, Tony P. “The Neurobiology of Opioid Dependence: I[…]tions for Treatment.” Science & Practice Perspectives, July 2002. Accessed December 22, 2021.

National Library of Medicine. “Acetaminophen and Codeine.” MedlinePlus, December 15, 2020. Accessed December 27, 2021.

National Library of Medicine. “Codeine.” MedlinePlus, December 15, 2020. Accessed December 27, 2021.

State of Ohio Department of Health. “Drug Overdose.” Accessed December 27, 2021.

State of Ohio Board of Pharmacy. “For Prescribers – New Limits on Prescr[…]ioids for Acute Pain.” February 22, 2019. Accessed December 27, 2021.

Ohio Department of Health. “2019 Ohio Drug Overdose Data: General Findings.” November 2020. Accessed December 22, 2021.

Pathan, Hasan, et al. “Basic Opioid Pharmacology: An Update.” British Journal of Pain, February 2012. Accessed December 22, 2021.

Shah, Mansi; Huecker, Martin. “Opioid Withdrawal.” StatPearls, October 11, 2021. Accessed December 22, 2021.

Romach, M.K. et al. “Long-term codeine use is associated with depressive symptoms.” Journal of Clinical Psychopharmacology, August 1999. Accessed December 22, 2021.


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