What are the Effects of Combining Opioids and Alcohol?

Medical experts agree: Opioid medications and alcohol don’t mix. These substances have similar effects, which can lead to complications if they’re combined. Misuse of opioids and alcohol is associated with serious risk of overdose and death.

However, alcohol use is still common among many US adults who are prescribed opioids. According to the Centers for Disease Control and Prevention (CDC), an estimated 4.2 million Americans who misuse prescription opioids also binge drink.

In this article, we’ll review how opioids work, why they should never be combined with alcohol, how to recognize an overdose, and more.

Misuse of opioids and alcohol can lead to the development of an opioid or alcohol use disorder, commonly referred to as addiction.

If your body is regularly exposed to either alcohol or opioids over time, it can become dependent on them. This means you may experience withdrawal symptoms if use is abruptly stopped.

According to this 2018 review, both opioids and alcohol act as central nervous system (CNS) depressants in the body. When used together, these effects are heightened.

CNS depressants cause sedation, meaning your body’s functions slow down. This is especially dangerous when it comes to respiratory depression, or slowed breathing.

We’ll go over what happens when you take too many opioids, drink too much alcohol, or do both at the same time.

Effects of too many opioids

Opioids (also called opiates) are pain-relieving medications. This class of drugs includes morphine, codeine, and oxycodone.

Opioids are often prescribed in pill form for short-term use, such as for pain relief after a surgery or an injury. However, there are cases where opioids are needed long term. These include treating chronic pain or health conditions when other treatments have not worked.

As stated by the US Department of Health and Human Services, the overprescription of opioids played a big part in America’s “opioid epidemic.” This phrase refers to the high amount of deaths connected to opioid overdose every year. These days, the illegal manufacturing of opioids is considered more of a concern than overprescription.

Opioids can slow how many breaths you automatically take per minute. With too much opioid medication in your system, your breathing can become dangerously slow. It can even stop completely. Adding alcohol can worsen this effect.

During respiratory depression, your vital organs stop receiving oxygen. Your body can’t get the oxygen it needs to function. Overdose, and even death, can occur as a result. According to the CDC, in 2020, opioids were involved in over 68,000 overdose deaths in the United States.

Per This 2017 articletaking more opioid medication than directed is considered a form of substance misuse.

Effects of too much alcohol

Continued use of alcohol despite experiencing harmful consequences is the major sign that someone has an alcohol use disorder (formerly known as alcoholism).

Alcohol poisoning happens when too much alcohol has entered your bloodstream. This prevents your brain, heart, liver, and other organs from working properly. As you can see, both alcohol and opioids interfere with your’ ability to do their jobs.

The amount of alcohol in your system is measured as blood alcohol concentration (BAC). Because of alcohol’s significant effects on the CNS, it’s illegal in all 50 states to drive with a BAC of .08 grams of alcohol per deciliter (g/dL) of blood or higher.

However, even small amounts of alcohol can have immediate effects on your cognitive and motor functions. If taken alongside opioids, the alcohol in your system can cause even more impairment.

As a result, there’s no safe “recipe” for using opioids and alcohol together. The safest option is to avoid combining them entirely.

Because opioids and alcohol are CNS depressants, it can be tough to tell the difference between a person who is intoxicated by one, the other, or both. This also applies in cases of emergency.

Unless you know exactly what someone took, it may be unclear why they’re overdosing. But you can still recognize a dangerous situation and get help.

The World Health Organization (WHO) identifies three key signs to watch for in a potential opioid overdose:

  • pinpoint pupils (pupils that are smaller than usual)
  • unconsciousness
  • breathing difficulties

Learn more with SAMHSA’s opioid overdose prevention toolkit.

According to the National Institutes of Healthalcohol poisoning or overdose can look like:

  • confusion
  • difficulty staying conscious
  • inability to wake up
  • vomiting
  • slow or irregular breathing
  • slow heart rate
  • clammy skin
  • low body temperature (skin may look blueish or pale)
  • slow reflexes (including no gag reflex)
  • absence of gag reflex (person isn’t choking even when this would typically be triggered)

In case of potential overdose, it’s always better to be safe than sorry. Call 911 immediately or local emergency services. We’ll go over laws that protect you from prosecutions below, as well as other you can assist in a case of overdose.

The right thing to do is always to help someone who may be overdosing. There’s nothing more important than someone’s life.

You can respond to a potential overdose in the following ways:

  • Call 911 or a local emergency number and tell the dispatcher you think the person may have overdosed.
  • Provide as much information as you can about what that person consumed.
  • Do not leave the person who is overdosing alone in case they fall unconscious, stop breathing, or vomit. Aim to keep them either sitting up or lying down with their head turned to the side.
  • Try to keep the person awake. The more an overdosing person is conscious, the less likely they are to choke.

These may seem like difficult or overwhelming actions to take, but they could be lifesaving for someone experiencing an overdose.

Legal protections

Many people fear that if they call for help when witnessing a potential overdose, they’ll get in trouble with law enforcement. This may be especially true if the opioids have been acquiredly illegal and if participants in the situation are underage.

The good news is that, according to the US Government Accountability Office, an estimated 47 states and the District of Columbia have Good Samaritan laws. These laws protect those who step forward to help in case of an overdose against prosecution afterward. The intention is to save lives by removing fear of arrest.

All 50 states and the District of Columbia have naloxone access laws, which can help protect you if you administer naloxone to a person you believe is overdosing. You can learn more about this lifesaving drug below.

If you also know a loved one is taking opioids, you may wish to check into your state’s naloxone policy. This can be a lifesaving tool to have on hand.

Naloxone is an opioid antagonist medication. This means it can reverse an opioid overdose. It comes in injectable form (Zimhi) or as a nasal spray (Narcan, Kloxxado). If you give naloxone to someone who isn’t actually having an opioid overdose, it won’t have any effects. This means that even if you’re unsure of the situation, administering naloxone is a safe call.

Even if you give someone naloxone, you still need to call 911 or local emergency services. Naloxone’s effects may not last as long as the substances they took. Immediate medical assistance is still required.

You can get trained on how to use and carry naloxone online at GetNaloxoneNow.

This question has many factors for consideration. The best advice is to consult with your usual doctor, if you have one. A doctor you see regularly will be more likely to know your medical situation and history.

The amount of time an opioid stays in your system depends on:

  • type of opioid medication or substance
  • medication dosage and frequency
  • how fast your body processes the medication
  • Whether you have other health concerns that impact how your body processes the drug (such as heart, liver, or kidney conditions)

Typically, you shouldn’t consume alcohol if you have any opioids in your system.

If you’re coming off an opioid regimen, talk with your doctor about when it will be safe to drink again. If you have a daily regimen, talk with your doctor about ways to stay safe if you plan on consuming alcohol while taking your opioid medication.

You can also talk with your doctor about alternatives to opioids. Your options may include medications with less risk of addiction or those considered safe to combine with modest alcohol intake.

Mixing opioids and alcohol can have both short- and long-term effects that can impact your health.

In the short term, you are more vulnerable to overdose. In the long term, you are more at risk of developing serious health complications and chronic conditions.

Alcohol health risks

According to the National Institute on Alcohol Abuse and Alcoholism, as a result of long-term alcohol misuseyou may experience:

Opioid health risks

These risk factors are associated with long-term opioid therapy. This means researchers have found that health complications can occur with opioids even if you use them as directed by your doctor.

Being on opoids in the long termi increases risk of addiction and overdose, according to this 2012 study.

It can also contribute to:

  • bone fractures
  • breathing difficulty during sleep
  • gastrointestinal issues
  • immunosuppression (weakened immune response)
  • heart attack (myocardial infarction)
  • pain sensitivity (hyperalgesia)

While it’s not impossible to safely consume opioids and alcohol together, it’s best to avoid the combination if you can. There’s a risk of overdose, death, and other health complications.

Because both cause CNS depression, taking opioids and alcohol together can slow your organ function and breathing. When your body is unable to get enough oxygen, it shuts down.

If you think you’re witnessing someone overdose from alcohol, opioids, or both, call 911 or local emergency services immediately. Try to keep the person conscious until help arrives. Administer naloxone if it’s available to you.

The misuse of alcohol and opioids is a serious public health issue, taking tens of thousands of lives every year. Talk with your doctor to learn more about the risks of opioid medications you are on or may take. Always use prescriptions as directed.


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