Can I get addicted to a prescribed dose of codeine?

Understand the risks of codeine misuse and addiction potential. Learn about safe usage, side effects, and how to reduce the risk of dependency.

Ophelia team
Prescription codeine
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Fact checked by
Ashley Mazei, NP

Codeine is a naturally occurring opioid that was originally derived from the sap of the poppy, and it’s been used in medicine throughout human history. Because its effects are less potent than other opioids, such as morphine, it’s long been used to treat minor conditions. In fact, its most common use today is as an antitussive (cough suppressant). Codeine is currently listed as a Schedule III drug by the United States government when used alone, but combination drugs with lower concentrations of the opioid are less restricted.

Due to codeine’s prevalence in both prescription and some behind-the-counter medications, codeine abuse is surprisingly common. In fact, studies suggest that millions of people abuse codeine each year in the U.S. But is codeine addictive? And how should it be used? This guide covers all you need to know about codeine, from safe usage to addiction potential and more. 

What you should know about prescription codeine

When used as directed and prescribed, codeine is largely safe to use and presents few risks. It is most commonly used to treat moderate pain in adults, particularly pain that hasn’t been manageable with non-opioid drugs. When prescribed for this purpose, codeine is most likely to come in pill form in doses of 15, 30, or 60 milligrams. It should only be taken as instructed, which is orally no more than once every four hours, up to a maximum of 360 milligrams in a 24-hour period. 

Codeine may also be mixed with other drugs, such as acetaminophen. When mixed with acetaminophen, the resulting drug is known as Tylenol® #3 and is typically prescribed for moderate pain. It was previously common to use this formulation to treat coughs, but this practice is largely frowned upon now. Dosage for Tylenol #3 is similar to that of pure codeine, but each pill also includes 300 mg of acetaminophen. Neither drug is recommended for children under 12 years old.

Side effects of codeine use

Codeine’s side effects are similar to those of other opioids, though often (but not always) less severe. Side effects include drowsiness, dizziness and/or lightheadedness, constipation, nausea and vomiting, dry mouth, sweating, and shortness of breath. You should contact a medical professional immediately if you experience an allergic reaction, abdominal pain, or severe sedation. 

Is codeine addictive?

Addiction potential

As an opioid, codeine has a relatively high potential for addiction. Addiction may even occur when the drug is used as prescribed and under medical supervision. This is true even for drugs with low codeine concentrations, such as cough medicines. However, it’s important to draw a medical distinction between addiction and physical dependence. Developing a physical dependence on codeine during treatment is fairly common, especially during long-term regimens, but it isn’t necessarily a sign of addiction.

Physical dependence occurs when the body comes to rely on the presence of a drug to carry out routine functions efficiently. Essentially, your body gets used to a substance being in the system and incorporates it into the body’s daily functioning. After developing a physical dependence, it’s crucial to discontinue use slowly and with medical supervision. Abruptly stopping codeine use while physically dependent can lead to uncomfortable and potentially dangerous withdrawal symptoms

On the other side of the coin is addiction, which is characterized as a disorder with both psychological and behavioral components in addition to physiological dependence. Addiction is associated with a loss of control when it comes to use, continued use in the face of clearly harmful consequences, changes in personality, and other destructive behaviors. Not everyone who develops a physical dependence also develops a codeine abuse habit, but it’s still important to communicate with your medical care team if you experience dependence.

Codeine addiction symptoms

If you’re worried that you or a loved one may be at risk of codeine misuse, there are a number of codeine addiction symptoms that you’ll want to keep an eye out for. While it’s sometimes hard to detect, a common early symptom is continued codeine use after the typical treatment window or in higher concentrations than what was prescribed.

An individual may also develop codeine cravings or struggle to wind down usage during the early stages of addiction. Eventually, it becomes common to expend more effort to obtain the drug, experience social consequences in favor of continued use, and begin using in dangerous, risky, or unnecessary situations. If you notice these symptoms, seek help for codeine addiction.  

How to reduce the risk of codeine misuse

While prescription addiction is always a risk with opioids, there are fortunately ways to reduce the likelihood that an addiction will occur. Many of these methods start at the level of the healthcare provider, who should always screen patients for the risk factors of prescription opioid misuse. These risk factors include:

  • Past or current substance misuse issues
  • Family history of substance misuse
  • Poverty
  • Unemployment
  • Stressful work or private life
  • History of anxiety, depression, or other untreated mental illness

In cases where these risks exist, it’s a medical professional’s responsibility to explore other treatment options before prescribing opioids.

Codeine should be prescribed at the lowest possible dose at the beginning of treatment, as this can reduce the risk of physical dependence and consequent addiction. People under the age of 18 and over the age of 65 may also be at increased risk and should be prescribed opioids only when strictly necessary.

It’s also possible that a patient will develop a tolerance to their dosage of codeine throughout the course of treatment. Increasing the dose in response to increased tolerance can lead to the patient needing ever higher doses, which increases the risk of physical dependence and/or addiction. Increased doses should be avoided whenever possible, and your doctor should look to alternative treatment methods.

Personalized care for opioid use disorder

Dealing with opioid misuse can feel isolating, but it doesn’t have to be that way. Ophelia provides dedicated care teams who understand your needs, whether it’s getting a prescription for Suboxone® from your local pharmacy or scheduling telehealth appointments around work, school, or family obligations (important safety information). Our number-one goal is to create a comprehensive treatment plan that makes sense for your life. Find out if becoming an Ophelia patient is right for you.


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