Recreational codeine use — health effects?

Originally Published: November 13, 2009
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Dear Alice,

I like to use codeine occaisionally (once or twice a week at most) to help me relax and feel a minor high. Typically, I'll take about 90 to 150mg per session (100 to 200mg per week on average). Sometimes I take Tylenol-3's, and sometimes I extract the codeine from these pills and drink it pure. What are the potential health side-effects of this usage, both short- and long-term?


Dear Reader,

Knowing how to extract the codeine suggests you are asking this question for a fairly well informed starting point. Regardless, let's start with some basic information. Codeine is part of the family of opioid drugs, made from the opium poppy flower or produced synthetically. Opioids like codeine and morphine are most commonly prescribed for pain relief, but can also be used to induce feelings of intense pleasure, as you have likely experienced. It's important to keep in mind that opioids like codeine can be highly addictive, pose certain short-term and long-term health risks, and may also be illegal.

Short-term side effects of codeine can include nausea, vomiting, constipation, dizziness, drowsiness, blurred and poor night vision, and impaired coordination. Higher doses can lower heart rate and blood pressure, cause disorientation, convulsions, hallucinations, coma, and death. In addition, long-term use can bring on depression, difficulty concentrating and sleeping, sexual problems, severe constipation, tremors, seizures, relapse of addiction to alcohol or other drugs, and addiction codeine itself. For people who do become addicted, long term effects could include withdrawal symptoms when quitting codine or another opioid and a heightened sensitivity to pain once the drug is not in your system (this is because taking opioid drugs for an extended period inhibits the body from making natural painkillers). Another factor to consider when evaluating long-term risk is that long-term use of codeine with acetaminophen can cause kidney and liver damage. There are also possible interactions with antidepressants, cold medications, medications for mental illness, sedatives, and others.

As these lists indicate, there are certainly risks associated with the regular use of codeine, even if only once a week. Additionally, have you noticed any need to increase the amount of codeine needed to reach the desired effect? If yes, that may be an indication of tolerance (needing more of a substance to produce the sought after feelings, a development that leads to addiction for some). How about the frequency of use? Using a drug more frequently is another possible warning sign.

Are there are other ways you could try to catch some relaxation and feelings of high? Yoga, running, many other forms of exercise, and (safer) sex, are all healthy ways people rev up their natural production of endorphins to produce feelings of intense pleasure and peace, without the risks drugs that may be illegal and/or addictive. At the risk of appearing naïve, perhaps one of these activities could replace codeine as a source for the pleasure you crave?