Codeine is an opiate that is used to treat mild to moderate pain, as well as to relieve cough and as a treatment for diarrhea. Codeine, along with morphine, is one of the naturally occurring opiates that are used as narcotic pain medicines.
Codeine is found in opium in very small concentrations, in the range of 0.7% - 2.5% by weight. Because of the small concentration found in nature, most codeine found in pharmaceutical products today is synthetically produced from morphine.
Codeine is the most widely used opiate in the world, and is one of the most widely used painkillers. Codeine is available by prescription only in most areas of the US. Exceptions are seen in some states where codeine can be purchased over-the-counter (OTC) in products containing a small dose of codeine. Also in Canada, some codeine containing products are available OTC in most if not all provinces.
Codeine is abused in both pill form, and with the anti-nausea medication promethazine in the form of a syrup. The syrup is popular in the hip hop community in the southern United States. Many of the pill preparations containing codeine include the painkiller acetaminophen as well. To avoid taking dangerous doses of acetaminophen, abusers will crush the pills and use a cold water extraction process to separate the codeine from the undesired acetaminophen.
Tylenol No. 1, 2, 3, and 4; Paracod, Paramol, Panadeine, Nurofen Plus
T-three's(Tylenol #3 w/ codeine), cough syrup, sizzurp/purple/lean/drank (codeine cough syrup w/ promethazine)
Sold under many name brand products, the most popular being the Tylenol with Codeine series, the number on the tablet corresponds to the amount of codeine and caffeine found in the each tablet.
- Tylenol #1 w/ codeine - 300 mg acetaminophen, 8 mg codeine, 15 mg caffeine
- Tylenol #2 w/ codeine - 300 mg acetaminophen, 15 mg codeine, 15 mg caffeine
- Tylenol #3 w/ codeine - 300 mg acetaminophen, 30 mg codeine, 30 mg caffeine
- Tylenol #4 w/ codeine - 300 mg acetaminophen, 60 mg codeine, no caffeine
- Nurofen Plus - 12.8 mg codeine, 200mg ibuprofen
- symptomatic relief of mild to moderate pain;
- relief of certain types of difficult or labored breathing;
- suppression of severe cough (rarely);
- suppression of severe diarrhea (e.g., that produced by cholera or IBS).
Route of Administration
oral, rectal, subcutaneous (SC), intramuscular (IM)
- Pain relief : 30mg - 220mg oral or equivalent dose SC or IM
- Diarrhea relief : 10mg - 20mg orally
- Cough suppressant : 5mg - 15mg orally
- As a single product codeine is a schedule II controlled substance in the US.
- When combined with other non-controlled substance, and depending on amount per dose unit, codeine combined
- products range from schedule III to V.
- Canada has OTC codeine products available if product has no more than 8 mg of codeine per unit dose.
- Some US areas may have codeine preps available OTC, but usually require signing of a release form.
- Schumacher MA, Basbaum AI, Way WL, Opioid Analgesics & Antagonists (Chapter 31) in: Basic and Clinical Pharmacology. 12e. Katzung BG, Masters SB, Trevor AJ (Editors). McGraw-Hill / Lange, 2012.
- Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. United States Department of Veterans Affairs / Department of Defense, May 2010. [PDF]
- Controlled Substances - Alphabetical Order. DEA Office of Diversion Control, May 2013. [PDF]
- Controlled Drugs and Substances Act. Minister of Justice, Canada, Nov 2012. [PDF]