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Combining Codeine & Alcohol: What Are the Dangers & Risks?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated May 20, 2023 • 10 cited sources
pill bottles with alcohol bottles

Codeine and alcohol are both central nervous system depressants, capable of slowing breathing and heart rates. Combining them means hitting your system with two very similar drugs that can both slow your respiration. Your risk of overdose and other complications rises accordingly.

More than 60% of people in the United States drink alcohol, researchers say.[1] People who drink frequently may not realize they should change their daily habits when they start taking codeine. If you’re one of them, here’s what you need to know about the risks involved.

What Do Codeine & Alcohol Do?

Codeine and alcohol work directly on your central nervous system. Depressants like this come with very real risks. Both drugs can also come with other dangers.

What Does Codeine Do?

Codeine is an opioid medication used to treat mild-to-moderate pain and a dry cough. Each dose moves from your digestive tract to receptors inside your brain, triggering neurotransmitter release. 

Some people become psychologically attached to the euphoria or pain relief from codeine. They may start misusing the medication by taking doses closer together, or they may continue taking the drug after their symptoms have passed. In time, they develop opioid use disorders (OUD).

Some people face even higher risks due to genetics. Fast metabolizers process all active ingredients very quickly and experience overdose symptoms within minutes. Even at therapeutic doses, these people can overdose.[2]

Even people who metabolize codeine at the more typical speed can overdose if they take too much codeine. 

What Does Alcohol Do?

Alcohol is part of everyday life for many Americans. They use drinks to relax, socialize, celebrate and entertain. They may believe their drinks are harmless, but researchers say alcohol is the number one risk factor for premature death in people ages 15 to 49.[3]

Alcohol reduces decision-making ability, and it slows reaction times. People may make poor decisions (like driving) while under the influence and harm or even kill themselves or others. 

If a person is unable to control their drinking, they have developed an alcohol use disorder (AUD). This is a sign that help is needed.

Can You Mix Codeine & Alcohol?

More than half of people who misuse prescription painkillers like codeine also misuse alcohol.[4] Many people mix these drugs, and they may be unaware of how risky this is. When someone is misusing either substance, they are more likely to engage in polysubstance misuse, adding other substances to the mix over time.

In reality, combining two sedative drugs compounds the dangers of each substance. Combining these drugs is never considered safe.

What Are the Risks & Dangers Associated With Mixing?

All opioids are depressants, and researchers have conducted multiple studies on how they interact with alcohol. 

In one study, researchers found that mixing one type of opioid with a moderate amount of alcohol causes life-threatening respiratory distress.[5] This complication is more common in the elderly, but it could happen to anyone.

Researchers also found that in 2017, one in seven deaths involving opioids also involved drinking alcohol.[6]

And researchers also found that combining alcohol and opioids is related to worse outcomes for people who enter treatment programs for misuse of either substance.[7]

Treatment Options for OUD

An estimated 1.1% of Americans have an alcohol use disorder co-occurring with a substance use disorder.[8] While it’s more complicated to treat AUD and OUD together, it’s not impossible. Medication for Addiction Treatment (MAT) programs can help. 

In an MAT program, doctors use medications like Suboxone to amend chemical imbalances caused by chronic use of drugs like codeine. Your medications can help you to get sober without life-threatening complications. And those same medications can help you resist drug cravings, so you can maintain the sobriety you worked so hard to achieve.

When you take Suboxone, you’re able to focus on the work you’re doing in therapy without distractions from intense withdrawal symptoms and cravings. You can begin to build a new life in recovery.

If alcohol is your primary substance of misuse, three medications are FDA approved for treatment of alcohol use disorder: acamprosate, naltrexone and disulfiram.[9] 

While these medications are a vital part of sustaining recovering from both AUD and OUD, they work best in conjunction with therapy. Counseling is a key component of every MAT program.[10] In therapy, you’ll acquire skills that help you to lead a healthy, balanced life, and you’ll build a support network you can turn to when you’re tempted to relapse back to substance misuse. 

Whether you’ve struggled to quit misusing opioids, alcohol or both, ask your doctor if an MAT program is right for you.

Reviewed By Peter Manza, PhD

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 ... Read More

  1. What Percentage of Americans Drink Alcohol? Gallup. December 2022. Accessed April 2023.
  2. Codeine. Stat Pearls. February 2023. Accessed April 2023.
  3. What Are the Dangers and Risks of Alcohol and Substance Misuse? How Can You Prevent It? University of Alabama at Birmingham. November 2022. Accessed April 2023.
  4. More Than Half of People Who Misuse Prescription Opioids Also Binge Drink. Centers for Disease Control and Prevention. June 2019. Accessed April 2023.
  5. Mixing Opioids and Alcohol May Increase the Likelihood of Dangerous Respiratory Complication, Especially in the Elderly, Study Finds. American Society of Anesthesiologists. February 2017. Accessed April 2023.
  6. Alcohol and Other Substance Use. Centers for Disease Control and Prevention. July 2022. Accessed April 2023.
  7. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol: Clinical and Experimental Research. March 2019. Accessed April 2023.
  8. Treatment of Co-Occurring Alcohol and Other Drug Use Disorders. Alcohol Research and Health. 2008. Accessed April 2023.
  9. Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clinic Proceedings. September 2020. Accessed April 2023.
  10. Review of Medication-Assisted Treatment Guidelines and Measures for Opioid and Alcohol Use. U.S. Department of Health and Human Services. November 2015. Accessed April 2023.
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