Mixing Alcohol and Codeine (lean)
Dangerous
How strong codeine is varies hugely from person to person, and alcohol adds its own slowed breathing on top. Do not combine. Keep naloxone nearby.
The lean pairing, and the reason it kills people who thought they were being moderate. Codeine's conversion to morphine varies enormously between people — ultrarapid CYP2D6 metabolisers, roughly 1-2% of Europeans and up to 28% in some North African populations, produce metabolite levels as much as 45 times higher than poor metabolisers from an identical dose. You do not know which you are until it matters. Alcohol adds its own respiratory depression to a dose whose real strength is unknowable, and cough syrup formulations make it easy to drink far more than intended.
The risk here is to the body — breathing, heart, temperature or organs. Set limits before you start, because this kind of harm does not announce itself in time to react.
Headspace vs physical riskWhat to do
- Say what was taken and how much.Responders need it, and in most US states Good Samaritan laws protect both of you from drug possession charges when you call for an overdose.
- Unresponsive: put them on their side, tilt the head back, and stay until help arrives.Never leave someone alone to “sleep it off”.
- Give naloxone (Narcan) if you have it.It is sold over the counter in every US state and does no harm if opioids turn out not to be involved.
- Never Use Alone 1-800-484-3731Stays on the line and sends help if you stop responding.
- Full steps: what to do if it is already happeningOverdose signs, the recovery position, what to say on the call, and whether you can be charged for making it.
- Poison Control 1-800-222-1222Free and 24/7, for “is this bad?” before it becomes an emergency.
Can you mix Alcohol and Codeine (lean)?
MixSafe rates mixing Alcohol and Codeine as "Dangerous" — high risk of death or life-changing injury. Do not combine. Source: MixSafe research. Educational information, not medical advice.
- Codeine
- Weak, but metabolised unpredictably between people
- Alcohol also called
- alc, booze, beer, wine, liquor, ethanol
- Codeine also called
- lean, purple drank, co-codamol, dihydrocodeine
- Codeine Intoxication Associated with Ultrarapid CYP2D6 Metabolism. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa041888
- Codeine Therapy and CYP2D6 Genotype. Medical Genetics Summaries, NCBI. https://www.ncbi.nlm.nih.gov/books/NBK100662/
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Checking more than two?
Combinations of three or more carry risks that no pair-by-pair chart can show. The checker rates every pair at once and flags the whole-mix ones on top.
Open this in the checkerRelated combinations
All combinations →Rated dangerous. Educational information only, not medical advice. Absence of a documented interaction is not evidence of safety.