How Long Does Codeine Stay in Your System?
Possible long-term consequences of codeine abuse include frequent oversedation, a risk of overdose, chronic constipation, sexual dysfunction, low sex drive, and disrupted menstrual cycles.
Codeine can be detected for up to 48 hours in urine, 21 hours in saliva, and 10 weeks in hair.
What Is Codeine?
Codeine is a prescription opiate analgesic medication used to treat mild to moderate pain and to suppress cough.1 In its many formulations, codeine is available in tablet and capsule forms as well as oral solutions, suspensions, and syrups. As a cough suppressant, codeine is included in various combination products, including Robitussin AC, Brontex, Cheratussin AC, Guiatuss AC, Halotussin AC, Nalex AC, Vanacof, and others.2
Codeine, in any formulation, is a controlled substance. It is listed as a Schedule II, III, and V drug by the U.S. Drug Enforcement Administration (DEA) depending on the specific type of medication and the dose of codeine contained in it. Codeine sulfate tablets are classified as Schedule II controlled substances, meaning that they have high potential for abuse and severe physiological dependence.3,4
Codeine is frequently misused for its ability to cause relaxation and euphoria at high doses. People who abuse the drug may attempt to crush, chew, snort, or inject the tablets. A common method of abuse is to combine codeine with soda (a mixture known as syrup, sizzurp, purple drank, barre, or lean) and sometimes hard candies or cannabis as well. Some users mix codeine syrup with alcohol.1,3
How Long Does Codeine Remain in the System?
The estimated detection times for codeine are as follows:
- For most, people codeine can be detected in their urine for up to 48 hours after their last use of the drug. However, it may be detectable for up to 1 week in chronic users.5,6
- It can be detected in saliva for 21 hours after last use.6
- It can be detected for up to 10 weeks in hair follicle tests.7
How Many People Abuse Codeine?
According to data from the Substance Abuse and Mental Health Services Administration (SAMHSA), about 2.8 million people misused codeine in 2017, up from 2.7 million in 2016. About 26.8 million people used codeine in 2017, up from 26.5 million in 2016.8
In addition to the type of drug test being used, the detectability of codeine in anyone’s system can depend on:5,9
- Metabolism, which can be affected by age, gender, or ethnicity.
- Urine pH levels.
- Urine concentration, which can be affected by fluid intake.
- Kidney or liver dysfunction.
- How much codeine the person took prior to the test, and when they took it in relation to the testing.
- How long the person has been using codeine.
How Is Codeine Broken Down in the Body?
Codeine is metabolized by the liver, which results in the production of metabolites. About 50-70% of codeine is converted to codeine-6-glucuronide, about 10-15% is converted to norcodeine, and as much as 15% is converted to morphine. With the exception of morphine, these metabolites are inactive, meaning they do not produce any drug effects of their own.10,11
Many urine tests are able to detect not only codeine, but its metabolites as well.
Codeine and its metabolites are excreted in the urine. Some sources indicate that hydrocodone may also be a minor metabolite of codeine which, when present, can be excreted in the urine at concentrations as high as 11% that of the excreted codeine.10,11
Many urine tests are able to detect not only codeine, but its metabolites as well. Different tests can detect codeine, morphine, and norcodeine, as well as hydrocodone.5
Codeine’s half-life is between 2.5 to 3 hours.11 Half-life is the amount of time it takes for half of a dose of codeine to be eliminated from a person’s system.
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Risks of Abuse
Repeated abuse of codeine can lead to addiction, which is a chronic, relapsing condition in which a person continues to use codeine despite harmful effects on their personal life and health.1
Long-term effects of codeine abuse include:12
- Chronic constipation.
- Low sex drive.
- Irregular menstruation.
- Muscle tension and twitches.
- Tolerance, in which the person needs to use more of the drug to get the same effect.
- Physical dependence.
- Withdrawal symptoms when the person stops using, which can include cravings, abdominal cramps, runny nose, aching muscles and joints, fever, chills, sweating, restlessness, irritability, and depression.
Codeine abuse can also lead to overdose, and this risk is increased by combining it with alcohol, sedatives, or other opioid substances. Overdoses can be fatal due to the drug’s effects on the central nervous system, which can lead to respiratory arrest and cardiovascular dysfunction.1
Potential signs and symptoms of an overdose include:3
- Constricted pupils.
- Extreme drowsiness.
- Limpness in arms and legs.
- Cold and clammy skin.
- Cyanosis (bluish skin).
- Severe respiratory depression.
- Respiratory arrest.
- Low blood pressure.
- Slowed pulse rate.
- Cardiac arrest.
An overdose requires prompt medical attention. Call 911 immediately if you observe these signs in someone who has been using codeine.
Someone who has become addicted to codeine will usually need some form of professional treatment to recover. It can be very difficult to quit using on your own.
For people who have been abusing codeine for a long time, a supervised medical detox is recommended. The person can receive medications to ease withdrawal symptoms, manage cravings, and receive medical care if any complications arise.
After detox, it is recommended that people continue their recovery work with the help of a rehab program. Many substance rehabilitation programs use a combination of treatment medications and behavioral therapies, and provide individual and group therapy sessions to help those in recovery work through the reasons that led to and were supporting their continued misuse of codeine or other substances.
. National Institute on Drug Abuse. (2014). Cough and Cold Medicine Abuse.
. U.S. National of Library Medicine, Medline. (2018). Codeine.
. Food and Drug Administration. (2009). Codeine sulfate tablets for oral use.
. U.S. Drug Enforcement Administration. Drug Scheduling.
. Moeller, K., Kissack, J., Atayee, R., and Lee, K. (2017). Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens. Mayo Clinic Proceedings.
. Verstraete, A. (2004). Detection Times of Drugs of Abuse in Blood, Urine, and Oral Fluid. Therapeutic Drug Monitoring, 26(2).
. Rollins, D., Wilkins, D., and Krueger, C. (1996). Codeine disposition in human hair after single and multiple doses. European Journal of Clinical Pharmacology, 50(5), 391-397.
. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables.
. HealthPartners Institute For Medical Education. (2018). Interpretation of Opiate Urine Drug Screens.
. Thorn, C., Klein, T., and Altman, R. (2009). Codeine and Morphine Pathway, Pharmacokinetics. Pharmacogenetics and Genomics.
. ScienceDirect. Codeine.
. Alcohol and Drug Foundation. Codeine.