Codeine vs. Vicodin (hydrocodone)

Vicodin is six times stronger than Codeine. But experts recommend generic codeine for its long track record of effectiveness, safety, flexibility and cost. More comparisons on codeine and vicodin here.

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Both Codeine and Vicodin are recognized by the U.S. Drug Enforcement Agency as having a current medical use and these narcotics are usually prescribed for pain relief or cough suppression.  More on uses for Vicodin here.  But what are the relative advantages of each medication?

| Natural | Synthetic |  Delivery  | Efficacy | Withdrawal | DEA classification |

Codeine        Y            N              oral        reliable      difficult      Schedule II

Vicodin         N             Y             oral        reliable        easier      Schedule III

Natural or synthetic?

Codeine is a naturally occurring opiate. In fact, Codeine is the most widely used, naturally occurring narcotic used for medical treatment in the world. On the other hand, Vicodin is made up of hydrocodone and acetaminophen, and is a semi-synthetic opiate which can be derived from codeine.


Both Codeine and Vicodin are taken orally. Codeine comes as a tablet, a capsule, and a solution (liquid). On the other hand, Vicodin is usually taken orally in tablet form. Both types of medication are prescribed to be taken as needed, generally once every 4-6 hours.


Both Vicodin and Codeine are highly effective for acute severe pain relief. However, these pain medications are only moderately effective in treating long-term chronic pain, and their effectiveness can diminish over time. You can speak with your prescribing doctor about the relative merits and dosing for each of these pain medications.


Generic codeine seems to be the better buy for pain relief.  Consumer Reports on opioids recommends that people choose generic versions of opioids over brands names such as Vicodin. In fact, the rating agency suggests generic forms of codeine plus acetaminophen as the Best Buy of opioid medications for its value. Furthermore, high doses or extended release versions of opioid medications can be more expensive than low dose prescriptions. Most low dose prescriptions will cost < $150 per month.


Opioids like Codeine and Vicodin can produce drowsiness, constipation and, depending on amount taken, can depress breathing. Other possible side effects can include:

  • agitation
  • depression
  • dizziness
  • impaired memory
  • irregular menstruation
  • nausea
  • vomiting

Additionally, long-term use of opioids has been linked to:

  • decline in immune function
  • decrease in sex hormones (testosterone)
  • increased sensitivity to pain
  • impaired sexual function
  • loss of interest in sex

Potential for abuse

Long-term use of opioids such as Vicodin and Codeine can lead to physical dependence and addiction, though they are rarely addictive in people who genuinely need them to control pain and take prescription medications as prescribed. Codeine is classified as a Schedule II narcotic by the DEA. Vicodin is a Schedule III narcotic. This means that U.S. law describes Codeine as having a higher potential for abuse than Vicodin.

If you are worried that you may become addicted to your pain medications, you are not alone. The exact risk of pain pill addiction is not known, but some factors which may increase chances of addiction include past drug or alcohol problems, problem with anxiety, depression or other mental health disorders. This is also true if someone in your family has been diagnosed with substance abuse problems.


Codeine withdrawal is worse than Vicodin withdrawal. Withdrawal from both Codeine and Vicodin can be painful, but getting the drugs out of your system is not life threatening. People who have withdrawn from both Vicodin and Codeine report that Codeine withdrawal is more severe and painful and that Vicodin detox, by comparison, is easier and quicker. Opiate withdrawal is best when completed under the supervision of a medical professional, because additional medications or interventions may help related symptoms.

Reference sources: US Department of Justice Drug Scheduling chart
National Institutes of Health Drug Info on Hydrocodone
NIDA prescription pills drug pages
MedHelp [dot] org discussion on codeine and vicodin withdrawal
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.


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  1. Absolutely, brand names compared to generics are at least 10 to 20% more effective! I have over 60% of my spine with significant damage, DDD and stenosis are just the main problems in cervical, thoracic and lumbar of my spine. With over 15 years living with chronic pain I have had to move on to more potent meds. FOLLOW YOUR DOCTORS DIRECTIONS but certainly question their decisions and do your own research on the meds you NEED to control the pain!

    1. Hi Rick. Yes, both Codeine and Vicodin are opiates. Codeine is a naturally occurring opiate, while Vicodin is a semi-synthetic opiate made up of hydrocodone and acetaminophen.

  2. I suffer from severe chronic back, joint, hip pain. The brand name medications I noticed are more effective so anyone saying it’s a waste and that the generics are exactly the same isn’t giving the entire picture. Brand name is made of a higher quality, when I switched to brand name and questioned those who have medical degrees I was told that the brand name are a higher quality. I never thought about it before but now it makes sense for example compare a generic paper towel to something like Viva or Bounty, which one does a better job? Same thing with generic aspirin compared to Bayer. I don’t know why so many are fooled and give wrong information to people telling them that brand name and generic is 100% exactly the same when it’s not. Yes, the main ingredient is exactly the same but often of a lower quality on generics which makes sense why the brand names cost more money. People need to think for themselves. The pharmacies from what someone told me also make less money on brand name prescriptions which is why they always try to push generics on everyone. Whatever you decide to get brand or generic for those reading this it’s still very important to follow the directions of your doctor which is what I do, never take more than what your doctor says. He or she doesn’t put the directions on the label for decoration, it’s for our safety. Too much of any medication, even over the counter isn’t good for the body that’s why it’s important to take the directions of your doctor very serious. If you don’t understand something ask questions.

  3. I have request a change but the will not return me to what works which is Vicadin I never realized how much i needed them the pain is unreal I am going down to see them in October in hope of some help

  4. Hello Ron. From what I’ve read, codeine is considered less potent than Vicodin while morphine is considered a stronger” opiate/opioid relative to Vicodin (hydrocodone). Can you request a change?

  5. The VA hospital in West Palm Beach will not renew my Vicidan based on policy change I have been told VA Pittsburg where I originally came from did . My pain meds worked until the changed them to Codine base I believe this is based on cost so we get to suffer while VA cuts cost at Veterans expense .. This is a travesty as I haven’t been out of pain for more than a month.

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