Opioids and Alcohol: A Dangerous Combination

Dangers of Mixing Opioids and Alcohol

Opioids are a type of drug often referred to as narcotics and includes prescription medications, such as oxycodone or fentanyl, or drugs like heroin.² Opioids can cause numerous side effects because they are central nervous system (CNS) depressants, 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 CNS depressants, including the following: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 occur from opioid or alcohol use alone, but mixing opioids and alcohol significantly intensifies the effects.¹ According to experts, mixing can even include instances when someone has 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 experiencing life-threatening symptoms.¹ In fact, a 2025 Pew report shows that almost 70,000 people who died from a synthetic opioid overdose also had other stimulants in their systems.

Here are signs of an overdose due to CNS depressants:^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 is life-threatening. Seek immediate medical attention.⁷

Treating an Overdose

If you notice someone is showing any signs of overdose, it’s critical to get them medical help as soon as possible. Don’t 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 reduces 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 naloxone isn’t available, 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’ve 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’ll go through withdrawal symptoms as the substance leaves your system.^9,10

Withdrawal is generally 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 create sudden and severe nervous system changes that cause long-term health issues, including possible death.⁷ They tend to increase the risk of relapse because you might be tempted to re-use substances to minimize withdrawal symptoms. This keeps the cycle of substance misuse going and increases risk of dangerous symptoms.⁹

Once you experience withdrawal, your tolerance for a substance decreases. This means that going back to the same amount of an opioid or alcohol as you did before quitting can create an overdose.⁹

Medical detox centers can be helpful with withdrawal. Medical detox centers provide 24/7 medical supervision and treatment to make the withdrawal process as comfortable and safe as possible.¹¹

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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 like the following:¹⁴

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

Injecting and snorting opiods also carry health risks. 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 a combination of medications, illicit drugs, and/or alcohol. Getting treatment for polysubstance addiction is critical to ensure a safe withdrawal process and stable recovery.

Treatment will also 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 services are: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 duration. Usual programs last between 30-90 days, but some offer care for several months. This treatment option can be helpful for those who are tempted to mix 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.

Behavioral therapies may be incorporated into treatment for opioid and alcohol misuse. This can consist of: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 disorders. Prescribed methadone or buprenorphine can prevent relapse by blocking the positive effects of opioids or reducing cravings and withdrawal symptoms.
Cognitive behavioral therapy (CBT): CBT aims to change your behavior by guiding our thought processes and developing new coping skills.
12-Steps: 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(Sponsored) to speak with a specialist.

Resources

Lawson, S., Bryant, J., Freund, M., Dizon, J., Haber, P.A., Shakeshaft, A., Jeffries, M., & Farrell, M. (2024). Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse. Drug and Alcohol Review, 43(5): 1194-1203.
National Library of Medicine. (2024). Opioid misuse and addiction treatment.
Haber, P. S. (2025). Identification and treatment of alcohol use disorder. The New England Journal of Medicine, 392(3): 258-266.
United States Drug Enforcement Administration. (2024). Depressants.
National Library of Medicine. (2024). Opioids and opioid use disorder (OUD).
National Institute on Alcohol Abuse and Alcoholism. (2025). Understanding the dangers of alcohol overdose.
National Library of Medicine. (2025). Delirium tremens.
Substance Abuse and Mental Health Services Administration. (2020, August 19). Opioid overdose prevention and reversal.
American Society of Addiction Medicine. (2020). The ASAM national practice guideline for the treatment of opioid use disorder.
National Library of Medicine. (2025). Alcohol withdrawal.
Substance Abuse and Mental Health Services Administration. (2025). Substance use disorder treatment options.
Centers for Disease Control and Prevention. (2024). Infectious diseases for persons who inject drugs.
Bicket, M. C. & Bateman, B. T. (2025). Long-term opioid therapy for pain: What is known about harms–and still not known about benefits. JAMA, 334(12):1057-1058.
Centers for Disease Control and Prevention. (2025). Alcohol use and your health.
United States Drug Enforcement Administration. (2025). CY 2023 annual heroin report.

the Take-Away

Misusing opioids and alcohol are 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 …

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