Codeine and hydrocodone are opioid painkillers. Both are chemically similar to heroin, but their pharmaceutical nature can make them seem safe for everyday use.
In reality, both codeine and hydrocodone are dangerous drugs, and repeated misuse of these drugs is capable of causing physical dependence, withdrawal symptoms, opioid use disorder and overdose.
Research suggests hydrocodone is stronger — and therefore more addictive — than codeine. But neither drug is safe for long-term misuse.
Hydrocodone and codeine are prescription painkillers in the opioid class. Both are made in laboratories, prescribed by doctors and administered by pharmacists. Both are associated with drug misuse.
Codeine is U.S. Food and Drug Administration (FDA) approved for pain. Doctors also use this medication to help people struggling with coughing and restless legs syndrome.[1]
Slang terms for codeine include Captain Cody, Cody, and school boy. Some codeine formulations also include Tylenol, and users often call these pills doors and fours. When codeine is mixed with alcohol and soda, it’s often called purple drank, lean, or sizzurp.
Hydrocodone is a strong opioid medication that is FDA approved for pain and coughing. Doctors only use this medication when other therapies (like aspirin) don’t work.[2] Some hydrocodone formulations include acetaminophen or ibuprofen.
Slang terms for hydrocodone include hydros and Watsons. It is also sometimes referenced by the brand name Norco.
Experts say hydrocodone has been the second most commonly encountered opioid submitted to forensic labs since 2009.[3] This suggests dealers are either stealing the drug from pharmacists to sell to customers or manufacturing the drug in clandestine labs.
Codeine and hydrocodone are both opioids. While codeine comes from poppy sap and hydrocodone is partially synthetic, they work in the same way.
Prescription opioids are generally considered safe when taken as directed for short periods of time.[4] However, repeated use of hydrocodone and codeine can cause radical changes deep within the brain that may spark an opioid use disorder.
Understanding the differences and similarities between these drugs can help you determine which is right for you.
FactorsCodeineHydrocodoneDrug ClassNatural opioidSemi-synthetic opioidDrug ScheduleSchedule II to Schedule V depending on the productSchedule IIBrand NamesTylenol with codeine, Robitussin ACVicodin, Norco, Lortab, Zohydro,Common UsesPain relief, cough suppressant, restless legs syndrome Pain relief, coughingDosageVaries; example dose is 15 mg to 30 mg every 4 hours as neededVaries: example dose is 10 mg every 12 hoursWarningsFDA warning for addiction, overdose and drug interactions with CNS depressantsFDA warning for addiction, overdose, drug interactions with CNS depressants and a warning against combining with alcoholDrug InteractionsAvoid taking with other CNS depressants, including benzodiazepinesAvoid taking with other CNS depressants, including benzodiazepinesMisuse PotentialHighVery highCommon Street NamesLean, Purple Drank, Sizzurp, Texas Tea, Captain CodyFluff, Hydros, V-itamin, Vic, Vike
Using opioids like codeine and hydrocodone can cause unpleasant side effects. The discomfort you might experience can vary between the two drugs.
CodeineHydrocodoneIndividual Side EffectsLightheadedness, Shortness of breath, Sweating, Changes in vision, SeizuresItching, Loss of appetite, Difficulty urinating, Tight muscles, Hives or itching
Common Side EffectsDizziness, Drowsiness, Constipation, Nausea, and vomiting
Both hydrocodone and codeine prompt brain cells to release the neurotransmitter dopamine. Users describe a rush of sensation, followed by deep relaxation.
For patients who are in pain, these changes are very helpful. But sometimes, people become attached to the euphoria or the pain relief the drugs bring, and they develop an unhealthy relationship with their drugs.
Hydrocodone is stronger than codeine, and in a head-to-head comparison, hydrocodone has a higher misuse potential. Stronger drugs produce bigger chemical reactions within your brain, potentially altering your receptors and impairing your ability to control drug use. Since hydrocodone is stronger, it’s likely more addictive than codeine.
While codeine and hydrocodone share many characteristics, important differences separate them. They include the following:
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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