Is it Safe to Combine Alcohol with Narcotics?

Alcohol is legal in the United States for people 21 and older, and many narcotic drugs are available through prescriptions if one suffers from moderate or severe pain. While these drugs are legal in certain situations, both narcotic substances and alcohol can be very dangerous. These substances can lead to addiction, overdose, chronic health disorders, and death.

When combined, alcohol and narcotics are even more deadly. Both of these substances are central nervous system (CNS) depressants, meaning they slow the brain’s processes, induce a sense of relaxation and tiredness, and release calming neurotransmitters. This can be addictive for some people, and the combination of drugs can rapidly cause an overdose, as the substances compound each other’s effects.

Americans Drink Alcohol More than Ever Before

According to the National Survey on Drug Use and Health (NSDUH) from 2015, 86.4 percent of adults in the US, ages 18 and older, reported drinking alcohol at least once in their lives. Over 70 percent of those adults reported drinking alcohol at least once in the prior year, and 56 percent reported drinking alcohol in the prior month. For the most part, these patterns of consumption are not bad; many people drink moderately or occasionally drink enough to experience a hangover. However, according to more than one survey, Americans are drinking more than before, and rates of problem drinking are increasing among all socioeconomic and gender groups.

The Journal of the American Medical Association (JAMA) examined data from several surveys and reported that American adults drank in excess and developed more alcohol use disorders (AUDs) between 2001-2002 and 2012-2013.

  • Past-year alcohol use increased 11.2%.
  • High-risk drinking increased 29.94%.
  • AUD rates increased 49.4%.

Women had the greatest increase in excessive drinking patterns, although women are more prone to developing AUD.

  • High-risk (binge) drinking increased 60%.
  • AUD prevalence rose 84%.

Older adults, starting at age 65, also increased their problem drinking.

  • Binge drinking increased 65%.
  • Rates of AUD increased 107%.

Women and older adults are more likely to receive prescription medications, especially sedatives and opioid painkillers, than other demographic groups. With rates of drinking on the rise across the board, it is much more likely that anyone taking prescription medications will mix these drugs with alcohol. It is also much more likely that people who struggle with addictions to other substances, like narcotics, will also drink – either to increase the potency of the narcotic substance or accidentally.

US Adults Consume More Narcotic Drugs than the Rest of the World

The general term narcotic comes from the ancient Greek word for “stupor,” as drugs derived from the opium poppy have been known for thousands of years to ease pain, cause sleepiness, and lead to a relaxing, addictive high that dulls the senses. Modern narcotics include opium, and all opioids are synthetic drugs derived from opium.

Starting with morphine in the 19th century, the most abused opioid drugs in the 21st century, according to the Centers for Disease Control and Prevention (CDC), include:

  • Heroin
  • Fentanyl
  • Oxycodone
  • Hydrocodone
  • Codeine
  • Methadone

The CDC found that, since 2015, about 91 people die in the US every day from opioid overdoses, including on illicit and prescription narcotics. Americans use more opioid drugs than any other country in the world. Although prescription narcotics are being much more closely monitored by regulatory agencies, and doctors are prescribing smaller courses of painkillers to treat post-injury or post-surgery pain, the US still tops all of the countries in the “top 25 list” for most opioids consumed. According to the National Institute on Drug Abuse (NIDA):

  • Between 21% and 29% of people who receive prescriptions for opioid painkillers begin to abuse these drugs for nonmedical reasons.
  • Between 8% and 12% develop an addiction to these narcotics.
  • Between 4% and 6% transition to heroin abuse, especially when they can no longer obtain prescription narcotics.
  • About 80% of those who currently abuse heroin started abusing prescription narcotics first.

With so many people receiving prescription narcotics, beginning to misuse or abuse them, and transitioning to illicit narcotics like heroin, the likelihood that a person may combine opioids and alcohol is very high. This combination is extremely dangerous.

Concerns of Mixing Alcohol with Opiates

Mixing Alcohol with Narcotics Can Be Lethal

Opioid prescriptions in the US come with warnings, from the prescribing physician and on the pill bottle itself, not to mix these drugs with alcohol. Even taking a prescription painkiller like Vicodin or Percocet with a moderate amount of alcohol can dangerously depress breathing, according to a recent study.

In 2010, the CDC found that alcohol was involved in numerous opioid and benzodiazepine overdoses and deaths. A survey of information across 13 states reported that alcohol was involved in 18.5 percent of opioid-related emergency room admissions and 22.1 percent of opioid-related deaths. This does not count data involving all three CNS depressant drugs: alcohol, narcotics, and benzodiazepines.

NIDA reported that teenagers still mix opioids and alcohol, along with other drugs, at high rates. Although general rates of teen opioid and alcohol abuse are going down, adolescents who abuse one substance are more likely to abuse multiple substances. The data showed that seven out of ten adolescents who struggled with nonmedical opioid abuse mixed opioids with other drugs, with 52.1 percent involving a combination of alcohol and narcotics. This mixture is dangerous enough for adults; teens who begin abusing substances are likely to struggle with addiction to other substances for the rest of their lives, damage their brains since they are still developing, and suffer chronic health issues requiring long-term care.

Research published by the American Society of Anesthesiologists (ASA) reported that taking even one oxycodone tablet with a modest amount of alcohol amplified the chances of respiratory depression, which is the main symptom of an opioid overdose. In healthy volunteers between 21 and 28 years old, and older adults between 66 and 77 years old, researchers administered one oxycodone tablet with 20 mg of the narcotic painkiller; then, they administered ethanol intravenously, to control how much the volunteers “drank” during the sessions. The first session involved a placebo rather than ethanol; the second provided volunteers with the equivalent of a moderate daily amount of alcohol, or one drink for women and up to three drinks for men; and the third session involved low-level binge drinking, or three drinks for women and five drinks for men. The study found that one oxycodone tablet alone, with no alcohol, reduced breathing by 28 percent; adding moderate amounts of alcohol reduced breathing a further 19 percent, for a total decrease of 47 percent. The study reinforced the synergistic relationship between alcohol and narcotics – that each substance enhances the other’s side effects, including low breathing rate, low heart rate, sleepiness, and risk of overdose.

Those who receive prescriptions for opioid medications must follow their physician’s directions: Take the medication as prescribed, in the amounts prescribed, and do not drink alcohol while taking painkillers. People who have a history of alcohol use disorder should speak with their doctor about this condition because they may be at higher risk of developing an addiction to opioids. Anyone who suffers from addiction to alcohol, narcotics, or both should seek help immediately. There are many evidence-based rehabilitation programs with professionals who understand alcohol or opioid addiction, and they can help.

Many programs are equipped to treat polydrug abuse, including abuse of both alcohol and narcotics. This combination of substances can rapidly lead to overdose death, so appropriate treatment is vital.