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Mixing Codeine With Alcohol: What Are the Risks?

Mixing codeine with alcohol can be dangerous and potentially life-threatening. Both substances are central nervous system depressants. Combining the two can lead to increased sedation, respiratory depression, and overdose, which can be fatal.

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What Is Codeine? 

Codeine is a potent opioid medication that is commonly prescribed to provide pain relief and cough suppression.[1] Once in effect, codeine acts on opioid receptors within the brain and body, reducing pain perception and potentially triggering a euphoric high. 

Use of codeine comes with potentially significant risks, such as addiction, respiratory depression, and potential overdose. Use of the drug should only occur under medical supervision. Users should adhere to the guidelines of a valid prescription and never take codeine with other substances, including alcohol. 

Effects of Mixing Codeine With Alcohol

Combining codeine with alcohol is extremely hazardous because both substances affect the central nervous system, leading to slowed brain function, shallow breathing, and irregular and slower heart rate. This dangerous mix can cause a person to become unresponsive, lose consciousness, and, in some cases, slip into a coma or experience a heart attack or stroke.[2]

People often use codeine and alcohol together purposefully in the hopes of experiencing a far greater high than they would if they were to either take codeine or drink alcohol alone. Especially in cases where there is a high tolerance to either substance due to heavy use, polysubstance users may seek to break the tolerance barrier by adding in more substances that have the power to alter their perception. When substances are mixed like this, it can amplify the effects of each substance rather than simply combining their effects. 

In other cases, people may inadvertently combine the two drugs, not realizing the risks they are taking. They may be prescribed codeine for pain and have a drink with dinner, not realizing how much it will impact their ability to drive home. 

Others may drink regularly and take a codeine pill to relax. They may find themselves overwhelmed by the combo, experiencing intensified drowsiness, impaired motor skills, and a higher chance of accidents or injuries.

No matter the reason behind the choice to combine codeine and alcohol, the effects are the same and the risk of overdose is high.[2] Since both codeine and alcohol can impair judgment, recognizing the signs of an overdose while under the influence is challenging, which can delay connecting with needed medical help. 

Codeine & Alcohol: Overdose Risk

Since both codeine and alcohol are central nervous system (CNS) depressants, combining them can significantly increase the risk of a deadly overdose. When taken together, the depressant effects on the CNS can synergistically suppress vital functions like breathing and heart rate to dangerous levels. This can lead to respiratory failure, loss of consciousness, coma, and, in many cases, death.[3]

Researchers from the Centers for Disease Control and Prevention say almost 80% of the opioid overdose deaths in 2016 involved another drug like alcohol.[9] Research from Texas in 2019 suggests that opioid deaths that involved alcohol were most common in people ages 18 to 44.[10]

Additionally, there is the risk that overdose does not cause the person to lose consciousness but to “blackout.” In this condition, they may do things under the influence that they are not intentionally choosing and will have no recollection of later.

What to Do During an Overdose

An overdose on Codeine is a life-threatening emergency. Don’t wait for the person to get worse or try to help by forcing them to drink coffee or walk around. Stop, pick up your phone, and call 911.

Give the following information to the operator when you call:[7]

  • The person’s age, weight, and condition
  • The name of the drugs taken
  • The time they were taken
  • The amount used (if you know)
  • Where you are

Opioid drugs like codeine respond to naloxone. This medication is typically sold as a nasal spray, so anyone can use it, including people with no medical training.[8] It’s not harmful to people who don’t have opioids in their system, but it can reverse an overdose caused by opioids in seconds.

If you have naloxone with you, deliver a dose to the person while you wait for the ambulance to arrive.

Teen Drinking & Codeine Abuse

Teenagers may be drawn to experiment with the combination of alcohol and codeine for the same reasons they might try any drug: peer pressure, curiosity, or an attempt to escape from stress, boredom, or emotional difficulties. 

Unfortunately, for teenagers especially, abusing the two substances at the same time can be perilous for many reasons. Here are some of them:

  • Serious health risks: Both substances can individually harm a developing teenage brain and body, but when combined, their effects can be even more detrimental, leading to impaired cognitive function, memory issues, and disruptions in brain development.
  • Risk of addiction: The mixture of alcohol and codeine triggers the pleasure pathway in the brain, which can start the young person on the cycle of drug use to quell drug cravings. This can increase the likelihood of the development of addiction to one or both substances. Teenagers are particularly susceptible to developing addictive behaviors as a part of pleasure-seeking, which can have repercussions on their physical and mental development that follow them well into adulthood.
  • Respiratory depression: As CNS depressants, both substances slow down the central nervous system and respiratory functions. Combining them can result in severe respiratory depression, posing a risk of unconsciousness, coma, or fatal overdose.
  • Because teenagers are unlikely to abuse the substances around adults or teens who are sober enough to realize what is happening, they may be less likely to have someone call for medical help on their behalf. Fear of getting in trouble may also stop them from seeking help when it’s medically necessary, which can increase the risk of fatal overdose. 
  • Impaired decision-making abilities: Use of alcohol and codeine together may reduce judgment, leading to reckless behaviors, such as drunk driving or engaging in activities that come with a high risk of accident, injury, or legal consequences.
  • Long-term health consequences: Adolescent drug abuse can have severe long-term health repercussions, including liver damage, kidney issues, cardiovascular issues, and increased vulnerability for mental health disorders that will impact health in early adulthood and for the rest of life.[4]
  • Interactions with other medications: Alcohol and codeine may interact with other medications or supplements taken by teens for medical reasons, disabling them or causing them to behave differently in the body than intended. This can put the teen at risk of complications related to underlying medical or mental health issues. 
  • Legal and social ramifications: Substance abuse among young people can result in legal issues and strain personal relationships, which may then affect academic performance and future opportunities.

Preventing Teen Drug Abuse

Adolescence is a time of exploration, and many teenagers work hard to keep their habits and preferences secret. These same teens might be willing to change their ways with a little input from parents.

The Substance Abuse and Mental Health Services Administration recommends using these five concepts when you talk with your children:[11]

  • Express your disapproval. Tell your children you don’t agree with young people drinking alcohol or using drugs.
  • Show you care. Explain that you want your children to avoid drugs and alcohol because you want them to be happy and safe (not because you’re controlling).
  • Give information. Explain what you’ve learned about the risks of mixing alcohol and codeine.
  • Pay attention. If you’ve seen evidence of drinking, point that out to your child. Demonstrate that you’re monitoring behavior regularly.
  • Give advice. Outline the steps you used to avoid peer pressure when you were a child, or offer to role-play responses to help build skills.

Teenagers who want to learn more may benefit from these resources:

Long-Term & Short-Term Risks of Mixing Codeine & Alcohol

It’s never smart to mix codeine and alcohol. However, some people aren’t aware of the dangers they might face—both now and in the future.

Short-term risks associated with mixing codeine and alcohol include the following:

  • Extreme sedation
  • Loss of consciousness
  • Coma
  • Overdose death
  • Impaired ability to make good decisions
  • Increased risk of accidents

Long-term risks associated with mixing codeine and alcohol include the following:

  • Liver damage
  • Kidney problems
  • Cardiovascular issues
  • Poor mental health

Treatment for Codeine & Alcohol Abuse

Polysubstance abuse involving the misuse of multiple substances at once — like codeine and alcohol — presents unique treatment challenges compared to the treatment of a single substance use disorder. 

Not only do the potential withdrawal symptoms and triggers for relapse differ from one drug to the next, but they may differently impact the person’s energy levels and mental state. This can create the need to come up with different sets of coping skills to help the person find new ways of managing challenges without drug use. 

Here is what to expect in treatment for codeine and alcohol abuse:

  • Comprehensive assessment: Treating polysubstance abuse requires an in-depth assessment that includes an understanding of past drug use, medical history, mental health issues, and social challenges the person will be facing as they undergo detox and treatment. 
  • Withdrawal management: When an individual is physically dependent on both codeine and alcohol, management of withdrawal symptoms becomes more complex. Seizures or delirium tremens can accompany alcohol detox, while opioid detox comes with its own set of extreme withdrawal symptoms. The good news is that medications are available to make both types of withdrawal far easier, but medical supervision is recommended.[5,6]
  • Individualized treatment plans: Treatment plans will include therapies and life skills development that address how to avoid drug use. This will be multifaceted for people who struggle with both codeine and alcohol abuse since the urge to use these drugs is often triggered by different circumstances.
  • Integrated care: An integrated approach that targets both substance abuse and mental health issues concurrently is key for successful recovery. Therapies and medical care should happen together.
  • Relapse prevention: The part of treatment dedicated to helping people avoid relapse should focus on building coping skills to avoid relapse, developing strategies to address relapse should it occur, and creating an extensive system of support in recovery.
  • Holistic approach: Holistic treatment approaches that focus on physical, emotional, and social aspects can help people to address financial difficulties, relationship issues, and legal problems that may make their path to recovery more challenging.
  • Aftercare support: After treatment, ongoing support through aftercare programs, peer support groups like 12-step groups, and counseling can reduce relapse risk. These resources can also offer guidance as people work to navigate the challenges that come up as they rebuild their lives and relationships in recovery.

Frequently Asked Questions

These are the questions we hear most often about codeine and alcohol:

Is there a safe mixture or ratio of codeine to alcohol?

No. Mixing codeine and alcohol is never safe, no matter what recipe or ratio you follow. These two substances are central nervous system depressants, so combining them can lead to life-threatening overdoses.

Can I just let someone sleep off an episode of drinking too much?

No. It’s very hard to tell the difference between alcohol sedation and alcohol overdose. Never leave the person alone if they’re unconscious. Call 911 and ask the operator to send an ambulance to help.

Will naloxone reverse an alcohol and codeine overdose?

Maybe. Naloxone only works on opioids like codeine, so it may not be enough to counteract all of the problems caused by mixing codeine and alcohol. However, naloxone won’t hurt either. When in doubt, give it.

Are teenagers the only ones who mix codeine and alcohol?

No. Research from Texas suggests that people ages 18 to 44 are most frequently associated with overdoses from alcohol and opioid overdoses. The next age group most commonly associated is 45 to 64.[10]

Updated May 10, 2024
  1. Codeine. AHFS Patient Medication Information. Revised May 15, 2023. Accessed July 20, 2023.
  2. Harmful interactions: Mixing alcohol with medicines. National Institute on Alcohol Abuse and Alcoholism. Published 2003. Accessed July 20, 2023.
  3. The effects of combining alcohol with other drugs. University of Michigan. Accessed July 20, 2023.
  4. FDA drug safety communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; Recommends against use in breastfeeding women. U.S. Food and Drug Administration. Published March 8, 2018. Accessed July 20, 2023.
  5. Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: A systematic review. Margaret A. Maglione, Margaret A. Maglione, Laura Raaen, Christine Chen, Gulrez Azhar, Nima Shahidinia, Mimi Shen, Ervant Maksabedian, Roberta M. Shanman, Sydne Newberry, Susanne Hempel. Journal of Substance Abuse Treatment. Published March 13, 2018. Accessed July 25, 2023.
  6. Medication-assisted treatment for alcohol-dependent adults with serious mental illness and criminal justice involvement: Effects on treatment utilization and outcomes. Robertson AG, Easter MM, Lin H, Frisman LK, Swanson JW, Swartz MS. Am J Psychiatry. 2018;175(7):665-673.
  7. Acetaminophen and codeine overdose. University of Florida Health. Accessed February 8, 2024.
  8. Access to naloxone can save a life during an opioid overdose. U.S. Food and Drug Administration. Published March 29, 2023. Accessed February 8, 2024.
  9. Other drugs. Centers for Disease Control and Prevention. Published August 22, 2023. Accessed February 8, 2024.
  10. Alcohol-related polysubstance overdose deaths in Texas: 2010-2019. Texas Department of Health and Human Services. Published December 2021. Accessed February 8, 2024.
  11. Talk: They hear you. S ubstance Abuse and Mental Health Services Administration. Accessed February 8, 2024.
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