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Medically Reviewed by Dr. Mohammed Saeed, MD.

Have you or someone you know been prescribed codeine? Doctors typically prescribe the opioid to manage mild to moderate pain, coughs, and diarrhea. Codeine is also an effective way to reduce pain and discomfort, especially after surgery or injury. Even though codeine can be an effective pain reliever, there are physical and psychological risks associated with long-term use.

Where Does Codeine Come From & How Does It Work?

Codeine, like most opioid medications, comes from the opium poppy plant. When ingested, codeine binds to specific proteins in the brain and spinal, reducing the transmission of pain signals from the nerves to the brain. This binding results in pain relief.

Codeine also helps reduce the cough by binding to opioid receptors in the brainstem, the part of the brain that houses the cough reflex. When this happens, neural activity that triggers the cough reflex diminishes, resulting in less frequent and intense coughing.

Physical Long-Term Effects Of Codeine

Even though codeine can help relieve pain and ease coughing, the medication can have adverse long-term effects. Some of the most commonly experienced long-term physical effects of codeine include:

  • Tolerance: With regular use of codeine, your body may become less responsive to the medication’s effects, leading to a need for higher doses to achieve the same level of pain relief or cough suppression.
  • Dependence: Long-term use of codeine can lead to physical dependence, which means your body requires the medication to function normally. Dependence can cause withdrawal symptoms such as nausea, vomiting, sweating, and anxiety if you stop taking the medication suddenly.
  • Respiratory depression: Codeine can slow or stop breathing, especially when taken in high doses or with other medications that depress the central nervous system. Respiratory depression can be life-threatening, especially in people with respiratory conditions such as asthma or COPD.
  • Cognitive impairment: Chronic codeine use can also lead to impaired cognitive function, such as decreased attention span, memory problems, and difficulty with decision-making. This can interfere with daily activities, such as work or school, and may require treatment to address.
  • Gastrointestinal issues. Long-term use of codeine can also lead to gastrointestinal issues, such as constipation, nausea, vomiting, and abdominal pain. These symptoms can be severe and may require medical intervention. Additionally, chronic constipation can lead to other complications, such as hemorrhoids, anal fissures, and bowel obstruction.
  • Addiction. Finally, long-term codeine use can lead to addiction, which is a chronic and often relapsing condition characterized by compulsive drug-seeking behavior and continued use despite negative consequences. Addiction can have severe physical, psychological, and social consequences and often requires professional treatment to overcome.

Psychological Long-Term Effects

Long-term codeine use can also trigger psychological problems. Some of the most common psychological adverse effects of long-term codeine use include:

  • Insomnia. Codeine is a central nervous system (CNS) depressant, meaning that it can slow down brain activity and cause drowsiness. While codeine can help people fall asleep initially, chronic use can disrupt normal sleep patterns, leading to insomnia and other sleep disturbances.
  • Moodiness. Chronic codeine use has been shown to impair cognitive function, which can lead to frustration and difficulty managing emotions, which can contribute to moodiness.
  • Depression. Chronic use of codeine can lead to changes in the brain’s chemistry, specifically affecting the levels of neurotransmitters such as dopamine, which plays a crucial role in regulating mood and motivation. At first, codeine use increases the release of dopamine, causing a temporary sense of euphoria, pleasure, and motivation. However, over time, the brain adapts to this increased dopamine release and becomes less sensitive to it, leading to a decrease in motivation and pleasure.
  • Anxiety. Chronic codeine use can lead to changes in the brain’s stress response system, leading to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, a complex system that regulates the body’s response to stress. This dysregulation makes it harder for people to regulate their emotions and cope with stressful situations, which can trigger anxiety. Prolonged codeine use can also increase the amount of cortisol in the body, leading to symptoms such as racing thoughts, rapid heartbeat, and sweating, which are characteristic of anxiety.
  • Irritability. Long-term use of codeine can change the way the brain releases certain chemicals, called neurotransmitters, including dopamine. Dopamine is a chemical that affects mood and motivation. When codeine alters the release of dopamine, it can lead to a decrease in the ability to feel pleasure from activities that were once enjoyable, which is called anhedonia. This can cause feelings of frustration, irritability, and depression.

Break Free Of Codeine Today

While codeine can be an effective pain reliever, long-term use can lead to physical and psychological effects that can have severe consequences. If you or a loved one are struggling with codeine use, we can help. Contact us today if you or someone you love is ready to break free of long-term codeine use today.


Dr. Mohammed Saeed, MD.

Dr. Saeed is a psychiatry specialist with over 40 years of experience in the medical field. He received training in General Psychiatry at the University of Texas Medical Branch, where he was selected as the Medical Director of the Division of Child and Adolescent Psychiatry. He currently serves as the medical director at Into Action Recovery Centers. Full Bio

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