According to the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol is the most commonly abused drug behind tobacco products, and the most commonly abused prescription medications are opiate medications. It should be no surprise then that these two medications are also commonly abused in conjunction with one another.
Alcohol and opioid medications like OxyContin (oxycodone); hydrocodone products such as Vicodin, Lortab, and Norco; morphine; and heroin are central nervous system depressants. The primary mechanism of action for alcohol and opiates involves different neurotransmitters, but the use of both substances also activates some of the same neurotransmitters, like dopamine. Most often, people use alcohol to enhance the effects of opiate drugs and not the opposite, although using opiates to enhance the effects of alcohol does occur occasionally.
Central nervous system depressants slow the functioning of the neurons in the central nervous system, produce a rather relaxed type of euphoria, produce sedation in mild doses and lethargy in higher doses, and often involve similar overall psychoactive effects that most people experience when they drink moderate quantities of alcohol. However, because both of these drugs are central nervous system depressants, taking them at the same time enhances their effects. This means that individuals who use these drugs together will experience the pain-relieving effects of opiates to a higher degree, the interference to their normal level of rational judgment to a higher degree, problems with motor coordination to a higher degree, etc. In addition, the high or “buzz” that either produces is enhanced and occurs more rapidly when they are taken together.
People who chronically use opiates and alcohol together are more apt to develop physical dependence on one or both drugs since both substances are capable of producing severe physical dependence. Mixing alcohol and opiate drugs is never advised by physicians who prescribe opiate drugs for pain control, and individuals who do this recreationally are setting themselves up for some potentially serious problems.
The Dangers of Mixing Opiate Drugs and Alcohol
The information in this article is taken from the books Alcohol and Opiates: Neurochemical and Behavioral Mechanisms, Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment and Addictive Substances and Neurological Disease: Alcohol, Tobacco, Caffeine, and Drugs of Abuse in Everyday Lifestyles. According to these sources, some of the major issues that are associated with the use and abuse of alcohol and opioid drugs include:
- Enhancement of central nervous system depressant effects: As mentioned above, mixing drugs enhances the effects of both drugs. These drugs produce several bodily reactions when taken singularly, and mixing them intensifies these effects. Some of the most concerning are:
- Suppression of breathing rates
- A decrease in heart rate
- A decrease in blood pressure
- Suppressed neuronal firing
- Potential organ damage: Because of the enhancement of the effects of both drugs, individuals need less of either drug to produce serious manifestations of the effects listed above. Of significant concern is the ability of central nervous system depressant drugs to slow down the functions of the neurons in the area of the brain known as the brain stem. The brain stem maintains automatic functions like breathing and heart rate. When taken in sufficient quantities, either alcohol or an opiate drug can significantly slow the actions of the neurons in the brain stem and lead to significant suppression of breathing and heart rate, which can result in a decreased amount of oxygen to tissues and organs. The organ affected first is the brain. When oxygen supply is reduced to the brain, neurons begin to die, and this can lead to significant brain damage that may not be reversible. When taken together, this effect is enhanced.
- Increased chances of overdose: Because both alcohol and opiate drugs have the same primary effect of depressing the functions of the central nervous system, when taken in conjunction, one needs less of either drug to experience an overdose. An overdosed on either drug can be fatal, and the probability that significant brain damage, other organ damage, or a potential fatality can occur as a result of an overdose is enhanced when one mixes these drugs.
- Increased absorption rates: According to research cited in the above sources, there are studies that have suggested that certain combinations of opiates and alcohol can lead to increased absorption and distribution of an opiate drug in one’s system (e.g., codeine). This means that the effects of the opiate drugs are increased even more when taken with alcohol.
- Dumping effects: Taking an extended-release opiate drug with alcohol can alter the mechanism of the extended-release formula. A dumping effect may occur, such that an amount of the drug that was intended to be released slowly over time is suddenly dumped into the person’s system all at once. This can lead to significant issues with overdose and other problems.
- Increased potential for alcohol poisoning: There are some studies that suggest that due to the enhancement of the effects of these drugs when taken together, there is potential that an individual may suffer the effects of alcohol poisoning with lower doses of alcohol.
- Atypical and unpredictable side effects: Mixing different drugs nearly always results in an increased potential that a person will experience side effects that are unusual or unpredictable. This can occur even when the drugs are prescribed by a physician. Because abusers typically use higher amounts of drugs than are prescribed for medicinal purposes, combining alcohol with these drugs may result in very unpredictable effects, including effects that would normally be rare.
- Increased potential for long-term health issues: It should not be a surprise that chronically mixing alcohol and opiates increases the potential for serious long-term effects. Numerous potential long-term health effects can occur, including increased risk to develop many different types of cancer, increased potential to develop cardiovascular issues (e.g., problems with blood pressure, heart attack, stroke, etc.), increased potential to develop liver damage, decreased functioning of the immune system that can lead to an increased risk for infectious disease, an increased risk to develop neurological issues, an and increased risk to develop emotional or psychological issues or disorders.
- Lack of attention to self-care: Related to the above risks, individuals who chronically abuse either opiates or alcohol also tend to neglect self-care and hygiene over time. Abusing both drugs increases this potential. This can lead to more rapid development of long-term physical and emotional issues. In addition, individuals may begin to engage in very risky behaviors or make poor decisions as a result of the cognitive effects of these drugs (see below).
- Cognitive issues: Both alcohol and opiate drugs have significant effects on an individual’s ability to focus, remember things, and make judgments. Chronic use of these drugs can result in permanent issues with these cognitive abilities. Because the enhancement of the effects of taking these drugs together is not limited to just physical issues, individuals may develop cognitive problems as a result of habitually combining these drugs that may not fully remit once one stops using the drugs. Individuals under the influence of these drugs are extremely likely to engage in behaviors that are the result of a loss of inhibitions and rational thinking, and they are extremely prone to self-harm or to contribute to harming others. For instance, under the influence of these drugs, individuals are more likely to share needles, engage in unprotected sex, and operate machinery, such as driving an automobile, when they should not do so.
- Developmental issues: Pregnant women who drink alcohol and use opiate drugs are putting their unborn child at serious risk for developmental problems that may be permanent. Combining these drugs while pregnant increases this risk even further.
- Acetaminophen overdoses: Many prescription opiate drugs, such as Vicodin, also contain the over-the-counter analgesic acetaminophen. High doses of drugs like Vicodin can result in extremely high doses of acetaminophen, which can lead to significant issues, such as the potential to develop liver damage.
- Increased risk for addiction: Chronic abuse of opiate drugs and alcohol together can result in an increased probability to develop a substance use disorder. Individuals who chronically abuse opiates and alcohol may develop very severe forms of physical dependence.
- Increased risk for being diagnosed with another form of mental illness: Individuals with substance use disorders are at increased risk to be diagnosed with some other mental health disorder. Individuals with a substance use disorder and a co-occurring mental health disorder present with very complicated treatment challenges. Polysubstance abusers are at an increased risk to also be diagnosed with another form of mental illness.
- Increased risk for negative ramifications of drug abuse: Individuals who chronically abuse opiate drugs and alcohol are at increased risk to become victims of crime, engage in crime, develop financial difficulties, have difficulties with employment, develop relationship issues, etc. Having a substance use disorder by definition indicates that the individual is suffering significant distress and impairment associated with their substance use, and chronically abusing two or more substances together increases the distress and potential types of dysfunction an individual will experience.
- Increased mortality: Individuals who abuse alcohol and opiates in conjunction are at increased risk for mortality due to accidents, being involved in a crime, overdose, or suicidality.
The National Institute on Drug Abuse has stated that there is a rising rate of individuals between the ages of 18 and 24 being hospitalized for overdoses that consist of alcohol and prescription drugs. These individuals represent the future of the country. Prevention programs to reduce substance abuse should target this particular age group; however, substance abuse affects individuals of all ages.
Anyone who thinks that they have a substance use disorder as a result of chronic abuse of alcohol and/or opiate drugs should seek professional help. These situations do not remit on their own, and the vast majority of individuals cannot control their behavior without professional assistance.