Codeine Withdrawal And Detox

What Is Codeine Withdrawal?

Codeine is a highly addictive prescription opioid used as a pain reliever and cough suppressant. Like all opioids, codeine has a high potential for tolerance, dependence, and addiction, especially when misused or abused.

Codeine withdrawal is one of the most powerful factors driving both dependence and addiction. Codeine (and other opioids) directly impact the brain’s neural circuits and chemistry because they bind to the opioid mu receptor and control the release of noradrenaline and dopamine. These important neurotransmitters play a role in mood, pleasure, arousal, blood pressure, and breathing.

The locus coeruleus (LC) and the mesolimbic reward system are the primary areas in the brain that are responsible for codeine dependence and withdrawal. When a person continues to use codeine, the amount of dopamine and noradrenaline is altered in these specific brain areas, and the body becomes accustomed to these changes, clinically referred to as dependence.

Instead of relying on natural signals and a balanced release of neurotransmitters, codeine is the primary driver of their release. Therefore, when codeine is abruptly stopped or cut down, the brain goes into disarray. The person experiences withdrawal symptoms, which are often unpleasant or even painful, and can drive the person to continue to use codeine to avoid experiencing them.

Codeine withdrawal symptoms will vary by person, as will the severity and duration of the withdrawal process. The timeline and severity of an individual’s withdrawal process can be affected by:

• The length of time they used codeine
• The average dose of codeine they regularly took
• How frequently they used codeine
• Whether they combined codeine with alcohol or other drugs
• Their mental health
• Their medical history
• Their gender
• Their body weight
• How they took codeine

How Is Tolerance Different From Dependence?

Although they both result from the body’s physiological adaptation to repeated substance use, tolerance and dependence are not the same. Tolerance develops before dependence and occurs when a person needs more codeine to feel the desired effects.

A tolerance to codeine can develop as early as a couple of weeks when used regularly, and it is not always associated with misuse or abuse, as it can happen to anyone, even if they are taking their prescription as directed.

A dependence means your body has come to rely on the substance to function, causing you to experience uncomfortable withdrawal symptoms when you try to quit.

Symptoms Of Codeine Withdrawal

In general, codeine withdrawal symptoms mirror other opioid withdrawal symptoms, but are often described as less intense than stronger opioids, such as heroin or morphine, because codeine is considered a low-potency opioid. Its potency is approximately one-tenth that of morphine.

Codeine withdrawal can be quite uncomfortable, producing symptoms that are usually moderate to severe. As a result, people will often use codeine to avoid or minimize these withdrawal effects.

Common symptoms of codeine withdrawal include:

• Headaches
• Insomnia
• Muscle aches
• Fever
• Nausea
• Vomiting
• Sweating
• Stomach pains
• Diarrhea
• Dehydration
• Depression
• Cravings

While codeine withdrawal symptoms are not typically life-threatening, there’s always a chance that symptoms will get worse. For example, if not treated properly, dehydration can lead to dangerous and sometimes fatal health complications.

Additionally, a person is at high risk of overdose during the abstinence phase when they are experiencing withdrawal symptoms because their tolerance to codeine is now reduced. Taking the same dose that was once previously tolerated could cause an overdose in the event of a relapse.

Seeking treatment in a medical detox program is highly recommended to avoid relapse and complications from codeine withdrawal.

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How To Detox From Codeine

Abruptly quitting codeine “cold turkey” typically produces very intense withdrawal symptoms, including extreme cravings, diarrhea, nausea, vomiting, body aches, pain, and insomnia. If a person has been taking codeine for a long time, then it is best to establish a detox regimen with a healthcare professional who has experience with addiction and pain management.

A codeine taper or medication-assisted treatment (MAT) can be used to help detox from codeine and minimize uncomfortable withdrawal symptoms, as well as reduce the risk of relapse. Medical detox for codeine (and all opioids) generally involves using an FDA-approved medication that is prescribed to treat opioid use disorder and works to reduce withdrawal symptoms and minimize urges and cravings, therefore decreasing the risk of relapse and increasing the overall rate of recovery.

It is important to note that medical detox is the first step before entering a formalized addiction treatment program. Because it is possible to have a codeine dependency and be at risk of withdrawal but not have a codeine addiction, some people may only need detox, while others who have an addiction will need subsequent treatment in an opioid addiction treatment program.

The FDA-approved medications for codeine dependency include:

• Buprenorphine
• Methadone
• Lofexidine

Buprenorphine (brand names include Suboxone and Sublocade) is a partial opioid agonist, and methadone is a full opioid agonist, meaning they mimic some effects of opioids but with a lower risk of overdose. Because they work on the same opioid receptors as codeine, they can be given during the detox period to ease withdrawal side effects.

Codeine is a short-acting opioid with a relatively short half-life, meaning it leaves the body quickly, and therefore withdrawal symptoms will appear quicker. Buprenorphine and methadone are both long-acting opioids, with longer half-lives, meaning they stay in the body much longer than codeine. Using a long-acting opioid substitute, such as methadone or buprenorphine, will ease rapidly appearing codeine withdrawal symptoms because not only do they act on the same opioid receptors as codeine, but they stay in the body longer. Additionally, gradually decreasing the dosage of both of these long-acting opioids over time makes for a safe and comfortable detox process.

Lofexidine is an alpha-2 adrenergic agonist, suppressing the effects of norepinephrine, which helps to alleviate many of the physical symptoms of withdrawal, like sweating, anxiety, and cramps. It is very similar to clonidine but has fewer side effects. Clonidine is not FDA-approved for opioid withdrawal; however, it is used off-label to help treat symptoms of codeine withdrawal.

It is important to note that for people choosing medically supervised withdrawal from codeine, studies have shown that methadone and buprenorphine are still the most effective. In some cases, under medical supervision, lofexidine can be combined with methadone or buprenorphine, with extreme caution due to potential serious cardiac side effects.

Should I Taper Off Codeine?

A codeine taper is another safe and effective way to detox from codeine and is often completed under medical supervision. Tapering off codeine involves slowly reducing the codeine dosage each week. The person will gradually adapt to having less codeine in their system, so the withdrawal symptoms are much less severe. This method is usually recommended over quitting cold turkey and should be monitored by a physician. The recommendation is to reduce the dosage by no more than 10% each week.

Experts advise caution when tapering codeine and other opioids too quickly, as withdrawal symptoms can appear if the taper is reduced too fast.

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Is It Safe To Detox At Home For Codeine?

Detoxing at home is not recommended because codeine withdrawal symptoms can be very painful. It is recommended to detox from codeine under medical supervision, either using a codeine taper or medication-assisted treatment; however, this can be done at home under the careful instructions of a physician.

Detoxing from codeine does not necessarily mean the person has to enter into an inpatient medical setting, but often detox can be done on an outpatient basis if the patient is a good candidate. The medical team will determine whether or not a home environment is the best setting for a codeine detox, depending on factors such as:

• The presence of a medical condition
• The extent of codeine use and dependency
• Any signs of addiction
• Polysubstance abuse
• The person’s support structure
• The person’s likelihood of maintaining medical appointments

How To Find A Detox Center For Codeine

Detox is the first step in overcoming and treating a codeine addiction. Many inpatient rehabs and outpatient treatment programs offer medical detox services for codeine users. For more information on treatment options, please visit our rehab directory or contact a treatment provider today.