Codeine is a narcotic painkiller and cough suppressant that is used to decrease coughing or treat mild to moderate pain. It may come in the form of a capsule, tablet, or liquid and is available on its own and in forms with other medicines. However, because it is an opioid drug, it may be addictive.1
Codeine is generally only available with a prescription, but in a small number of states there are cough medications with codeine accessible over-the-counter.2 Based on 2017 surveys, it was estimated that over 11 million Americans ages 12 and up misused pain medications in the prior year. 3 There were nearly 400,000 opioid overdose deaths from 1999 to 2017.4 Globally, drug overdoses deaths oftentimes involve mixtures of alcohol, opioids, and sedative medicines.5
Prescription opioids (e.g., codeine, OxyContin, and Vicodin) can cause a person to feel relaxed and high and so may be misused. Unfortunately, misusing opioids can decrease breathing, which may be fatal.6 When codeine is combined with alcohol or illicit drugs, potentially fatal side effects are more likely.1
Cough syrup that contains codeine and promethazine may be combined with soda. This mixture may be referred to by street names such as purple drank, sizzurp, lean, or syrup. Starting in the later ‘90s, some popular music often referred to the drink.7
A study analyzed 100 Instagram posts related to misuse of codeine and found alcohol, marijuana, and benzodiazepines use were sometimes also portrayed. The study’s second appendix indicates that 11% of the posts depicted polysubstance use.8
Using codeine with other substances that depress the central nervous system, such as benzodiazepines or alcohol, can make effects like low blood pressure, respiratory depression, coma, and death more likely.9
The Dangers of Mixing Opioids and Alcohol
There are several negative effects that may result from combining codeine and alcohol. Persons who use both opioids and alcohol may experience effects such as sleepiness, dizziness, trouble breathing, problems with motor control, and memory difficulties.10
According to the Drug Abuse Warning Network’s estimates, there were an estimated 81,365 emergency department visits in the U.S. in 2010 involving a combination of opioid pain medications and alcohol.11 Some of the biggest potential dangers from combining opioids and other depressants of the central nervous system, such as alcohol, are respiratory depression (not being able to breathe normally), significant sedation, coma, and death.9,12
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Concerns of Mixing Alcohol with Other Opioids
Stopping Codeine Use
Both codeine and alcohol are drugs that a person can become dependent on. If a person is dependent on a drug, they experience withdrawal symptoms if use is stopped abruptly or dramatically decreased.9,13 Suddenly stopping codeine may result in withdrawal symptoms, possibly including anxiety, insomnia, restlessness, runny nose, sweating, pupil dilation, yawning, muscle aches, diarrhea, nausea, and vomiting.9
In someone dependent on alcohol, withdrawal symptoms may begin in less than 8 hours after his or her most recent drink. Symptoms may include anxiousness, being irritable, tiredness, depression, nightmares, headache, decreased appetite, vomiting, pupil dilation, tremors, and fast pulse.14 A severe and potentially life-threatening condition called delirium tremens may emerge.15
For individuals going through withdrawal from alcohol, opioids, and/or sedative-hypnotics, it is recommended that they detox in a setting with medical care 24 hours a day in order to help individuals stay safe and comfortable.16 During inpatient medical detox, you should receive 24-hour monitoring. Medications may be used to manage alcohol and opioid withdrawal symptoms. Any complications should be addressed. Patients should also be evaluated for any other medical conditions.16
For those with addiction, detox generally is not enough on its own to help them to stay sober long term. After detox, they should engage in an inpatient or outpatient rehabilitation program.17 As part of a comprehensive treatment plan, individuals may participate in group therapy, individual counseling, family counseling, and support group meetings, and medications may be prescribed.17
Many insurance providers cover some, if not most of treatment. To see if your insurance provider provides resources for addiction related services, fill out the free and confidential form below.
. American Society of Health-System Pharmacists. (2018). Codeine. In AHFS Patient Medication Information.
. U.S. Food & Drug Administration. (2018). FDA Drug Safety Communication.
. Substance Abuse and Mental Health Services Administration. (2017). National Survey on Drug Use and Health.
. Centers for Disease Control and Prevention. (2018). Understanding the Epidemic.
. World Health Organization. (2018). Information sheet on opioid overdose.
. National Institute on Drug Abuse. (2019). Prescription Opioids.
. National Institute on Drug Abuse for Teens. (2019). Cough and Cold Medicine (DXM and Codeine Syrup).
. U.S. National Library of Medicine. (2018). Representations of Codeine Misuse on Instagram: Content Analysis.
. U.S. Food & Drug Administration. (2017). Codeine Sulfate Oral Solution CII.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing Alcohol With Medicines.
. Centers for Disease Control and Prevention. (2014). Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths — United States, 2010.
. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine (6th ed.). Philadelphia, PA: Wolters Kluwer.
. U.S. National Library of Medicine. (2008). Alcohol Dependence, Withdrawal, and Relapse.
. A.D.A.M., Inc. (2019). Alcohol withdrawal. In A.D.A.M. Medical Encyclopedia.
. A.D.A.M., Inc. (2019). Delirium tremens. In A.D.A.M. Medical Encyclopedia.
. Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment (Treatment Improvement Protocol (TIP) Series, No. 45).
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.