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A Comprehensive Guide to Promethazine/Codeine Syrup Abuse and Addiction

Whether most people know it or not, promethazine/codeine syrup abuse and addiction have become serious problems in the United States today.

While not nearly as notorious as other potent opioids like OxyContin, Vicodin, Percocet, or Fentanyl, codeine cough syrups can be quite addictive on their own. And when you combine its potential for abuse with the unassuming exterior of a simple cough syrup, this drug can actually be more dangerous because it’s often so under the radar of most people.

That’s why it’s so important to understand as much as possible about promethazine/codeine syrups. What are they for? Where do they come from? Why are they abused? How addictive are they? And when is it time to start seeking help?

We’ll take a look at all of these questions and more in this comprehensive guide to promethazine/codeine syrup abuse and addiction.

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What Are Promethazine and Codeine?

Promethazine/codeine syrups are primarily used to relieve coughing, ease allergy signs, and also ease some of the symptoms associated with the common cold. It is a prescription medication and requires the approval of a doctor to use.

What is Codeine?

It goes by a couple of different brand names. In the United States, some of the most common brand names according to MedlinePlus are:

  • Pentazine VC
  • Pentazine with Codeine
  • Phenergan VC with Codeine
  • Phenergan with Codeine
  • Prometh with Codeine
  • Codeine Phosphate-Promethazine HCl
  • Promethazine with Codeine
  • Promethazine HCl and Codeine Phosphate
  • Promethazine HCl with Codeine

It also goes by a number of different names around the world as well. The most notable is Cofcodyl.

To better understand how promethazine/codeine syrups work, it helps to break down the individual ingredients one at a time.

Promethazine is an antihistamine used to treat the symptoms of allergies. Coughing, runny nose, itchy skin, and watery eyes are just some of the physical symptoms of allergies. It’s also a sedative and a mild antipsychotic.

When used alone or with drugs other than codeine, it can be used to treat a wide range of conditions. According to MedlinePlus, these include:

  • Sedating patients before or after surgery, during labor, or at other times
  • Preventing and controlling nausea and vomiting after surgery
  • Relieving pain after surgery
  • Preventing and treating motion sickness
  • Treating anaphylaxis (sudden, severe allergic reactions)

It’s also worth noting that promethazine belongs to a class of drugs known as phenothiazines. These medications are used to treat serious mental and emotional disorders as well as physical problems (as with promethazine).

However, these drugs are generally non-addictive. In fact, they may even be used to treat patients with a history of substance abuse specifically because of this fact.

As a result, promethazine abuse and addiction are largely due to its combination with addictive opioids like codeine, not because it is habit-forming itself.

That being said, promethazine’s sedative effects can end up intensifying other drugs. When used with codeine, then, it can make the addictive opioid more powerful than it already is.  

Some of the most popular promethazine brands include:

  • Phenergan
  • Promethegan
  • Remsed

Another main component in these syrups, codeine is a type of narcotic analgesic – an opioid-based pain-reliever. It’s also a common compound found in prescription-strength cough suppressants as with promethazine/codeine syrup.

Codeine is one of three compounds naturally derived from the opium poppy. The other two are morphine (which is used in synthesizing heroin) and thebaine (which is used in making oxycodone, naltrexone, and buprenorphine).

Codeine itself is actually the basic component used in creating a variety of other medications as well. The most notable is hydrocodone, the active opioid found in drugs like Hycodan, Lorcet, and Vicodin.

Along with other prescription opioids, these medications have been a driving force in the spread and worsening of the deadly opioid epidemic.

In general, codeine is considered to be much less powerful (and less addictive) than these other medications. However, as an opioid itself, it can create feelings of pain relief, sedation, and euphoria when it’s used improperly.

And that means that it can become the source of a crippling addiction, not just an abuse problem.

Given the addictive potential of this drug, most healthcare providers tend to use codeine and other opioids only when there are no other equally powerful alternatives. Doctors will usually only use codeine and codeine-containing medications in the short term to reduce the risk of addiction as well.

In fact, as many as one in four patients receiving long-term opioid therapy will end up struggling with opioid addiction. And following good prescribing practices is the easiest way to cut down on accidental addiction and overdose.

Compared to other opioids like heroin and oxycodone, however, codeine isn’t quite as addictive. However, one aspect that makes it just as dangerous is the fact that medications containing codeine don’t carry the same heavy stigma that other drugs do. As a result, some people may end up

In most cases, codeine will be prescribed as either an oral tablet or more commonly in a liquid solution like cough syrup.

Pills come in 15 mg, 30 mg, and 60 mg doses and the liquid form comes as 15 mg/mL, 30 mg/mL, 60 mg/mL.

Initial doses usually start out at 15 to 60 mg every 4 hours, and maximum doses are typically around 360 mg in 24 hours.

Some of the most popular codeine brands include:

  • Brontex
  • Guiatuss AC
  • Nalex AC
  • Robitussin AC
  • Vanacof
  • Tuzistra XR

This drug combination can come with a variety of both mental and physical side effects. According to RXList.com, the ones below are common among people taking this drug appropriately.

  • Nausea, vomiting
  • Confusion, drowsiness
  • Fast heartbeats, feeling restless
  • Urination problems
  • Dry mouth, nose, or throat
  • Trouble breathing

Other side effects can end up being more serious, and patients experiencing these side effects of promethazine codeine use should contact their doctor immediately.

  • Noisy breathing, sighing, shallow breathing
  • A slow heart rate or weak pulse
  • A light-headed feeling, like you might pass out
  • Confusion, agitation, hallucinations, unusual thoughts or behavior
  • Seizure (convulsions)
  • Little or no urination
  • Severe constipation, stomach pain
  • Jaundice (yellowing of the skin or eyes)
  • Increased blood pressure--severe headache, blurred vision, pounding in your neck or ears, anxiety, nosebleed
  • Severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out

It’s also worth repeating that these symptoms may occur with normal use of promethazine and codeine syrup. When this drug is abused either by taking higher doses or combining it with other drugs, these side effects can become worse, and new ones may also develop as well.

What Is Promethazine & Codeine Abuse?

Given the fact that this combination drug is technically legal when accompanied by a legitimate prescription, many people don’t think of promethazine codeine syrup as a substance of abuse. How can a drug be dangerous if it came from a doctor anyway?

Codeine Addiction

But the truth is that prescription drugs like these are easier to abuse than most people think. Added to that, the range of actions that technically constitute abuse is typically much wider than many people know.

Promethazine codeine abuse can look like any of the following:

  • Taking promethazine/codeine in higher doses than instructed
  • Using this drug without a prescription
  • Using someone else’s medication, even if you have the same condition
  • Taking promethazine and codeine at a different time than prescribed
  • Combining Phenergan or Pentazine with other drugs like other opioids, benzodiazepines, or even legal substances like alcohol
  • Taking the medication in an improper way (i.e., crushing pills, injection solutions, snorting powders, etc.)
  • Sharing your promethazine and codeine prescription with someone else, even if they have the same condition

While abuse can occur accidentally, someone who is abusing codeine medications is probably doing so for the drug’s euphoric effects. However, abusing codeine doesn’t necessarily indicate that an addiction is present. On the other hand, abusing it frequently or for long periods will increase your chances of becoming addicted to codeine.

Codeine is a very powerful drug that can produce a euphoric high at relatively small doses. In fact, you may be wondering, how many 30mg codeine pills will it take to get high? The answer is that it might not take that much at all.

People on the drug abuse forum at Bluelight explain the codeine high as being a warm and fuzzy feeling. This feeling is a pleasant one, and this is what leads people to frequently abuse the drug.

Typically, it would probably take more than 30mg of codeine to get high. However, you should be prepared for that amount to increase over time as tolerance to opioids can develop incredibly quickly. In fact, tolerance to this class of drugs can actually develop in as little as several hours (a condition called tachyphylaxis).

Similar to taking higher doses of other unassuming drugs like cough syrups or other OTC medications, abusing promethazine and codeine syrups can create a euphoric “buzz.”

However, users tend to describe this type of high differently from opioids on their own. Effuzion from Bluelight.org, for example, says, “I've drank tons of codeine + promethazine syrup and it's a different high than taking either of the two alone, different than just an opiate buzz.”

Others describe the high as being similar to an out-of-body experience attached to some mild euphoria and of course sedation.

Many promethazine codeine syrup abusers prefer to get high on the drug within a party or club setting. This is due in part to the drug’s rising popularity as a party drug in rap and pop culture.

Whether you call it lean, purple drank, sizzurp, barre, dirty Sprite, or any of the other countless slang names being used today, they’re all referring to the exact same thing: a concoction of promethazine and codeine syrup, a soda (preferably Sprite, Mountain Dew, or Grape Fanta), and a Jolly Rancher for added sweetness.

This drink, usually consumed out of a Styrofoam cup, has gained notoriety in the world of rappers, artists, and pop icons alike as being a beverage of choice for getting a unique buzz. And while it might not sound particularly dangerous, a cup of this combination can end up containing as much as 25 times the recommended dose of the drug.

The world of hip-hop has been instrumental in popularizing and glamorizing the deadly combo. And in fact, many big names in the industry have actually fallen prey to its dangerous side effects. Below are just some of the people that have died from or been negatively affected by circumstances surrounding purple drank.

While purple drank may already be dangerous on its own, one of the biggest hazards of using this drug on the club scene is just how easy it is to mix it with other drugs along the way. And doing so can be especially deadly.

Many people abusing promethazine and codeine tend to use the syrup with other drugs at the same time. This is what’s known as polydrug abuse. And when left unchecked, it can develop into a full-blown addiction for multiple substances known as cross addiction.

Of course, cross addiction on its own can be absolutely devastating and can make the physical, psychological, social, legal, and many other negative effects of addiction even worse. However, one of the most notable dangers of mixing promethazine and codeine with other substances is a massively increased risk of overdose.

And one of the most common drugs that are abused alongside this medication is alcohol.

Alcohol should never be consumed along with codeine alone. These two drugs are a dangerous combination because both alcohol and codeine are depressants. When combined, the sedative effects of each tend to overlap and can lead to deadly levels of respiratory depression.

Users may also suffer from heart damage, liver damage, or damage to other organs in the body like the kidneys or even the lungs, stomach, or esophagus in certain cases.

However, when promethazine is added into the equation, the risk of damage or death is even higher thanks to promethazine’s sedative effects. As a general rule, the overwhelming majority of medications should not be combined with alcohol.

There are other drugs that can cause significant damage when mixed with promethazine and codeine.

  • Benzodiazepines Like Xanax and Ativan – These medications are prescription depressants usually used to treat anxiety, insomnia, or even epilepsy.
  • Stimulants Like Crystal Meth and Cocaine – While depressants tend to slow down the body as a whole and the heart, stimulants turn things into overdrive. These competing messages can end up causing abnormal heartbeats when both are combined. And that can lead to a higher incidence of serious heart complications that may even lead to death.
  • Other Opioids Like Heroin – Similar to benzodiazepines and alcohol, combining promethazine codeine syrup with other opioids can lead to an overlapping depressant effect that may lead to dangerously slow breathing. And if you aren’t careful, it may result in a fatal overdose.

A Quick Word on the Opioid Epidemic

As an opioid, codeine can be highly addictive and especially hazardous. And while the dangers of the drugs surrounding this epidemic are regularly covered on the news today, it can be easy to forget just how bad the problem has actually gotten.

Abusing Codeine

Here are a few statistics from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the National Institute on Drug Abuse (NIDA) to help put the breadth of the problem into perspective.

  • Around 46 people die from prescription opioids every single day in the United States according to historical data.  
  • Newer figures for 2016 estimate that as many as 89 people died from prescription opioids each day. This figure includes natural, synthetic, and semi-synthetic opioids.
  • Synthetic opioids like fentanyl specifically are causing a rapid increase in overdose deaths. Death counts involving this drug (usually illicitly manufactured) spiked by 540% from 2013 to 2016.
  • Roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them while 8 to 12% develop an actual opioid use disorder.
  • An estimated 4 to 6% who misuse prescription opioids transition to heroin.
  • There were an estimated 27 million people who suffered from opioid use disorders in 2016 around the world.
  • Driven largely by the worsening opioid epidemic, drug overdose is now the leading cause of death among Americans under 50 years old.

What Is Promethazine & Codeine Addiction?

Over the course of abusing promethazine codeine syrup, the body becomes more and more used to its regular presence. And since our bodies are always trying to maintain homeostasis (not too high, not too low, but always just right), it starts to compensate for this drug always being in the system by making physical changes.

What is Codeine Addiction?

Certain bodily chemicals become stronger, more receptors grow while others die off, and a host of other changes take place over time. These changes make it harder to experience the same high from a single dose of the drug. And that means you have to take more of it to get the same effect.

This is what’s known as tolerance. And it’s one of the hallmarks of physical dependency.

However, there’s an enormous difference between being dependent on a drug and being addicted to it.

For instance, even when a patient takes a drug 100% as prescribed, they can still develop a physical dependency. And when that happens, a doctor simply ups the dosage to get the desired effects.

Addiction, on the other than, is more about behaviors than it is about physical effects. According to NIDA, addiction is defined as:

a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

Addiction causes physical changes in the brain that make it difficult, if not impossible, for addicts to overcome their cravings to use again, even if they know their life is falling apart because of it.

It’s also worth mentioning that it is very possible to be physically dependent on a drug without being addicted. And likewise, someone can be addicted without being physically dependent. The two often go together but that isn’t always the case.

The amount of codeine that causes addiction is going to vary from person to person. Everyone has different tolerance levels. Some people may only take 60mg of codeine a day, while others may take much more.

Plus, just because someone is taking massive amounts of the drug doesn’t necessarily mean that they’re addicted. It’s when their use of the drug becomes harmful and compulsive that they’re addicted, not just when they’re taking a high dose regularly.

However, abusing Phenergan or any other promethazine codeine combination at all is never a good idea. While you may not have a full-blown addiction now, abuse can and often does lead to a total loss of control.

And oftentimes, the more promethazine codeine that someone abuses, the higher their likelihood of developing an addiction will be.

Again, the answer to this question varies from person to person. It might take one person only two weeks of regular codeine abuse to form an addiction. For someone else, they may abuse the drug for months, and still not have an addiction.

There’s really no way to tell how long it will take for you to become addicted to codeine. But if you or someone you love is struggling with a promethazine codeine abuse problem, it’s vital to know how to spot the signs of addiction before the problem gets out of control.

Denial and addiction often go hand in hand.

In fact, the 2016 National Survey on Drug Use and Health found that of the 17.7 million U.S. adults that needed treatment but never received it, around 95.5% didn’t get help because they didn’t think they had a problem at all. That’s 16.9 million people in downright denial about their addiction.

That’s why it’s so important to recognize the telltale signs of a promethazine codeine addiction. These might include 

  • Having strong cravings for Pentazine or Phenergan
  • Needing to take more of the drug to get high than you previously did
  • Experiencing withdrawal symptoms when you stop taking promethazine codeine syrup
  • Thinking about the drug almost all the time
  • Becoming withdrawn from people you care about because you’d rather be using 

If you’re not sure if you’re a codeine addict, taking an addiction quiz can help you. Once you take this quiz, you should have a better idea of what steps you need to take next to stop the cycle of abuse for good.

Side Effects of Codeine

What Are the Short-Term Effects of Codeine Abuse?

As you can imagine, the 60mg codeine effects are going to be much different from those of lower doses. Likewise, the more promethazine codeine you take, the more pronounced the effects will be.

If you have been taking codeine for a short time, you should know about its effects on the body. When you use the drug, slurred speech, euphoria and feeling like you’re drunk are common.

Other short-term side effects may include:

  • Bouts of confusion or dysphoria
  • Bouts of constipation
  • Slower breathing rates than normal
  • A drop in heart rate and blood pressure
  • A rash on the skin, or profuse and chronic itching
Long-Term Effects of Codeine

What are the Long-Term Effects of Codeine?

Promethazine and codeine should not be taken for long periods of time. The long-term effects of codeine on the stomach are significant. Plus when you abuse this drug, liver damage can also be quite common. You may also suffer from:

  • Problems with sleeping at night
  • Pain when codeine starts to leave your system
  • The onset of seizures
  • Damage to various organs in the body
  • Risk of coma or even death

The long-term effects of lean are included in the effects of codeine. Also, abusing codeine with other drugs can also cause serious health problems, even if they are prescribed. And that can lead to a heightened risk of a dangerous overdose.

Overdosing on Promethazine & Codeine

One of the most dangerous effects of promethazine and codeine abuse is the risk of overdosing. And in order to reduce the harm that can come from such an event, it’s critical to know the physical and psychological signs of taking too much of this deadly drug.

Signs of a friend or loved one going through a promethazine codeine overdose include:

  • The person will be extremely drowsy.
  • They will experience a weakness in their muscles.
  • Their pupils will be constricted.
  • They may faint.
  • You may notice they have difficulty breathing which can lead to respiratory failure.
  • Their skin color may change. For example, lips or toes may go blue.
  • Their skin becomes cold and clammy.
  • They may become unconscious.
  • It's possible that they may fall into a coma.

Relapse & Accidental Overdose

If you attempt to stop using promethazine and codeine on your own, the risk of a codeine overdose is very high. These types of overdoses typically occur when people go back to using the drug after quitting cold turkey.

That’s because tolerance to opioids like codeine tends to drop especially quickly after an individual stops using. As a result, if they go back to trying to using the same dose that got them high before, it’s likely to be far more than their body can now handle. And that means they could end up fatally overdosing.

This is why it’s so important to stop using codeine in a professional setting. A professional treatment program is not only the best way of preventing relapse but also educating recovering addicts about the dangers of falling back into old bad habits.

It’s without a doubt the smartest and safest way of recovering from a promethazine codeine addiction.

Codeine Withdrawal Stages and Symptoms

When someone is physically addicted to codeine and promethazine, they’ll undergo what are known as withdrawal symptoms if they try to quit using the drug. And similarly to quitting other opioids, these symptoms can be incredibly uncomfortable.

Codeine Withdrawal Stages and Symptoms

In fact, many codeine addicts (and addicts in general) will continue to use over and over again just to stave off the symptoms of withdrawal because they’re often so painful. However, pushing through these symptoms is the first step of recovery and helps the body adjust to living without the drug.

Typical codeine withdrawal symptoms include two separate stages:

Initial Stage

  • Feeling irritable or anxious
  • Trouble sleeping
  • Teary eyes
  • Runny nose
  • Sweating
  • Yawning
  • Muscle aches
  • Faster heartbeat

Later Stage

  • Loss of appetite
  • Nausea and vomiting
  • Stomach cramps
  • Diarrhea
  • Enlarged pupils
  • Chills or goosebumps

How Long Does it Take to Withdraw from Codeine?

You may be wondering, how long do codeine withdrawal symptoms last? Codeine withdrawal may be severe for only about a week, for some people. For others, it might last much longer. In general, the promethazine codeine withdrawal timeline typically lasts for around 7 to 10 days.

Codeine Withdrawal Timeline

However, some recovering addicts may experience what’s known as Post-Acute Withdrawal Syndrome or PAWS. This condition is marked by a variety of lingering symptoms that can take weeks, months, or even years to fully disappear.

Some of the most common symptoms of PAWS include:

  • Lack of emotional control (either an overreaction or no reaction)
  • Irritability
  • Depressed mood
  • Anxiety and/or panic
  • Insomnia
  • Increased levels of stress
  • Increased sensitivity to stress
  • Increased social anxiety
  • Low enthusiasm and energy
  • Lack of concentration

Working with a professional recovery program can help reduce the severity and duration of these symptoms.

If you are coming off a promethazine and codeine addiction, the side effects can become pretty severe. But one thing that can help is knowing what to expect and when to expect it.

This promethazine codeine withdrawal timeline should help make the process a little bit more clear.

  • Mild symptoms of codeine withdrawal during the first 12 hours
  • Moderate symptoms by the time you hit the 24-hour mark without codeine
  • Severe symptoms of codeine withdrawal by the 3rd day, which is when it typically peaks
  • Lessening symptoms of withdrawal by days 3-5
  • Easing of symptoms by day 7-10

It’s worth remembering that this timeline is just a guideline. Everyone’s withdrawal experience is going to be unique to them. And while some people may get through it relatively easily, others can suffer from symptoms that are much more severe.

If you have an addiction to purple drank or lean, you should certainly consider codeine detox. This is a professional method of drug detox that will assist you in reaching your goals. Professionals will help keep you healthy and comfortable as your body removes the numerous toxins that have built up over the course of your addiction.

Added to that, they can also offer medications, coping strategies, and expert guidance to make detoxification quicker and far less painful than it has to be. And that translates to an easier recovery and a lower risk of relapsing.

There are several promethazine and codeine withdrawal tips that may be able to help addicts recover from their drug use. Here are some of the most helpful.

  • Don’t try quitting on your own. Partnering with a professional treatment facility will not only make recovery much easier and quicker, but it will also ensure that you won’t suffer any dangerous or even deadly complications throughout the process.
  • Join a self-help group for motivation, connection, and social support. While these groups are most effective when combined with an actual treatment program, they can provide valuable insights and strategies that can be instrumental in overcoming the powerful pull to start using again.
  • Ask friends and family for help. Addiction can be a lonely disease and sometimes that isolation can make it harder to recover. Friends and family members can help keep you on the right path and give you a reason for striving to be a better version of yourself.
  • Know what to look for in a treatment program. Not all programs are the same and finding one that attends to your specific needs can mean the difference between lifelong sobriety and relapse only months after getting clean.
Ashwood Recovery

How Codeine Addiction Treatment Can Aid in Recovery

By now, you may be wondering, how do I quit my cough syrup addiction? Codeine is a scary drug and abusing it alongside promethazine can have frightening consequences. But once you’ve become addicted to it, that doesn’t mean you’re helpless forever.

The absolute best step for recovering from an addiction to codeine and promethazine is to find a professional treatment center that’s right for you. And here at Ashwood Recovery, we offer the best treatment services in the area.

Our empirical, evidence-based programs are built on individualized treatment plans and an unmatched commitment to personalized attention. Our staff to patient ratio is one of the highest in the region and we’re even nationally accredited by the Joint Commission – a testament to our quality of standards.

But above it all, we’re passionate about helping our patients overcome their addiction. And it’s that passion that lets us offer a level of care you just won’t find anywhere else.

So, if you or someone you know is struggling with a promethazine and codeine addiction, please contact us today.

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