The dangers of mixing codeine and alcohol

Codeine is one of those medications that doesn’t feel like a serious drug. You can buy it over the counter at Boots or Superdrug, in familiar medicines like co-codamol, Nurofen Plus, and Solpadeine. People take it for headaches, period pain, back pain, the kind of everyday discomfort that doesn’t seem like anything to worry too much about.

All of this can make it easy to forget what codeine actually is. Codeine is an opioid in the same family of drugs as morphine and heroin. And while codeine is weaker than those drugs, it works on your body in similar ways. When you add alcohol, the effects of both can multiply and, in some cases, even turn deadly.

Why the codeine and alcohol combo is so easy to underestimate

Many people mix codeine and alcohol because neither substance feels particularly dangerous by itself. Drinking is completely normalised in British culture, and is part of how we socialise, celebrate, and just relax.

Codeine is found in bathroom cabinets up and down the country alongside plasters and paracetamol. The idea that codeine and alcohol could be seriously harmful doesn’t occur to most people, because neither one triggers the alarm bells we associate with hard drugs. But this is a dangerous misconception. Mixing alcohol and prescription painkillers like codeine can slow your brain and body, and this is one of the main causes of fatal overdoses.

What codeine does inside your body

Codeine works by changing how your brain perceives pain, while also creating feelings of calm or mild euphoria. Codeine side effects include slowed breathing, dulled reflexes, and reduced alertness. At normal codeine doses, when you take it alone, these effects and side effects are manageable, and your body can handle the sedation without any real danger.

There is one often overlooked complication, however. Codeine itself isn’t actually the active painkiller. Your liver converts it into morphine, and how quickly that happens varies significantly from person to person. Some people are what’s called “ultra-rapid metabolisers,” meaning their bodies convert codeine to morphine much faster than average. For these people, a standard dose can hit considerably harder than expected, producing stronger sedation and greater effects on breathing. You can’t easily tell which type you are without genetic testing, which means some people are walking around with a vulnerability they don’t know about.

Alcohol does something remarkably similar. It is also a depressant, which means it slows your brain activity, relaxes your muscles, and affects your coordination and judgment. For most people, of course, a pint in the pub or a glass of wine with dinner is unlikely to cause serious harm. The same is true with a small amount of codeine. The problem is what happens when you combine them.

How codeine and alcohol affect each other

Both codeine and alcohol slow your body down, affecting everything from your reflexes to your breathing, and separately, your body can usually cope. Together, however, they amplify each other, and your breathing can slow right down, sometimes without you noticing anything is wrong because you’re too drowsy.

This is called respiratory depression, and it’s one of the most serious risks of mixing codeine and alcohol. Your breathing becomes shallow and infrequent, your brain doesn’t get enough oxygen, and in severe cases, this can lead to loss of consciousness, coma, or death. It doesn’t always take large amounts of either substance to trigger this. Even a regular dose of codeine combined with a couple of glasses of wine or beer can be too much for some people.

The increasing drowsiness and coordination problems can also be dangerous. Mixing codeine and alcohol can make you extremely tired, which affects your ability to stay awake or make safe decisions. This can put you at risk of falls and accidents, and even issues like choking on vomit in your sleep.

Warning signs to watch for

If you’ve taken codeine and alcohol together, or if someone you’re with has, you need to watch for signs that the combination is becoming dangerous. These include:

• Shallow or slow breathing, where breaths seem infrequent or weak
• Extreme drowsiness, particularly if the person is hard to wake or keeps drifting off mid-conversation
• Serious confusion
• Slurred speech or incoherence
• Pale or bluish skin around the lips or fingernails
• Nausea and vomiting

The difficulty is that some of these signs look like being very drunk, and it’s easy to assume someone just needs to sleep it off. But the combination of opioids and alcohol is different, and waiting to see if someone improves can be a serious mistake.

When to get emergency help

The signs listed above are all signs of a potential overdose, which can be fatal. In 2024, there were 246 deaths involving codeine in England and Wales, more than ten times the number recorded in the early 1990s. You should call an ambulance or take the person to the hospital immediately if you spot any of those signs. Even if you’re not sure, the emergency services would far rather attend a call that turns out to be precautionary than arrive too late.

While you wait, try to keep the person awake if possible. If they’re unconscious but breathing, place them in the recovery position to keep their airway clear. Stay with them and keep watching their breathing until help arrives. If their breathing changes or slows even more, make sure you tell emergency services straight away.

How codeine dependence develops

What makes codeine particularly risky is how available it is. Around 40% of people who use codeine in the UK obtain it over the counter, without a prescription, and that accessibility can create a false sense of safety. If you can buy something at the pharmacy without seeing a doctor, it must be fine to use regularly. That’s the logic, even though it isn’t true.

Codeine is converted to morphine in your body, and like all opioids, it can lead to physical dependence if used regularly. Your body adapts to the presence of morphine, which means you need more codeine to get the same effect, and you experience withdrawal symptoms when you stop. This can happen faster than people expect, sometimes within just a few weeks of daily use, and it often takes people by surprise because they never thought of themselves as someone who could become dependent on anything.

If you’re finding it hard to avoid alcohol while taking painkillers

But sometimes, it isn’t a one-off mistake but a pattern that leads to dependence. You know you shouldn’t drink while taking codeine, but you find yourself doing it anyway because it doesn’t seem that serious. You don’t mean to mix them, but that’s what keeps happening.

That gap between intention and action might mean that your relationship with alcohol is more complicated than you’d like, or that the codeine has become harder to manage than you realised, or both.

In 2024, 963 people in England and Wales died from combining drugs with alcohol. More than half of all drug poisoning deaths involved more than one substance. This is a pattern, and it reflects how easy it is to underestimate the risks when both substances feel routine and unremarkable.

Get professional support for addiction at Recovery Lighthouse

If any of this feels relevant to you, whether that’s concern about mixing codeine and alcohol, worry that your codeine use has become harder to control, or a growing sense that alcohol is playing a bigger role in your life than you’d like, Recovery Lighthouse can help. RL rehab support includes medically overseen detox, residential rehab, and ongoing support to help you understand what’s causing your substance use and how to live without it.

You don’t need to have hit a crisis point to reach out. The best time to ask for help is often when you first notice something isn’t right, before the consequences become severe. Contact Recovery Lighthouse to talk through your options, our team can help you find the right programme and centre for your situation.