What to know about codeine withdrawal

Written by Lindsay Slowiczek, PharmD

Codeine is a drug that doctors may prescribe for pain, coughing, and sleeplessness. Short term use under the close supervision of a doctor is generally safe. However, codeine can cause addiction.

Codeine belongs to a class of drugs called opioids, which are a leading cause of drug addiction and overdose.

People who become addicted to codeine or use the drug for long periods may experience withdrawal when they stop taking it. Although withdrawal can be unpleasant, it is not usually dangerous. For most people, the most intense withdrawal symptoms ease within a few days.

In this article, we discuss the symptoms of codeine withdrawal and their expected duration. We also outline the causes of codeine withdrawal and the various treatments available.

Symptoms

Withdrawal symptoms may be both psychological and physical. Some of the most common symptoms include:

• an intense and overwhelming desire to use the drug, which may get worse over hours or days
• a distorted sense of reality, such as believing that codeine is the only thing making life worthwhile
• negative emotions, such as depression, anger, or irritability
• anxiety and restlessness
• shedding tears
• difficulty concentrating
• dilated pupils
• headaches
• sinus congestion and sneezing
• digestive problems, such as diarrhea, bloating, and constipation
• stomach pain and nausea
• chills or hot flashes
• intense muscle aches
• bone and joint aches and pains
• tremors and shaking
• trouble sleeping

For many people, withdrawal symptoms are similar to those of a more severe bout of flu. A person experiencing withdrawal may not be able to work or go to school for several days.

The type and intensity of opioid withdrawal symptoms depend on several factors, including:

• Overall health: People with chronic health issues may find that those issues get worse during withdrawal.
• Addiction to benzodiazepines: Research suggests that codeine withdrawal may be worse in people who are also addicted to this class of anti-anxiety drugs.
• Pregnancy: Women who are pregnant and going through codeine withdrawal may experience more intense symptoms. Withdrawal may also increase the risk of miscarriage or stillbirth. Pregnant women should see a doctor before coming off codeine. In many cases, a doctor may recommend medically supervised withdrawal or the use of a drug such as methadone.

Timeline

Withdrawal symptoms usually begin shortly after a person misses their next usual dose of a drug. For example, a person who takes codeine every 6 hours may begin noticing withdrawal symptoms after 6 or 7 hours without the drug.

The duration of codeine withdrawal varies from person to person. Physical withdrawal symptoms, such as muscle aches and tremors, typically get worse over a few days, then quickly improve. Psychological withdrawal symptoms, such as cravings or an intense desire to use, may last several weeks.

Some people feel so overwhelmed by the withdrawal that they decide to treat their symptoms with a small dose of codeine. However, taking codeine resets the withdrawal period, causing symptoms to last longer or become more severe.

Causes

Frequent use of codeine causes the body to become chemically dependent on the drug. Over time, the body begins treating codeine as important for normal functioning. Quitting the drug disrupts the normal functioning of the body, causing a wide range of symptoms.

Factors that increase the risk of intense codeine withdrawal include taking high dosages of codeine for longer than 6 months and using codeine with other drugs, especially benzodiazepines such as alprazolam (Xanax) and diazepam (Valium).

Treatments

Not everyone who experiences codeine withdrawal will require treatment. However, people should see a doctor if they experience severe withdrawal symptoms or require longer term treatments for addiction.

Treatments for severe withdrawal

In some cases, a doctor may prescribe drugs to ease severe withdrawal symptoms.

One such drug is buprenorphine (Subutex), which is a partial opioid agonist (POA). POAs stimulate the same receptors as other opioids, such as codeine, but to a much lesser extent. As a result, these drugs can ease opioid withdrawal symptoms without increasing a person’s dependence on opioids.

In severe cases of drug dependency and withdrawal, a doctor may prescribe methadone, which is an opioid agonist. Methadone stimulates the opioid receptors to a higher degree than POAs, so it is particularly effective in weaning a person off codeine and other opioids.

However, methadone itself can be addictive. A person should talk to their doctor about the risks and benefits of using methadone to ease codeine withdrawal.

Treatments for specific withdrawal symptoms

Doctors may also recommend medications to treat specific symptoms. These medications may include:

• pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to help with muscle or joint pain
• antidiarrheal medicines to help with stomach pain and digestive problems
• antinausea medication to ease vomiting and prevent dehydration

People who become severely dehydrated may need intravenous (IV) fluids. A doctor may also recommend that the person undergoes supervised withdrawal in a hospital or addiction center.

Longer term treatments

Addiction is a complex illness, and treating withdrawal is only one aspect of addiction treatment. Other important aspects of addiction treatment include:

• supporting the person to resist cravings
• helping the person understand the reason why they became addicted
• treating any underlying conditions, such as pain or depression

Longer term treatments for drug addiction include:

• lifestyle changes, such as replacing addictions with more healthful pursuits
• support groups
• therapy
• treatment for chronic pain, such as physical therapy, surgery, or exercise
• medications to help improve mental well-being

When and how to seek help

A person should seek help for codeine addiction if they are taking the drug:

• at higher dosages than the doctor recommended
• for longer than the doctor recommended
• without a prescription

Some people can wean themselves off codeine. However, it is helpful to talk to a doctor before quitting the drug. A doctor can offer treatment options that will ease withdrawal symptoms.

Certain people should not quit taking codeine without medical assistance. These people include those who:

• are pregnant
• have another addiction
• have a co-occurring mental health condition
• have a history of severe health problems during withdrawal
• have serious chronic health issues, such as cancer or cardiovascular disease

Summary

Codeine addiction is a serious health issue that can cause lasting harm. The longer a person uses codeine, the harder it becomes to quit. Therefore, the best time for a person with a codeine addiction to quit the drug is right away.

The symptoms of codeine withdrawal can be intense. However, the worst symptoms usually pass within a few days. A doctor who is knowledgeable about addiction can offer options for minimizing the symptoms of withdrawal while quitting codeine.

Some of the psychological symptoms of codeine withdrawal can last several weeks. However, with ongoing care and support, a person can overcome these symptoms.

SOURCE: MEDICAL NEWS TODAY