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Cough Syrup Addiction Explained

It may seem like one of the most harmless medicines in any household cabinet and a vital accompaniment to cold winter months, but cough syrup can have a darker side. It’s responsible for many cases of substance abuse and even addiction thanks to its habit-forming ingredients.

How Codeine Works in Cough and Cold Medicines

One of the most common – and problematic – ingredients found in cough medicines is codeine, an opiate (a drug originally derived from the opium poppy). It is also an opioid (a drug acting on opioid receptors in the brain to produce morphine-like effects). Codeine acts on the central nervous system to produce an analgesic (painkilling) effect, and which also reduces the irritation in the chest and throat which prompts coughing.

Although codeine is a comparatively weak opioid, it is metabolised in the liver to produce morphine, which has a significantly stronger impact on the body. As with any opioid, codeine has a notable dependence liability (i.e., it is known to be habit-forming and to have the potential to cause dependence in the user). Nevertheless, its analgesic effects can also create a euphoric “high” in anyone consuming it in sufficiently large quantities, giving rise to its potential for recreational use and abuse.

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What Is the Difference between OTC and Prescription Cough Syrups and Cold Medicines?

The difference between over-the-counter and prescription medications is a purely legal one. Even though based on numerous factors including the strength and dependence liability of the medicine in question, this is still valid.

In the UK, medicines are divided by law into three categories: The first is prescription-only medication (POM) that is legally available only from a qualified prescribing authority (such as a GP). General sales list (GSL), able to be sold anywhere – such as in supermarkets – without prescription form the second. Pharmacy medicines (P), able to be sold without prescription, but only from registered pharmacies, and not open for self-selection make up the third category.

The term “over-the-counter” has no legal basis in the UK but effectively refers to GSL and P medications (i.e., those not requiring a prescription). Prescription medications may include products containing small amounts of codeine, including certain cough syrups. In other words, it is possible to obtain codeine in cough syrup without a prescription, though levels of the drug in such products are low compared with POMs.

Cough Syrup Addiction & Abuse Explained

There are typically two ways in which the use of cough syrup containing codeine can lead to addiction: by taking cough syrup for longer and in greater quantities than advised and by using cough syrup recreationally.

As with all opioids, codeine is essentially habit-forming: its use over time can lead to addiction and dependence. Addiction is, technically, a disorder of the brain’s reward system in which a person engaging in a certain behaviour becomes compelled to repeat that behaviour, regardless of the awareness of any negative consequences of doing so; in the case of cough syrup abuse, that behaviour is the consumption of cough syrup and the experience of its effects.

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Dependence is a primarily physiological phenomenon in which the system of someone consuming a specific substance over time becomes used to certain levels of that substance and comes to require it in order to function normally. In the case of codeine, the brain and central nervous system of a dependent individual need the presence of codeine (or other opioids) in order to perform their normal functions, and the absence of codeine will trigger abnormal functioning in the form of numerous potentially distressing and dangerous withdrawal symptoms.

Someone taking codeine-based cough syrup to treat a cough,

who ignores instructions regarding dosages and the length of time they should take the syrup, risks developing dependence to codeine after a while because of the constant presence of the substance in their system.

Anyone consuming codeine-based cough syrup recreationally for the euphoric effects created by the codeine is likely to consume much greater quantities of the syrup than recommended for normal use, and may mix it with alcoholic drinks to increase those effects. Such consumption constitutes abuse, and if this abuse is repeated regularly over a period of time dependence is likely to result.

Causes and Risk Factors of Cough Syrup Addiction

The exact causes of addiction are not yet completely understood, in terms of what makes one person susceptible to addiction while another, in very similar circumstances, may not be (though it is, of course, certain that someone who never consumes cough syrup at all will not go on to develop a cough syrup addiction). Nevertheless, certain risk factors have been identified which are known to increase significantly the likelihood that a given individual will become addicted.


Living in a situation in which cough syrup is readily available – for example, if it is always present in the home – greatly increases the chance that it will be abused.

Genetic factors

A family history of substance abuse and addiction is one of the single most prominent risk factors for any form of addiction.


Environmental risk factors for cough syrup addiction include living in a household in which substance abuse and addiction are present, in unsanitary conditions where coughs are likely to develop and consorting with a peer group in which substance abuse is commonplace.

Lack of education

Individuals who are unaware of the dangers of substance abuse and the dependence liability of codeine are much more likely to abuse codeine-based cough syrup and to go on to develop addictions.

Routes of Cough Syrup Administration

Cough syrup is intended to be swallowed as a liquid, usually in relatively small doses (as per the instructions on the packaging). People abusing cough syrup typically ignore the recommended dosages and may swig the syrup from the bottle, or mix it with other drinks (possibly alcoholic).

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Street Names for Codeine in Cough Syrup

Codeine-based cough syrup and associated substances (for example, cough syrup mixed with alcohol) are known by a range of street names, including:

  • Cody
  • Captain Cody
  • schoolboy
  • lean
  • sizzle
  • drank
  • purple drank
  • doors and fours
  • loads
  • pancakes and syrup
  • Coties
  • T-threes

Cold Medicine and Cough Syrup Addiction and Abuse Signs, Effects & Symptoms

Because of the stigma associated with substance abuse and addiction, and the shame an individual may feel if they have succumbed to the condition, it may be difficult to identify signs and symptoms of cough syrup abuse and addiction due to the addict’s attempts to conceal their situation. Nevertheless, some symptoms may manifest, which could indicate the presence of addiction. (NB: It is important to recognise that the presence of these symptoms does not automatically confirm the presence of addiction; other explanations may be valid.)

Mood symptoms

  • euphoria
  • calm
  • depression
  • anxiety
  • mood swings

Psychological symptoms

  • hallucinations
  • delusions
  • memory loss
  • lack of emotions

Behavioural symptoms

  • drowsiness
  • increase in the amount of time sleeping
  • decreased appetite
  • apathy
  • increased hospital visits
  • no longer caring for loved ones
  • “doctor shopping” (visiting several doctors to obtain more codeine prescriptions)
  • prescription forgery
  • stealing prescriptions or opiates from friends and family
  • healthcare fraud
  • lying to cover-up amount used

Physical symptoms

  • constipation
  • blue tinge to lips and fingernails
  • muscle twitches
  • dizziness
  • fainting
  • nausea and vomiting
  • dry mouth
  • itching
  • rashes
  • urinary retention
  • hypotension
  • seizure
  • respiratory depression
  • decreased libido
  • seizures

Possible effects of cough syrup abuse

  • acute pancreatitis
  • major depression
  • liver damage
  • kidney damage
  • financial problems
  • legal issues
  • domestic problems
  • job loss
  • heightened pain sensitivity
  • uncontrollable muscle twitches
  • muscle spasms, cramps, and pain
  • loss of productivity at school or work
  • impaired social relationships
  • seizures
  • incarceration
  • respiratory depression
  • bradycardia
  • cold, clammy skin
  • decreased muscle tone
  • coma

Cough Syrup Addiction Treatment

Because a cough syrup addiction is fundamentally an opioid addiction, its treatment is very similar to that of other opioid use disorders. Treatment is typically divided into two phases: detoxification and withdrawal (monitored by medical professionals, and potentially alleviated at least to some degree by medication); and therapy, aimed at revealing and addressing the fundamental psychological causes of substance abuse and addiction, and providing the patient with defence mechanisms against relapse.

Treatment may be conducted on an inpatient or outpatient basis and may be sought through the NHS or privately. High-quality treatment facilities can now be found throughout the UK, offering great expertise in the treatment of opioid addiction.

Detoxing from cough syrup

Detoxification is a fundamental aspect of addiction treatment: cleansing an individual’s system of substances of abuse is vital in order to overcome any physical dependence, as well as to prepare them properly for the therapy phase of treatment, which will be much less successful if they continue to be plagued by the physical pressures of dependence.

Because opioid detoxification typically results in withdrawal, which can be really unpleasant,

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it is always advised that detoxification should be assisted by medical professionals. Detoxification in residential rehabilitation (rehab) has the advantage of taking place away from the patient’s environment of substance abuse, so the ability to relapse is minimised (and thus the likelihood is increased that detoxification will be successful).

Cough Syrup Withdrawal

Any withdrawal from opioids can be unpleasant – though in most cases, cough syrup withdrawal is less severe than that of, say, withdrawal from long-term intravenous heroin use. Cough syrup withdrawal typically lasts between one and two weeks, with acute withdrawal peaking after two or three days and lasting up to a week. In some instances, the affected individual will go on to develop post-acute withdrawal syndrome, with symptoms lasting months or even years; specialist treatment is typically required in such cases.

Effects of cough syrup withdrawal
Some of the most common symptoms of cough syrup withdrawal include:

  • cravings for the drug
  • runny nose
  • intense sweating
  • chills
  • goosebumps
  • stomach cramps
  • nausea and vomiting
  • spasms of the muscles
  • agitation and irritability
  • psychosis
  • suicidal thoughts
  • homicidal thoughts
  • racing thoughts
  • hallucinations

Getting through withdrawal from cough syrup

Withdrawal can be tough – but if you have succumbed to a cough syrup addiction, it is, unfortunately, an inescapable part of the recovery process. Withdrawal can be made easier with pharmaceutical help – and it is always advised that you do not go through detoxification and withdrawal without medical assistance, due to the dangers associated with the condition.

Going through withdrawal in a safe environment away from the environment in which you have succumbed to substance abuse is always preferable. Speak with your GP and an addiction specialist about what treatment options may be available to you, and how to optimise your withdrawal from cough syrup addiction.

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Mental Disorders Interaction with Cough Syrup Addiction

As with other opioids, cough syrup is a comparatively common element of dual diagnosis: cases in which substance abuse disorders cooccur with other mental health disorders. Treatment in cases of dual diagnosis is typically more complex than treatment of addiction by itself, and expert care is usually required.
Some of the most common mental health issues co-occurring with cough syrup addiction include:

  • anxiety disorders
  • bipolar disorders
  • schizophrenia
  • depressive disorders
  • conduct disorders
  • antisocial personality disorders

Cough Syrup Addiction Facts, Statistics and Trends

  • In the UK, it is legal to possess codeine without prescription as long as it is compounded with at least one other ingredient, and the dosage does not exceed 100mg per tablet or a 2.5% concentration in the case of liquid preparations.
  • In 2015, the UK was responsible for 16% of the world’s codeine consumption.
  • Cough syrup has been associated with a number of high-profile deaths including those of rappers Mac Miller and Pimp C.
  • Codeine was first discovered in 1832.
  • Around the world, 249,000 kilograms of codeine were consumed in 2013, making it the most commonly consumed opiate worldwide.

Find Help for Cough Syrup Addiction

If you are suffering from a cough syrup addiction, do not risk any further damage to your health and your relationships with loved ones and other people important to you: if you’re ready to acknowledge your addiction, you’re ready to get help.

Get help today

Many people across the UK are currently receiving help with fighting a cough syrup addiction – and you could be one of them. Contact your GP and/or an addiction specialist today to discuss your situation and what treatment options may be open to you.

Take control of your life – get started on the road to recovery

You may feel that you have lost control of your life to your addiction. However, you can take back that control by seeking professional help: don’t waste another minute before calling your GP and/or an addiction specialist to take the first steps down the path back to happiness and health.

Get Confidential Help Now

Call our admissions line 24 hours a day to get help.

Related FAQ’s

What are the types of cough syrup and cold medicines?
There are numerous different types of cough syrup and cold medicines available, divided into prescription-only medications (POM), general sales list (GSM) and pharmacy medicines (P) depending on their strength, specific ingredients and other factors.
Why is cough syrup addictive?
Some cough syrup is addictive because it contains codeine, which is an opioid. Opioids are habit-forming, with a comparatively strong dependence liability – meaning that someone taking them in sufficient quantities over time will become reliant upon them to function normally, and will experience withdrawal symptoms when they stop taking them.
How does someone develop a cough syrup habit?
Anyone taking cough syrup in sufficient quantities for long enough is at risk of developing dependence and addiction. If you abuse cough syrup by taking it recreationally, and in any dosages and methods other than those given in the instructions on the packaging, you are especially likely to go on to develop an addiction.
Is cough syrup misuse something to be concerned about?
Yes: any substance abuse is something to be concerned about since it endangers your physical and mental health and your life circumstances. Opioid misuse is especially serious because of opioids‘ high dependence liability, and the prospect of fatal overdose and other dangerous complications.
What happens to your brain when you misuse cough or cold medicines?
The consumption of codeine-based cough medication can have an analgesic effect because of codeine’s action upon the central nervous system. This effect can be pleasurable, and indeed euphoric; however, codeine also has a high dependence liability, meaning that the brain and central nervous system adjust to the presence of codeine and come to rely upon it in order to function normally.
What are the signs of teen cough syrup abuse?
There are many signs which could possibly betray cough syrup abuse amongst teens; see above for relevant signs and symptoms. Please note, however, that these signs do not necessarily indicate the presence of substance abuse or addiction. Speak with an addiction specialist about how best to proceed if you believe a teen close to you is abusing cough syrup or any other substance.
How many teens misuse cough and cold medicines?
Precise statistics for teen cough medicine abuse in the UK are not available. However, it is known to involve at least tens of thousands of teens and young people.
Can you overdose or die if you use cough and cold medicines?
Yes: consumption of excessive quantities of any opioid can result in death.

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