Mixing Alcohol with Opiates

It is generally understood that individuals who take prescription medications should not use alcohol in excess. Individuals who suffer from issues with pain may often turn to alcohol as a means to self-medicate because alcohol is a central nervous system depressant drug. Central nervous system depressants act on the brain and spinal cord by decreasing the rate of firing of the neurons. This results in a number of sedative effects, including the suppression of pain.

Opiate drugs are large class of drugs that include illegal drugs like heroin and drugs that are medicinally used for the control of pain in addition to other medical uses. This class includes drugs like morphine, codeine, Vicodin (and other similar drugs like Norco and Lortab that contain hydrocodone and acetaminophen), OxyContin (oxycodone), methadone, Suboxone, etc. These drugs are also major central nervous system depressants, and their use results in a dampening of the firing of the neurons in the brain and spinal cord.

The Risks of Mixing Opiate Drugs and Alcohol

Sources, such as the books Concepts of Chemical Dependency, Alcohol and Opiates: Neurochemical and Behavioral Mechanisms, and Drug Interactions: Analysis and Management, indicate that there are several general issues that can result from individuals mixing alcohol and opioid drugs.

  • Mixing these drugs can result in the enhancement of effects. This means that the effects that the drugs normally produce when they are taken individually are increased and often to an unpredictable level. Some of these enhancement effects include:
  • A sharp decrease in rate of breathing
  • A sharp decrease in heart rate
  • A sharp decrease in blood pressure

The effects of opiate drugs and alcohol include the suppression of the neurons that work in an area of the brain known as the brain stem. This area of the brain controls several automatic and life-sustaining functions that include respiration rate, heart rate, etc. Combining alcohol and opiate drugs enhances these effects and can result in dangerous suppressions of these life-sustaining bodily functions.

This can lead to very serious physical effects, including hypoxia (decreased oxygen to organs like the brain) and/or anoxia (a total lack of oxygen to vital organs). When these conditions occur, there is serious potential for brain damage and even fatal consequences. Other enhancement effects, such as severe issues with motor coordination, slurred speech, problems with balance, etc., also occur as a result of this interaction.

  • The enhancement of effects also extends to the effects that these drugs have on an individual’s cognition or thinking abilities. Individuals taking combinations of alcohol and various opiate drugs will suffer severe declines in their cognitive capacity that can include issues with memory, spatial perception of objects in the environment, and issues with judgment and reasoning.
  • There are some studies that suggest that using alcohol with certain types of opiate drugs (e.g., Demerol, codeine, etc.) may actually result in increased absorption and distribution of the opiate drug. This means that the effects of the specific opiate drug may be significantly enhanced beyond what would be expected when the drug is taken by itself normally, or beyond what would be expected from normal enhancement effects due to combining these drugs.
  • Some opiate drugs have extended-release forms (e.g., certain types of morphine) and using alcohol with the drug may result in alterations to the mechanism of extended release. Some studies suggest that there may be a dumping effect in these instances where the drug that was intended to be released over a lengthier period of time is released all at once due to its interaction with alcohol. There is some controversy regarding this issue, but it remains a significant concern.
  • Some studies have suggested that combining alcohol with drugs like methadone slow the metabolism of the methadone and this can result in issues with toxicity and overdose as individuals continue to take the drug. Because the opiate drugs and alcohol have similar actions when individuals mix them there is an increased potential for overdose. The effects of the drug are enhanced and the level of each drug that can produce overdose effects is sharply reduced. So, for instance the more alcohol a person has used will lower the threshold for overdose from using an opiate drug like Vicodin and vice versa.
  • A number of unpredictable interactions and effects can occur as a result of mixing opiate drugs and alcohol. For instance, side effects associated with these drugs may be enhanced, or individuals may develop side effects that are atypical of either drug individually. Because there are variations in everyone’s metabolism and emotional makeup, these specific types of potential interactions are unpredictable. Individual differences may result in a person reacting in a totally atypical manner to a combination of these classes of drugs, and this can make things extremely difficult to treat.
  • Individuals who chronically abuse alcohol and opiate drugs together are also setting themselves up for a number of potential long-term issues that are enhanced as a result of using these drugs individually. For instance, combining drugs like alcohol and opiates results in increased risk of developing diseases such as liver disease (including cirrhosis and/or cancer), gastrointestinal issues (including issues with ulcers and cancer), cardiovascular issues (including issues with potential heart conditions, arteriosclerosis, increased risk for stroke, etc.), and neurological issues (issues with brain damage or the development of dementia). In general, it can be assumed that chronic use of any one particular substance will increase the risk for an individual to develop a number of potential health issues, and chronically abusing more than one substance with obviously increases risk even further.
  • Individuals who abuse alcohol and opiate drugs are also at risk for the development of diseases such as HIV or hepatitis as a result of poor sanitary practices.
  • Some opiate drugs contain the nonprescription analgesic drug acetaminophen (e.g., Vicodin). Large doses of acetaminophen over time are associated with a number of issues, including potential liver damage. Taking large doses of acetaminophen with alcohol increases this risk.
  • Pregnant women abusing opiate drugs and alcohol increase the risk of developmental disorders in their children, including issues with fetal alcohol syndrome, neonatal abstinence syndrome (having unborn children develop physical dependence on drugs), and other issues.
  • The chronic combination of opiate drugs and alcohol will increase the risk that an individual will develop a substance use disorder to either one or both of these drugs. This results in a very complex situation when individuals are going through the withdrawal process for these drugs, or they are being treated for co-occurring substance use disorders.
  • Individuals with substance use disorders are at higher risk to also be diagnosed with other mental health disorders that can include issues with anxiety-related disorders, depressive-related disorders, psychotic disorders, personality disorders, trauma- and stress-related disorders, etc.
  • Individuals with polysubstance abuse are at higher risk to be the victims of crime or to engage in self-harm. The increased potential to engage in activities that can lead to harming oneself include unintentional actions, such as being involved in accidents or harming oneself due to poor judgment, and an increased risk for intentional self-harm, such as the development of suicidal thoughts.

The potential serious issue of combining alcohol and opiate drugs occurs over all age groups. It is a particular concern for younger individuals between the ages of 18 and 24. Research from organizations such as the National Institutes of Health indicates that hospitalizations for this particular age group have increased significantly due to combined drug and alcohol overdoses. Thus, it is extremely important to educate the public regarding the dangers of combining alcohol and other drugs, particularly other potentially dangerous drugs of abuse such as opiate medications.

Individuals who are concerned that they, or someone they know, are engaged in potentially dangerous use of alcohol and opiate drugs should consult with a licensed mental health professional. Because there is a significant potential to develop physical dependence on both of these drugs when they are used for significant periods of time, it is not advisable to immediately discontinue use without first consulting with a physician. The withdrawal effects from opiate drugs can be very uncomfortable, but they are not considered to be potentially physically dangerous except in cases where individuals may become dehydrated or emotionally distraught. However, the withdrawal process from chronic alcohol abuse can be potentially fatal as a result of the development of serious seizures that occur in a portion of individuals who have chronic alcohol use disorders. Undergoing withdrawal from both drugs simultaneously can result in a number of unpredictable effects that can include potentially dangerous and even fatal consequences. As a result, medical detox is recommended.