Last Updated: June 30, 2023

Codeine and alcohol are central nervous system depressants, and using them together can result in additive risks, even at low doses.

Mixing codeine with alcohol can enhance the pleasurable high more than taking either substance alone. However, this combination is also more dangerous than using either substance alone, and chronic use can increase your risk for overdose and result in liver and kidney damage.

What Is Codeine?

Codeine is an opioid prescription often used to treat pain (analgesic) or coughing (antitussive). Because of its abuse potential, it is classified as a Schedule II, III or V medication, depending on whether codeine is prescribed alone or with other medicines. Like other opioids, codeine binds to mu-opioid receptors in the brain and alters how you feel pain. 

The most common side effects of codeine include the following: 

• Drowsiness
• Nausea or vomiting
• Constipation
• Mild itching
• Sweating 

What Happens When You Mix Codeine and Alcohol?

Codeine and alcohol are central nervous system depressants that work on different brain receptors — alcohol works on GABA receptors, and codeine on mu-opioid receptors. While some accidentally combine codeine and alcohol, others mix these substances to get high. This high is described as an uplifting and tranquil mood but can result in a comedown that some people avoid by getting high again. This can lead to dependence. 

What Is Lean (aka Purple Drank, Sizzurp)?

Codeine and promethazine cough syrup mixed with a soft drink and sometimes alcohol is a recreational drug beverage referred to as Lean, Purple Drank, Sizzurp and many other nicknames. Initially popularized in Houston, Texas, by rap artist and producer DJ Screw, who created a genre of music in the early 1990s with slower beats, meant to mimic the feeling of taking this combination. Since then, Lean has been popularized by different rap artists and athletes.

After the deaths of rappers (including DJ Screw, who died of a codeine overdose) and arrests of National Football League players, this combination gained national media attention. Despite the potential for severe brain damage, abuse of Lean has been documented worldwide, including in the U.S., India, China and other countries. 

Dangers of Mixing Alcohol With Codeine

Alcohol and codeine are central nervous system depressants, and using both can result in additive risks, even at low doses.

Short-term Risks

Using codeine and alcohol together can increase the risk of: 

• Lightheadedness
• Dizziness 
• Profound sedation
• Respiratory depression
• Coma
• Death 

Long-term Damage

When taken over the long-term, taking codeine and alcohol can harm several organs. For example, chronic alcohol use is associated with liver and kidney damage, which can be amplified if the codeine product you are taking also has acetaminophen (Tylenol), as it can cause liver damage too. 

In addition, codeine and alcohol can be habit-forming alone or in combination, leading to dependence. Dependence happens when you consistently take one or both of these substances, leading to chemical changes in your brain. Over time, you will feel symptoms of withdrawal without alcohol or codeine. 

Overdose Potential

Taking too much of an opioid, like codeine, can result in deadly respiratory depression. Likewise, mixing codeine with alcohol can cause respiratory depression, even at much lower doses. This combination can result in an accidental overdose if someone taking codeine has a drink or two, even hours after taking their medication. For this reason, it is safest to avoid alcohol altogether while taking any medicines with codeine or discuss it with your healthcare provider. 

In 2016, almost half of the opioid overdoses included alcohol, cocaine or benzodiazepines (like Valium or Ativan). The same study found a 5.5-time increase in opioid overdoses involving alcohol from 1999–2017.

Help for Alcohol and Codeine Abuse

If you or a loved one are struggling with polysubstance abuse, we can help. Our trained professionals are here to provide the support you need to regain control over your life. Contact a Recovery Advocate today and begin your journey to a healthier lifestyle.
In addition, we offer several treatment options, including medical detox, inpatient or outpatient rehab, medication-assisted treatment and teletherapy, to provide you with individualized care at our Joint Commission-accredited facility. We also offer the FORTITUDE track for veterans and first responders, as well as eye movement desensitization and reprocessing (EMDR) therapy.