Author: Samantha Bothwell, MA

Misusing opioids and alcohol can be dangerous. When these substances are combined, the risks are significantly higher for long-term, serious consequences.¹

In this article:

• Dangers of Mixing Opioids and Alcohol
• Dangers of Opioid and Alcohol Withdrawal
• Long-Term Effects of Mixing Opioid and Alcohol
  
• Treatment for Opioid and Alcohol Use

Dangers of Mixing Opioids and Alcohol

Opioids are a type of drug sometimes referred to as narcotics and can include prescription medications, such as oxycodone or fentanyl, or drugs like heroin.² Opioids can cause numerous side effects because they are a central nervous system (CNS) depressant, like alcohol.³

A CNS depressant slows brain activity, which can make you feel calm and pain-free. However, other side effects can result from a CNS depressant like opiates or alcohol, including:⁴

• Slurred speech
• Poor concentration
• Confusion
• Headache
• Light-headedness
• Dizziness
• Dry mouth
• Problems with movement and memory
• Lowered blood pressure
• Slowed breathing

These side effects can be a result of opioid or alcohol use alone, but mixing opioids and alcohol can significantly intensify the effects.¹ According to experts on concurrent opioid and alcohol use, someone is considered to combine these substances if they have more than two drinks within two weeks of using opioids.¹

Risk of Overdose on Opioids and Alcohol

Mixing alcohol and opioids increases your likelihood of overdose and resulting life-threatening symptoms.¹ In fact, research shows that a large portion of overdose deaths are due to mixing opioids with another substance.¹ Of these deaths, about 18% were due to mixing alcohol and opioids.¹

Signs of an overdose on a CNS depressant include:^5,6

• Pale or clammy skin
• Limp body posture
• Purple or blue coloring to fingernails or lips
• Vomiting or making gurgling noises
• Excessive sleepiness, not waking up
• Slowed breathing or heart rate
• Seizures
• Irregular breathing
• Extremely low body temperature
• Dulled responses, such as lacking a gag reflex

Overdosing on alcohol and opioids can cause long-term damage to your brain and body and can be life-threatening without immediate medical attention.⁷

Treating an Overdose

If you notice someone is showing signs of overdose, it’s critical to get them medical help as soon as possible. Do not wait until they are showing all the signs of an overdose; take these steps immediately to help save their life:^6,8

• Call 911: Be prepared to give the medical responder as much information as possible, including how much alcohol and opiates someone used.
• Stay with the person until medical help arrives: A common way that someone dies from overdose is by choking on their own vomit. Helping them lean forward or roll over on their side with their ear to the ground can help reduce the risk of choking and suffocating.
• Give them naloxone (Narcan): Someone who uses opioids may carry this medication, which can rapidly reverse an opioid overdose. It can be administered through a nasal spray or an injectable. If this isn’t available, then the first responders will give it and transport the patient for further medical care and treatment.

Dangers of Opioid and Alcohol Withdrawal

Quitting alcohol and opioids abruptly can be dangerous. If you have been using these substances for a while, you might have become dependent on them.⁹

Dependence happens when your body and brain start to rely on opiates and alcohol to function normally. This can make quitting difficult because you will go through withdrawal symptoms as the substance leaves your system.^9,10

Withdrawal can be extremely uncomfortable and even dangerous.² Alcohol withdrawal symptoms include:¹⁰

• Agitation
• Anxiety
• Depression
• Muscle aches
• Feeling jumpy or shaky
• Mood swings
• Nightmares
• Insomnia
• Sweating
• Dilated pupils
• Nausea
• Vomiting

Symptoms of opiate withdrawal include:⁹

• Agitation
• Anxiety
• Muscle aches
• Abdominal cramping
• Insomnia
• Runny nose
• Sweating
• Yawning
• Diarrhea
• Goosebumps
• Nausea
• Vomiting

Withdrawing from alcohol can sometimes lead to a more severe form of withdrawal called delirium tremens. Signs of delirium tremens include:⁷

• Body tremors
• Changes in mental functioning
• Sleeping for a day or longer
• Sudden, severe confusion
• Hallucinations
• Bursts of energy
• Restlessness
• Seizures
• Chest pain
• Fever
• Stomach pain

Withdrawal symptoms can lead to sudden and severe nervous system changes that can cause long-term health issues, including death.⁷ They can also increase the risk of relapse because you might be tempted to use substances again to minimize withdrawal symptoms. Not only can this keep the cycle of substance misuse going, but it increases risk of dangerous symptoms.⁹ Once you experience withdrawal, your tolerance for a substance goes down.

If you go back to using as much of an opioid or alcohol as you were before trying to quit, then you can overdose.⁹ Medical detox centers can be helpful with this process. Medical detox centers provide 24/7 medical supervision and treatment to make the withdrawal process as comfortable and safe as possible.¹¹

Long-Term Effects of Mixing Opioids and Alcohol

There are risks associated with the long-term use of opioids and alcohol together. Mixing alcohol and opioids can increase the risk of: ¹

• Changes in blood pressure
• Insomnia
• Cardiovascular disorders
• Dizziness or loss of coordination
• Gastrointestinal issues
• Mental health symptoms like depression or anxiety
• Emergency room visits due to severe health problems
• Overdose
• Development of a substance use disorder
• Social issues, such as relationship problems or inability to fulfill work or school responsibilities

Long-term effects of opioid use include:¹³

• Constipation
• Sleep-disordered breathing
• Abnormal brain function

Alcohol misuse can also lead to negative, long-term health consequences. These include:¹⁴

• High blood pressure
• Heart disease
• Stroke
• Liver disease
• Digestive problems
• Cancer
• Weakened immune system
• Learning and memory problems

There are also health risks for injecting and snorting opioids. Injecting opioids can increase the risk of:^12,15

• Contracting viruses such as hepatitis or HIV
• Collapsed veins
• Infection of the heart lining and valves
• Abscesses

Health risks for snorting opioids include:¹⁵

• Damaged nasal tissues
• Lung complications

Treatment for Opioid and Alcohol Use

Mixing alcohol and opioids is an indicator of polysubstance abuse, which means that you misuse a combination of medications, illicit drugs, and/or alcohol. Getting treatment for polysubstance addiction is important to ensure a safe withdrawal process and stable recovery.

Treatment will also work to help you change beliefs and behaviors related to drug use, develop healthy coping skills, and stay engaged and compliant with the treatment programs.² Polysubstance abuse is best treated with an intensive, usually inpatient, program. Such programs include:²

• Inpatient hospitalization: You may need hospitalization if you have medical issues because of substance use. This tends to be short-term and can get you medical stability to continue treatment safely.
• Residential/Inpatient Rehab: Residential treatment is intensive, 24/7 care that can vary in length. Usual programs last between 30-90 days, but some can provide care for several months. This treatment option can be helpful if you are struggling with mixing alcohol and opioids in your current environment and require as much support as possible to reach and maintain lasting recovery.
• Intensive outpatient programs: Intensive outpatient programs allow you to live at home while attending treatment several hours per day, several days per week.

Several behavioral therapies may be incorporated into treatment for opioid and alcohol misuse. These include:¹¹

• Medication-Assisted Treatment (MAT): MAT combines medication with traditional counseling techniques, such as cognitive-behavioral therapy (CBT). This approach is used primarily for opioid use disorder. Medications can help prevent relapse by blocking the positive effects of opioids or reducing cravings and withdrawal symptoms.
• Cognitive-Behavioral Therapy (CBT): CBT is a type of therapy that aims to help you change your behavior by changing your thought processes and developing new coping skills.
• 12-Step Facilitation Therapy: Support groups to address opioid and alcohol use disorder might include Narcotics Anonymous or Alcoholics Anonymous.

If you feel that you could benefit from treatment for mixed opioid and alcohol misuse, please call 800-934-1582(Who Answers?) to speak with a specialist.

Resources

1. Saunders, K., Von Korff, M., Campbell, C.I., Banta-Green, C., Sullivan, M., Merrill, J., Weiser, C. (2012) Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: Prevalence and risk factors. The Journal of Pain, 13(3), 266-275.
2. National Library of Medicine. (n.d) Opioid Misuse and Addiction Treatment.
3. Costardi, J., Nampo, R., Silva, G., Ribeiro, M., Stella, H., Stella, M., Malheiros, S. (2015) A review on alcohol: from the central action mechanism to chemical dependency. Revista da Associacao Medica Brasileira (1992), 61(4), 381–387.
4. National Institute on Drug Abuse. (n.d) Prescription CNS Depressants DrugFacts
5. National Library of Medicine. (n.d) Opioid Misuse and Addiction.
6. National Institute on Alcohol Abuse and Alcoholism. (n.d). Understanding the Dangers of Alcohol Overdose.
7. National Library of Medicine. (n.d) Delirium tremens.
8. Substance Abuse and Mental Health Services Administration. (2020, August 19). Opioid Overdose
9. National Library of Medicine. (n.d) Opiate and opioid withdrawal.
10. National Library of Medicine. (n.d) Alcohol Withdrawal.
11. Substance Abuse and Mental Health Services Administration. (2021, November 4) MAT Medications, Counseling, and Related Conditions.
12. Centers for Disease Control and Prevention. (2018, July 19). Persons Who Inject Drugs (PWID)
13. Baldini, A., Von Korff, M., & Lin, E.H. (2012) A review of potential adverse effects of long-term opioid therapy: A practitioner’s guide. The Primary Care Companion for CNS disorders, 14(3).
14. Centers for Disease Control and Prevention. (2021, December 29) Alcohol Use and Your Health
15. National Institute on Drug Abuse. (n.d) Heroin DrugFacts