medically reviewed

Mixing Opioid Painkillers and Alcohol

Here's why mixing alcohol with painkillers, opioids / opiates can be a deadly combination. Learn the risks involved with mixing narcotic drugs and alcohol.

Pain medications may range from anything such as ibuprofen to prescription opioids. Also called analgesics or pain relievers, these drugs are used to reduce or relieve a variety of aches and pains.1

There are two main types of over-the-counter, or OTC, pain medicines: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen (Aleve); and acetaminophen (Tylenol).1 Most people are familiar with, and have used, many of these in their everyday lives to relieve pain.

painkillers and alcohol

Regardless of the type of analgesics you’re taking, the general rule of thumb is to avoid consuming alcohol while on pain meds.2,15 In order to determine how to safely use the drug and what other drugs are safe to take with it, you should:

  • Only take the medication at the recommended doses and time intervals listed on the instructions.
  • Avoid drinking more than small amounts of alcohol even if there is no warning about mixing alcohol and the medication that one is taking.
  • Always refer to the patient information insert that comes with medication for information regarding what types of drugs that can and cannot be taken with the analgesic in question.
  • You can always contact your physician or your pharmacist if you have further questions.

What Are Opioids?

When more severe pain is present, you may be prescribed stronger painkillers known as opioids.1 Sometimes called narcotics, prescription opioids include medications such as morphine, hydrocodone, oxycodone, and fentanyl.3 Heroin is also in the opioid class of drugs, though it is an illicit, Schedule I controlled substance, with no recognized medical use.3,16

The various opioid medications are available only by prescription and may be used to manage moderately severe pain, such as that associated with major surgery or injury; increasingly potent opioids may be used to manage more severe pain, such as cancer related pain or certain types of chronic pain.3

Common side effects of opioids may include6,17:

  • Sedation.
  • Dizziness.
  • Mental fog.
  • Slurred speech.
  • Nausea.
  • Vomiting.
  • Constipation.
  • Constricted pupils.
  • Respiratory depression.

Less common side effects may include:

  • Hyperalgesia (i.e., increased sensitivity to pain).
  • Muscle rigidity (i.e., muscle tension, stiffness).
  • Myoclonus (i.e., quick, involuntary muscle jerks).
  • Immunologic and hormonal dysfunction. 

While opioid medications are effective for a variety of pain management needs, their consistent use and, even more so, their misuse can put you at risk of physical dependence and addiction. 

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The Dangers of Painkiller Misuse

In 2018, an estimated 10.3 million Americans misused prescription opioids, with 2 million of those people having misused these drugs for the first time.4 Further, as some people may eventually switch from relatively difficult-to-obtain pharmaceuticals to illicit sources of opioids, prescription opioid misuse may sometimes lead to heroin use.3 In 2018, more than 800,000 people used heroin, and roughly 10% of those used the drug for the first time.4

Both chronic use and consistent nonmedical misuse of prescription opioids is associated with some degree of physical dependence. The misuse of these drugs at doses and on schedules that exceed prescribed guidelines can hasten the development of dependence and drive the compulsive patterns of use seen in people with opioid addictions. When a person has developed a significant level of physical dependence, unpleasant opioid withdrawal symptoms may develop should use of the drug slow or stop.5

According to Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid withdrawal include insomnia, body aches, nausea/vomiting, diarrhea, watery eyes or runny nose, excessive yawning, dilated pupils and light sensitivity.6

Signs and Symptoms of Opioid Addiction

Although not everyone who uses opioids will become addicted, continuous problematic use may increase the risk of significant adverse health issues. Addiction develops as a person loses control over many aspects of their lives due to drug use yet continues to use knowing the negative consequences of their drug use.13

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person who must meet at least 2 of the following criteria within a 12-month period to receive a diagnosis of an opioid use disorder: 14

  • Cravings, or strong urges to use.
  • Being unable to cut back on opioid use.
  • Continuing use despite knowing that you have a psychological or physical problem that is likely the result of opioid use.
  • Taking opioids in higher amounts or more frequently than originally intended.
  • Continuing opioid use despite having persistent or recurring interpersonal or social problems due to substance use.
  • Spending a lot of time obtaining, using, and recovering from the effect of opioids.
  • Using opioids in situations where it is physically dangerous to do so (e.g., driving).
  • Failing to fulfill major obligations at work, home, or school due to opioid use.
  • Giving up important recreational, social, or work activities because of opioid use.
  • Tolerance, meaning that you need larger amounts or more frequent doses of opioids to achieve prior results.
  • Withdrawal symptoms when you try to quit, such as sweating, muscle aches, or diarrhea. 

Note: When it comes to alcohol use disorders, a similar set of criteria is used to make a diagnosis. 

Mixing Opioids with Alcohol

Both opioids and alcohol abuse can damage the brain and body, the combination of these two substances can be additionally dangerous. For instance, combining them could intensify the sedative and respiratory depressing effects of both, increasing the risk of respiratory arrest, unconsciousness, coma, overdose, or death.7

painkillers and alcohol

Opioid-related respiratory depression can result in severe oxygen deprivation and long-term brain damage; these risks may be increased when opioids are combined with alcohol and other central nervous system depressants. When breathing becomes sufficiently slowed, it can impact the amount of oxygen that reaches the brain. This condition is referred to as hypoxia, and it can quickly result in coma or become fatal.8

Is It Safe to Stop Drinking Alcohol On My Own?

While stopping use of both alcohol and opioids is in a person’s best interest, it can be difficult, if not dangerous, to go through detox without the supervision of a medical professional. Though opioid withdrawal symptoms may be severely unpleasant on their own, people who are additionally alcohol-dependent and stop drinking suddenly may experience a risky acute alcohol withdrawal syndrome; such a situation of a combined alcohol and opioid dependence can increase the likelihood of an additionally severe or complicated withdrawal than when attempting to stop the use of either substance on its own.

Symptoms of alcohol withdrawal, which can be severe and lethal in some instances, can include:9,10

  • Fatigue.
  • Irritability.
  • Mood swings.
  • Sweating or clammy skin.
  • Headaches.
  • Rapid heart rate.
  • Chronic memory disorder.
  • Anxiety.
  • Depression.
  • Sleep disturbances.
  • Persistent alterations in mood and behavior even after acute withdrawal has ended.
  • Seizures.
  • Delirium tremens, a serious complication that can lead to hallucinations, mental confusion, and disorientation.

Medical detox can help people manage withdrawal from more than one substance. With supervision and support, as well as specific pharmaceutical interventions, medical detox for polysubstance use involving alcohol and opioids can help you safely and comfortably eliminate both substances from your body.18 When the risks of a severe or complicated withdrawal are relatively high, inpatient withdrawal management may be needed to keep a person as safe and comfortable as possible.18

In an inpatient or residential treatment setting, medical detox is able to provide 24/7 monitoring by a medical team who can assess patient progress, address any co-occurring medical or psychiatric issues, administer medication, and provide other types of support during the withdrawal process so that you are kept safe and comfortable and, as a result, are better prepared to enter a substance abuse treatment program after withdrawal has been successfully managed.9

Treating Comorbid Alcohol and Opioid Addiction

When it comes to addiction treatment, comprehensive rehabilitation efforts will go beyond more than just substance withdrawal management to best address a person’s recovery needs. It recognizes that people may need to simultaneously address multiple physical, psychological, social, vocational, and legal concerns in addition to their substance use disorder. Such individualized treatment plans should also be assessed and updated regularly to meet a person’s changing needs as they progress through treatment.11

Treatment for polysubstance addictions, such as those that involve both alcohol and opioids, may involve a combination of various therapeutic modalities such as medication, behavioral therapy, relapse prevention skills education, and support group attendance to address the problem as a whole. Behavioral therapies—which may be administered in individual, family and group settings—are an important foundation of many addiction treatment approaches.9

Other behavioral therapies you may encounter during treatment include:12

  • Brief interventions in a one-on-one or small group setting to take a closer look at your drinking patterns, potential risks, and to help you set goals to achieve positive changes.
  • Cognitive-behavioral therapy to identify and make positive changes to underlying thoughts and feelings that could otherwise reinforce continued substance use or other negative behaviors.
  • Motivational enhancement therapy to help resolve any ambivalence to treatment and strengthen your motivation and make positive life changes, including sobriety.
  • Marital and family counseling to help resolve relationship issues and increase family support as a valuable component of lasting recovery.

Getting Help

If you suspect that you or someone you care about has an opioid and/or alcohol addiction, it may be time to seek professional help. Research has shown that rehabilitation treatment can be very effective in helping individuals maintain a life of sobriety.12

Depending on the type of program and your insurance coverage, the cost of an alcohol treatment program can vary widely. Because treatment costs can differ, you want to make sure the program you enroll yourself or your loved one in will actually work. American Addiction Centers (AAC) can improve treatment outcomes for those in recovery for alcohol use disorder. Find out if your insurance covers treatment at an AAC facility by filling out the form below.

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[1]. MedlinePlus. (2016). Pain Relievers. 

[2]. National Health Services. (2020). Can I drink alcohol if I’m taking painkillers?

[3]. MedlinePlus. (2018). Opioid Misuse and Addiction.

[4]. U.S. Department of Health and Human Services. (2019). What is the U.S. Opioid Epidemic?

[5]. U.S. National Library of Medicine. (2019). Opioid Withdrawal.

[6]. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 545-546.

[7]. National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions: Mixing Alcohol with Medicines.

[8]. U.S. National Library. (2019). Opioid Overdose.

[9]. MedlinePlus. (2019). Alcohol withdrawal.

[10]. Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health and Research World, 22(1), 61–66.

[11]. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.

[12]. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.

[13]. National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics

[14]. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 562-567. 

[15]. American Family Physicians. (2000). Alcohol and NSAIDs Increase Risk for Upper GI Bleeding.

[16]. United States Drug Enforcement. (n.d.). Drug Scheduling. 

[17]. Benyamin, R., Trescot, A.M., Datta, S., Buenaventura, R.M., Adlaka, R., Sehgal, N., Glaser, S.E., Vallejo, R. (2008). Opioid Complications and Side Effects. Pain Physician, 11(2), 5105-5120.

[18]. Substance Abuse and Mental Health Services Administration. (2006). Treatment Improvement Protocol (TIP) Series, No. 45.