Via different (though sometimes overlapping) mechanisms, both alcohol and drugs can have profound effects on the brain.1 While each substance may have a somewhat differential effect on various neural functions and the physiological processes that they control, certain combinations may result in dangerously synergized intoxicating effects, which can lead to serious adverse consequences for the user.27

Alcohol also affects our feelings, sometimes in conflicting ways, such as causing sentiments of happiness and excitement as well as sadness and depression.2 These effects can be short- or long-term. Some instant behavioral and cognitive outcomes include delayed response times, slurred speech, trouble walking, and diminished memory.3 Long-term consequences of alcohol abuse can be more severe and even irreparable. These can include physical health problems like cirrhosis of the liver and cognitive problems such as memory loss.

OxyContin, an opioid generally prescribed for significantly severe pain conditions. As their primary indication for treatment, opioid agonist medications like OxyContin bind to and activate opioids receptors in throughout the brain and spinal cord to alter the perception of pain signaling.4 However, the full spectrum of physiological effects does not stop there, as oxycodone use may also impact vital respiratory and cardiovascular processes.

Since alcohol itself is a CNS depressant, it also its own physiological impact on important processes such as breathing and cardiovascular function. Because on their own, both can have dangerous side effects, when combined, they create more severe and possibly life-threatening outcomes.5

Statistics on Alcohol and Opioid Use

Given the staggering prevalence in opioid and alcohol abuse,6,7 the potentially devastating health risks posed by this combination of substances deserves closer attention.

U.S. & Global Alcohol Facts

  • As of 2018, alcohol is the third leading preventable cause of death in the United States, leading to an estimated 88,000 fatalities a year.20
  • Globally, 3 million deaths from harmful use of alcohol occur every year, representing 5.3% of all deaths.21
  • Overall 5.1% of the global burden of disease and injury is attributable to alcohol.21
  • 1 million adults—9.8 million men and 5.3 million women ages 18 and older—had an alcohol use disorder (AUD) in 2015.20
  • In 2015, only 6.7% of adults who had AUD in the past year received treatment.20
  • 6 million people ages 12 and over reported binge drinking in the month prior to the 2017 National Survey on Drug Use and Health (NSDUH).22

U.S. & Global Opioid Facts

  • According to the 2017 NSDUH, an estimated 2 million Americans misused prescription painkillers for the first time within the past year.22
  • 1 million people had an opioid use disorder between 2016-2017.7
  • More than 130 people died each day from opioid overdose from 2016-2017.7
  • 17,087 people overdosed from commonly prescribed opioid pain medications between 2016 and 2017. 7
  • Opioid-related emergency room visits increased 30% from 2016-2017. 6
  • In the U.S., both the sales of and deaths related to prescription opioids have quadrupled since 1999.6
  • People are 40 times more likely to develop an addiction to heroin if already addicted to prescription opioid painkillers.6
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Combining OxyContin with Alcohol

How the effects of both alcohol and OxyContin are felt will be influenced by several factors, including age, gender, body weight, and the presence of any tolerance.

Common side effects of alcohol use include:2,27

  • Memory loss.
  • Irregular or slowed breathing.
  • Slow reaction time.
  • Difficulty processing sensory information.
  • Depressed mood.
  • Increased risk for suicide.
  • Motor incoordination, resulting in slurred speech, difficulty walking, etc.
  • Impaired judgment and decision-making.

Opioid side effects, including some that resemble those of alcohol use, include:8,27

  • Drowsiness.
  • Fatigue.
  • Respiratory depression or arrest (slowed or stopped breathing).
  • Confusion.
  • Dizziness.
  • Decreased energy levels and strength.
  • Dry mouth, nausea, and vomiting.
  • Constipation.
  • Itching and sweating.

Short-Term Side Effects

Alcohol may enhance the effects of some concurrently-taken drugs; this includes both prescription and illicit drugs. 9 Short-term side effects of combining OxyContin and alcohol can include: 10

  • Sedation.
  • Drowsiness.
  • Impairment in motor skills.
  • Impairment in the ability to operate a vehicle.
  • Memory problems.
  • Unusual behavior.
  • Difficult or slowed breathing.
  • Respiratory arrest.
  • Increased risk of overdose.

Long-Term Health Risks

Chronic use of both alcohol and OxyContin can also have serious long-term consequences. Health risks of heavy alcohol use alone include:2

  • Chronic liver inflammation and damage.
  • Cirrhosis.
  • Increased risk of liver cancer.
  • Gastritis.
  • Atrophy of the brain.
  • Memory loss.
  • Chronic hypertension.
  • Cardiac arrhythmias.
  • Increased vulnerability to acquiring cancer in the stomach, pharynx, mouth, and esophagus.

Combined with OxyContin use, those long-term effects can also include:

  • Increased risk for risk of aspiration and/or asphyxiation which could lead to injury or death due to reduced cough reflexes and increased risk of vomiting when highly intoxicated.9
  • Increased risk of being unable to breathe due to a reduction in respiratory drive. 9

Along with their individual short- and long-term side effects, using alcohol in combination with OxyContin or other opioid pain relievers is a very dangerous combination. Because these drugs suppress areas in the brain that control vital functions such as breathing, consuming alcohol could produce an overdose by intensifying their individual effects.27

Specialized Treatment Programs For Polysubstance Use

When a person is physically dependent on either alcohol or OxyContin, or both, a medical detox program may be needed to allow for withdrawal management in a safe, stable, and medically-monitored environment. Withdrawal symptoms can be significant and include both physical and emotional symptoms; medical detox avails certain medications to alleviate some of these potentially-unpleasant symptoms, decrease the risk of experiencing certain withdrawal complications and, even, decrease cravings as an individual embarks on their recovery efforts.28

The acute alcohol withdrawal syndrome can be life-threatening because of the potential for seizure development. Some individuals are at risk of developing an extreme presentation of alcohol withdrawal known as delirium tremens (DTs), which can include hallucinations, severe mental confusion, fever, and seizures.29 It is not always easy to predict who is at risk for severe and/or complicated alcohol withdrawal, but may be even more of a challenge in cases of polysubstance use.

Opioids and alcohol are two substances that should not be stopped “cold turkey” due to the likelihood for significantly unpleasant, and potentially dangerous withdrawal symptoms.28 When two or more substances are combined, such as alcohol and OxyContin, withdrawal can be even more unpredictable than with either substance alone; in such an instance of polysubstance withdrawal, medications are quite likely to be needed to manage difficult withdrawal symptoms.

A medical detox team familiar with compound withdrawal syndromes will work carefully to monitor for and medically manage withdrawal symptoms and decreasing the likelihood of complications such as seizures, agitation, and other acute withdrawal-related health issues. Medical and mental health professionals on staff at a medical detox program will monitor vital signs and apply various interventions to stabilize a person in early recovery as prepare to continue on with additional addiction treatment.

When polysubstance abuse or co-occurring disorders are present, a residential addiction treatment program is a frequently sought treatment setting, as it may be best equipped to provide 24/7 monitored care, structure, encouragement, and support.30 Individuals are able to focus fully on recovery and their overall health and wellbeing in a comprehensive inpatient addiction treatment program. A specialized addiction treatment program may use a combination of therapy, counseling, support groups, holistic measures, and medications to boost overall wellness and sustained recovery.30

Further Reading on Mixing Alcohol With Other Opiates

Sources

[1]. U.S. National Library of Medicine. (2014). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies.

[2]. National Institute on Alcohol Abuse and Alcoholism. (n.d.) Alcohol’s Effects on the Body.

[3]. National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol alert.

[4]. National Institute on Drug Abuse. (2007). Prescription drugs.

[5]. University of Michigan. (n.d.). The effects of combining alcohol with other drugs.

[6]. Center for Disease Control and Prevention. (2016). Alcohol and drug use.

[7]. U.S. Department of Health and Human Services. (2018). The opioid epidemic by the numbers.

[8]. Center for Disease Control and Prevention. (2017). Prescription opioids.

[9]. Weathermon, R. & Crabb, D.W. (1999). National Institute on Alcohol Abuse and Alcoholism. Alcohol and medication interactions. Alcohol Research & Health. 23(1), 40-54.

[10]. National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing alcohol with medicines.

[11]. American Society of Anesthesiologists. (2017). Mixing opioids and alcohol may increase likelihood of dangerous respiratory complication, especially in the elderly, study finds.

[12]. U.S. National Library of Medicine. (n.d.). Substance abuse treatment for persons with co-occurring disorders.

[13]. National Institute on Alcohol Abuse and Alcoholism. (n.d.) Treatment of co-occurring alcohol and other drug use disorders.

[14]. U.S. National Library of Medicine. (2004). Alcohol withdrawal syndrome.

[15]. U.S. National Library of Medicine. (2019). Alcohol withdrawal.

[16]. U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.

[17]. U.S. National Library of Medicine. (2009). Co-occurring disorders in substance abuse treatment: Issues and prospects.

[18]. U.S. National Library of Medicine. (2016). Facing addiction in America; The Surgeon General’s report on alcohol, drugs and health: Chapter 4.

[19]. Sullivan EV, Harris RA, Pfefferbaum A. (2010). Alcohol’s effects on brain and behaviorAlcohol Res Health. 33(1-2):127–143.

[20]. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics.

[21]. World Health Organization. (2018). Alcohol.

[22]. Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). 2017 National Survey on Drug Use and Health.

[23]. MedlinePlus. (2019). Substance Use Disorder.

[24]. American Psychiatric Association. (2013). Substance Use Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 483-484.

[25]. Center for Substance Abuse Treatment. (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series, No. 43. Chapter 12.

[26]. Carroll K. M. (2004). Behavioral therapies for co-occurring substance use and mood disordersBiological psychiatry56(10), 778–784.

[27]. National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding the Dangers of Alcohol Overdose.

[28]. Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. Alcohol Withdrawal SyndromeAmerican Family Physician 69(6): 1443-1450.

[29]. Rahman A, Paul M. (2018). Delirium Tremens (DT)U.S. National Library of Medicine.

[30]. National Institute on Alcohol Abuse and Alcoholism. (2018). Common Comorbidities with Substance Use Disorders.