Codeine is an opioid painkiller, the same family of drugs as morphine and heroin. Doctors use it for pain, a dry cough or diarrhoea, but taken for the high, especially as cough syrup, it can lead to dependence and addiction, and stopping usually needs a plan rather than willpower alone.
This guide covers what codeine is, why cough syrup is the usual route into codeine addiction in Malaysia, the signs, what withdrawal feels like, and where to get help.
What is codeine?
The NHS describes codeine as an opioid painkiller for pain after an operation or injury, usually when paracetamol or ibuprofen have not worked. It is also used for a dry, painful cough and for diarrhoea. In Malaysia you will see it as codeine phosphate tablets, in combination painkillers, and in some cough syrups.
Codeine does very little on its own. The UK Clinical Pharmacy Association explains that the liver turns it into morphine using an enzyme called CYP2D6. How fast that happens depends on your genes. Some people make so little morphine that codeine barely works; others, called ultra-rapid metabolisers, make so much that they risk life-threatening breathing problems. You cannot tell which you are by how you feel, which is one reason taking more than prescribed is risky.
Why cough syrup becomes a problem
Most people who become dependent on codeine in Malaysia did not start with a street drug. They started with a bottle of cough mixture.
The Health Ministry said in March 2018 that cough medicines containing controlled ingredients come under the Poisons Act 1952. Only doctors and pharmacists may prepare and sell them, and only for medical use. After complaints, its enforcement officers inspected premises across the country in August 2017 and seized 100,480 bottles of cough mixture. The ministry linked cough mixture misuse to chakoroi, a drink of ketum water and fizzy drinks. A doctor or pharmacist found selling cough medicine for non-medical use can be fined RM3,000, jailed for up to a year, or both.[7]
It has not gone away. The New Straits Times reported in February 2021 that the General Operations Force in Kelantan seized 1,080 bottles of cough mixture, believed to contain codeine, that were meant to be mixed with ketum for a stronger high. In December 2024, Free Malaysia Today reported that police seized 130 litres of codeine syrup, worth RM75,150, hidden in a boat at a jetty in Masai, Johor.
Because it looks like medicine and is drunk like any other drink, families are often slow to see cough syrup as a drug problem. If ketum is part of the picture too, our guides to ketum addiction and how to stop ketum go into that side.
Prescription painkillers are a second route. CodeBlue reported in 2019 that government health clinics were receiving referrals from hospital pain clinics for people addicted to prescription opioids, mostly tramadol. Codeine painkillers taken for months for back pain or headaches can go the same way.
Is codeine addictive?
Yes. The NHS says addiction to codeine is possible, and that with long-term use your body gets used to it. Australia's Therapeutic Goods Administration, which made all codeine prescription-only in 2018, says codeine can cause tolerance, dependence, addiction, poisoning and, in high doses, death.
Dependence and addiction are not quite the same. Dependence means the body has adapted, so stopping brings withdrawal. Addiction means the drug has started to run the person's life: they keep using despite the harm, and find they cannot cut down.
The dangers of codeine
Taken as prescribed for a short time, codeine is usually safe. The risks grow with high amounts, long use and mixing.
- Slowed breathing. The NHS lists slow, weak or shallow breathing as a serious side effect that needs urgent help.
- Mixing with sleeping pills or alcohol. The US FDA warned in 2016 that taking opioid pain or cough medicines together with benzodiazepines has caused slowed or difficult breathing and deaths. Benzodiazepines include diazepam and the street pill Erimin 5. The NHS also advises avoiding alcohol with codeine.
- Harm from the other ingredients. Many codeine products also contain paracetamol or ibuprofen. The TGA warns that long-term high doses of paracetamol can harm the liver, and long-term ibuprofen can cause serious internal bleeding and kidney failure. People who take a lot of a combination painkiller to get enough codeine can be poisoned by the other drug.
- Everyday side effects. Constipation, nausea, drowsiness and sweating are common, according to the NHS.
If someone is very drowsy, hard to wake, or breathing slowly or noisily after taking codeine, call 999. Do not let them sleep it off.
Signs of codeine addiction
You might notice some of these in yourself or someone close to you:
- Needing more for the same effect, or taking it for the feeling rather than for pain or a cough
- Bottles of cough syrup, or strips of painkillers, turning up in the car, bag or bin
- Going to several pharmacies or clinics to get more
- Drowsiness and constipation that do not go away
- Mood swings, irritability or low mood when supply runs out
- Money going missing, or work and family slipping
- Feeling unwell (aches, runny nose, upset stomach, restlessness) when they have not had any
Our guide to signs of drug use covers the wider picture, and how long drugs stay in your system explains urine tests.
What does codeine withdrawal feel like?
Codeine withdrawal is the same kind of withdrawal as other opioids. MedlinePlus lists the early symptoms as agitation, anxiety, muscle aches, watery eyes, poor sleep, a runny nose, sweating and yawning. Later come stomach cramps, diarrhoea, large pupils, goosebumps, nausea and vomiting.
MedlinePlus says opioid withdrawal is very uncomfortable but not life threatening in itself. It also warns that going through it alone is very hard and can be dangerous, mainly because people relapse to stop the symptoms. Read more in our guide to drug withdrawal symptoms.
Two cautions matter here:
- If someone also takes sleeping pills or Erimin 5, or drinks heavily, they need a doctor before stopping. Withdrawal from benzodiazepines and alcohol can cause seizures. See our guide to sleeping pills and cough syrup misuse.
- Tolerance drops fast after stopping. MedlinePlus notes that most opioid overdose deaths happen in people who have just come through detox, because an amount they used to take is now too much.
How to stop codeine safely
If codeine was prescribed, do not stop it suddenly. The NHS says a doctor will usually lower the dose slowly over several weeks or months. Be honest with them about how much you are really taking; they cannot help with a number they do not know.
If codeine has become a habit or an addiction, these steps help:
- See a doctor first. A government health clinic or your GP can check what you are taking, including any sleeping pills or alcohol, and plan how to come off it.
- Ask about medicine for opioid dependence. MedlinePlus says methadone and buprenorphine can ease withdrawal and can also be used longer term. Both are available in Malaysia; see our guides to methadone and Suboxone.
- Get counselling as well as medicine. MedlinePlus recommends counselling and support groups, and checking for depression and other mental health problems, which often sit underneath painkiller use.
- Clear the supply. Throw out spare bottles and strips, and stop the routes you use to get more.
- Tell one person you trust. Withdrawal and the weeks after are easier with someone who knows.
Our guide on how to stop taking drugs goes further into triggers, cravings and what to do after a slip.
Where to get help in Malaysia
- Government health clinics. CodeBlue reported that the Health Ministry set up one-stop addiction centres (OSCA) in health clinics from 2017, and clinics take referrals for prescription opioid addiction.
- AADK, on a voluntary basis. Since the amended Act 283 took effect, Bernama reported in October 2026 that about 232 people a month come forward to AADK for voluntary treatment, up from 75 before, and that voluntary clients do not get a criminal record. Our guide to voluntary drug rehab in Malaysia explains how it works.
- Residential rehab. When outpatient help has not been enough, or life at home keeps pulling someone back, a residential stay gives distance and structure. Our heroin and opioid addiction treatment page explains what that looks like, and the drug rehabilitation centre in Malaysia page compares the options.
Salus is a voluntary residential recovery retreat in Cyberjaya for adults 18 and over. Treatment runs for 90 days, alongside medical care, with a Salus Clinician. It costs from RM7,000 a month; medication, deposits, medically supervised detox and any transfer to a psychiatric facility are charged separately. Read more about our addiction rehab centre in Malaysia, or our guide on how to help someone with drug addiction if you are a family member.
Questions people ask
Codeine phosphate is for what?
Codeine phosphate is the usual form of codeine in tablets. The NHS says it is used for pain, a dry or painful cough and diarrhoea, usually for a short time.
Is codeine cough syrup addictive?
It can be. The codeine in cough syrup is the same drug as in tablets, and drinking large amounts for the effect builds tolerance and dependence the same way.
Is codeine legal in Malaysia?
Codeine medicines are legal when a doctor or pharmacist supplies them for a medical reason. The Health Ministry has said cough medicines with controlled ingredients come under the Poisons Act 1952, and selling them for non-medical use is an offence.
Can I stop codeine at home?
If it was a short course, often yes, with your doctor's advice. If you have been taking a lot for a long time, or you also use sleeping pills or alcohol, see a doctor first and plan it together.
How long does codeine withdrawal last?
It depends on how much and for how long. The National Poison Centre at Universiti Sains Malaysia has described codeine withdrawal starting about eight hours after the last dose, peaking at around two days and usually settling within one to two weeks. The time just after withdrawal carries its own risk, because tolerance has dropped, so that is when support matters most.
Talk to us
If codeine, cough syrup or painkillers have taken more of your life, or someone you love's, than you wanted, you do not need to have it all worked out before you get in touch. Contact us for a free, confidential conversation about the next step, whether that is with us or somewhere else.
