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The Effects of Mixing Partial Opioid Agonists & Alcohol?

Alcohol is a central nervous system depressant substance. This means that it slows down some of the body's functions by interfering with brain chemistry and changing the way you think and feel. It can make you feel happy, and less likely to think clearly and recognize potential consequences of your actions. It also disrupts motor skills and coordination. Speech and vision are impacted, and breathing, heart rate, and blood pressure are all lowered when you drink alcohol.

Opioid drugs bind to mu-receptors in the brain to block feelings of pain, which is why they are commonly prescribed as pain relievers. They also impact brain chemistry and act as central nervous system depressants.

Partial opioid agonists are a little bit different than full agonists in that they don't activate the opioid receptors in the brain quite as much. Full agonists, such as heroin, oxycodone, hydrocodone, methadone, and fentanyl, "turn on," or activate, these receptors in the brain for maximum effect. The activation of opioid receptors in the brain can cause a burst of pleasure, or a "high," that can be very addictive.

Full opioid agonists are commonly abused, and the National Survey on Drug Use and Health (NSDUH) reports that in the month leading up to the 2016 survey, close to 3.5 million American adults misused prescription painkillers. Partial agonists, such as buprenorphine, do not activate the receptors in the brain to quite the same extent that full agonists do; however, they may still be misused and can have dangerous side effects when mixed with alcohol.

Partial Opioid Agonist

Buprenorphine Explained

Buprenorphine is a partial opioid agonist drug. It may be prescribed to treat pain, but it is commonly used to treat opioid addiction. The American Society of Addiction Medicine (ASAM) publishes that more than 2.5 million people in the United States struggled with opioid addiction in 2015.

Buprenorphine is one of the few medications that is FDA-approved to treat opioid addiction. When a person battles addiction to an opioid drug, they will likely suffer from intense cravings and difficult withdrawal symptoms if they try to stop taking it. Buprenorphine can help with this; therefore, it is often used during detox and for the medical management of opioid addiction.

As a partial agonist, buprenorphine still activates opioid receptors in the brain to some extent, which can help to manage cravings and keep withdrawal symptoms from being as bad, but is not likely to give a person the same high that a full agonist would. Also, partial opioid agonists have what is called a "ceiling effect," which means that after someone takes a certain amount, the drug will not have any more effect. Both the less intense high and the way the effects of buprenorphine plateau after a certain amount is taken can make it less likely to be a target of abuse.

Partial opioid agonists also have what are called "antagonist" effects. The National Alliance of Advocates for Buprenorphine Treatment (NAABT) explains that when high amounts of buprenorphine are taken, the drug can actually block the opioid receptors in the brain from receiving any more opioid drugs. Essentially, buprenorphine can keep a person from abusing a full agonist while taking it, like heroin, since they will not get any of the desired effects from taking the other opioid drug as long as buprenorphine is filling the brain's receptors.

Buprenorphine is also mixed with full antagonist drugs, such as naloxone, to further treat opioid addiction. The antagonist portion of the drug doesn't become active unless a person tries to inject or abuse the product, serving as a way to keep people from abusing it. The Substance Abuse and Mental Health Administration (SAMHSA) publishes that Zubsolv, Suboxone, and Bunavail all contain both buprenorphine and naloxone, and are FDA-approved to treat opioid addiction. Subutex and generic sublingual versions of buprenorphine products contain just the partial opioid agonist and are also used for opioid addiction treatment purposes. Another product, Butrans, is a prescription-based buprenorphine patch that dispenses the medication slowly over a period of days.

Possible Side Effects of Buprenorphine

Even though buprenorphine is only a partial opioid agonist and not a full agonist, it still disrupts brain chemistry and changes the way a person feels, thinks, and acts as a result. Buprenorphine can still be abused, too. While it may not produce the same high as other opioids, buprenorphine is sometimes abused to help with the "come down" off these other drugs and to blunt the symptoms of withdrawal in someone who is dependent on opioids. In a person who does not take other opioids regularly, buprenorphine can still cause a person to feel high, however.

Opioids make a person feel mellow, relaxed, and just good overall. Buprenorphine can also make it harder think straight and make a person more likely to make bad decisions and potentially get into dangerous situations. The risk for accident and injury goes up as does the possibility for falling victim to a crime, such as sexual assault, when under the influence of a partial opioid agonist.

The journal Pain Management warns that the following are possible side effects of buprenorphine:

  • Headache
  • Drowsiness
  • Depression
  • Sleep issues
  • Anxiety
  • Nausea
  • Constipation
  • Sweating
  • Rash on the skin
  • Itching
  • Weight gain
  • Lowered sexual libido
  • Disruption of menstruation
  • Stomach pain

Buprenorphine, like full opioid agonists, is also addictive. Over time and with regular use, a person can become physically and emotionally dependent on the drug and may not be able to control their drug use anymore. Opioid withdrawal is uncomfortable both mentally and physically, leaving a person feeling depressed, anxious, and irritable. It also interferes with sleep, memory, and thinking abilities. Physical withdrawal symptoms are very much like a bad case of the flu, including stomach issues, fever, tremors, chills and sweating, muscle aches, racing heart rate, yawning, runny nose, and watery eyes.

What Happens When You Drink Alcohol?

Alcohol has many effects on the mind and body. Alcohol raises the level of dopamine and inhibitory neurotransmitters in the brain. Dopamine makes a person feel pleasure and interacts with movement capabilities while inhibitory neurotransmitters slow down the central nervous system and in a sense "turn off" the stress response. The more alcohol is consumed, the more significant these effects will be.

Drinking a little bit of alcohol is likely to make you feel relaxed, happy, social, and less inhibited. Reflexes and motor skills are slowed down by the interaction of alcohol. Falling down, blurred vision, slurred speech, slowed reaction time, and sluggish movements are all common side effects of alcohol consumption. Drinking more alcohol will intensify all of these effects, make it hard to control emotions, and lead to risk-taking behaviors. Drinking alcohol makes it hard to think straight and move normally, which raises the odds for getting into an accident, becoming injured, and participating in, or being the victim of, a crime.

You can also overdose on alcohol, which is typically called alcohol poisoning, and this happens when the body can't break down the toxins fast enough. An alcohol overdose can be fatal. Warning signs include:

  • Slow and/or irregular breathing
  • Vomiting
  • Seizures
  • Severe mental confusion
  • Low body temperature
  • Loss of consciousness or trouble keeping a person awake

The National Council on Alcoholism and Drug Dependence (NCADD) warns that alcohol is the most regularly used addictive substance by Americans and as many as one out of every 12 adults in the United States struggles with alcoholism. The more a person drinks, the more their body gets used to alcohol being present, and the brain will begin to tolerate certain levels of alcohol. An individual will then need to drink more alcohol next time for it to take effect.

The more a person drinks on a regular basis, the more likely they are to become dependent on alcohol, which is what happens when the brain "needs" it to remain chemically balanced. When alcohol wears off, withdrawal symptoms can kick in. Headache, nausea, tremors, stomach pain, vomiting, diarrhea, muscle aches, sleep problems, fever, irregular heart rate and blood pressure, irritability, depression, fatigue, lack of energy and motivation, trouble thinking clearly, memory problems, and agitation are all side effects of alcohol withdrawal.

About 3-5 percent of people who are dependent on alcohol will suffer from the most severe form of alcohol withdrawal called delirium tremens, or DTs, the New England Journal of Medicine (NEJM) warns. DTs can be life-threatening. Hallucinations, fever, seizures, and confusion are signs of this serious condition.

Health Concerns and Overdose Danger When Combining Alcohol and Opioids

When you mix a partial opioid agonist such as buprenorphine with another central nervous system depressant like alcohol, the side effects of both substances are multiplied. Since they both act on the brain and body in similar ways, combining them can be very dangerous. All of the risk factors for each substance increase, and the potential for a life-threatening overdose is much higher when taking both buprenorphine and drinking alcohol at the same time.

The Centers for Disease Control and Prevention (CDC) reports that about six people die in America each day from alcohol poisoning. Opioid overdose deaths have reached epidemic numbers in the United States in recent years, and the journal Psychiatric Times publishes that according to data collected in 2010 almost one-quarter of all opioid-related deaths involved alcohol as well.

Alcohol can make a person sleepier when taking an opioid drug, and they may go to sleep and never wake up. Mixing an opioid with alcohol also greatly slows a person's respiration rate, making it hard for them to breath and possibly stopping their breathing altogether. The drug that is generally used to reverse an opioid overdose, naloxone (Narcan), doesn't work for alcohol poisoning. Stomach pumping, charcoal, or other methods will need to be used to try and reverse alcohol's toxic overdose effects.

A person will likely get drunk faster and experience more intense effects when taking buprenorphine. Buprenorphine is a long-acting opioid, meaning that it keeps working in the body for a day or more. Introducing alcohol can have unexpected, unpredictable, and unintended side effects. Long-term use of both alcohol and buprenorphine can damage the lungs, heart, brain, liver, and kidneys. Such polysubstance use can increase the risk for developing several kinds of cancer as well as lung, liver, or heart diseases.

How to Know When Intervention Is Needed

As of 2015, more than 85 percent of adults in America reported having at least one drink of alcohol in their lives, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. Alcohol is regularly enjoyed by adults of the legal drinking age of 21 and older. It can also be a source of addiction and cause problems when consumed to excess, however. When drinking seems to take over a person's life, it is time to consider professional help.

Alcohol may become the most important thing in a person's life, and drinking often comes before anything else. Family life, social relationships, schoolwork, employment, and finances are often negatively impacted by excessive alcohol abuse. Addiction can make it hard for a person to complete everyday tasks and consistently manage their life.

Also, if your loved one is using buprenorphine outside of a valid and necessary prescription, this is considered recreational drug use or drug abuse. Taking an opioid drug under the direction and supervision of a medical professional carries many potential risks, and these risks are compounded when taking it recreationally. Mixing alcohol and a partial opioid agonist is even more potentially concerning.

It may be time to help a loved one realize that a specialized rehabilitation program can help. A professional interventionist can help you to plan and carry out an intervention, a structured meeting with the goal of getting the person into a treatment program. The intervention can help your loved one realize that their drug and alcohol use has an impact on your life as well as others around them and hopefully encourage them to seek professional help.

Treatment Options for Concurrent Alcohol and Drug Misuse

It can be dangerous to detox from opioids and alcohol on your own without medical interventions. As a result, people should not try to do stop taking these substances "cold turkey" at home by themselves. A medical detox program is the best choice for someone who has a history of abusing more than one substance, such alcohol and buprenorphine. When there is more than one substance in a person's body at a time, detox can be more complex. A medical detox facility can make sure that the individual stays safe while the toxins process out of the body.

Medications are often useful for managing withdrawal during medical detox as are supportive methods. Buprenorphine itself may be slowly tapered down and weaned off with a structured schedule to minimize withdrawal symptoms and cravings. Detox is not a standalone treatment for addiction; after completing detox, individuals should continue into a complete rehabilitation program.