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Opioids & Alcohol: The Risks & Dangers of Mixing Both Substances

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 13, 2023 • 10 cited sources

Dangers and risks of mixing alcohol and opioids include liver damage, respiratory depression, substance use disorders (SUD), and overdose, which can be fatal.

Alcohol on its own can be deadly. It is often the cause of accidents, chronic health issues, and acute health issues. It is a contributing factor in violent crimes across the country. In short, alcohol misuse can be devastating. 

The same is true for opioids. Whether taken in the form of prescription drugs like OxyContin or in the form of street drugs like heroin, opioids cause overdoses every day in the United States — more than 220 a day in 2021, according to National Institute on Drug Abuse.[1]

When you combine alcohol with opioids, however, the damage is far worse. Organ systems sustain more harm and break down more quickly. The respiratory system is significantly more depressed, and overdose death is a much higher risk. 

Using alcohol and opioids in combination is never safe.

What Are the Risks or Dangers of Mixing Alcohol With Opioids? 

Mixing alcohol with prescription opioids or street opioids like heroin comes with a number of risks. Not only can the combination of these substances cause harm to the body over time, acute issues, like overdose, are a very real possibility as well. 

Both alcohol and opioid drugs depress the central nervous system.[2] This can lead to severe respiratory depression or even respiratory arrest, which causes breathing to stop, especially when either substance is taken in high doses. When the two substances are combined, the risk of respiratory depression rises exponentially. 

Some of the risks and dangers associated with mixing alcohol with opioids include the following:

  • Increased risk of overdose: Mixing alcohol with opioids can increase the risk of respiratory failure. When the central nervous system is depressed, signals can stop occurring in the brain.[3] Breathing stops and no oxygen flows to the brain, the heart stops and death occurs.

    Each substance alone can cause this issue, but the difference is that when they are taken together, the amount of respiratory depression is significantly higher. Because of this, death is more likely. 
  • Slowed breathing: Even if the central nervous system doesn’t stop functioning completely, the slow shallow breathing that results from respiratory depression can lead to a condition called hypoxia that is defined by low oxygen levels.[4] When this occurs for an extended period of time, brain damage or death can occur. 
  • Sedation: The combination of alcohol and opioids can cause extreme sedation, which can impair cognitive function, coordination, and judgment. An inability to process stimuli and respond or react to the environment contributes to the risk of accidents, falls, and injuries.
  • Increased risk of a substance use disorder: Both opioids and alcohol are highly addictive substances, and combining the two makes it even harder to avoid the development of an opioid use disorder (OUD) or alcohol use disorder (AUD), especially if repeated consistently over time. Tolerance to both substances can develop, and with higher doses of both, rates of SUD increase. 
  • Liver damage: Both alcohol and opioids can cause liver damage separately, and when taken together, the risk is compounded. Just as the impact on the central nervous system is increased exponentially, so too is the negative effect on other systems of the body. 

Statistics on Alcohol & Opioid Use 

  • When alcohol and opioids are combined, they have a synergistic effect in the body.[7] This means that they are exponentially more powerful together than they would if you simply added the effects of alcohol to the effects of prescription opioids. Suppression of the respiratory system specifically is significant and the reason why so many people die of an overdose when they combine the two substances. 

What Side Effects Can You Expect When Mixing Alcohol With Opioids? 

Mixing alcohol with opioids can cause a range of side effects, some of which can be severe and life-threatening. 

The specific side effects depend on various factors, including the type of opioids consumed and the dosage of each. It is important to note that the body is always changing, especially when chronically exposed to toxins like alcohol and drugs. The amount of alcohol and opioids that is “fine” and causes no negative repercussions one day can be overwhelming to the system the next day. 

Here are some common side effects that can occur when mixing alcohol with opioids: 

  • Slowed breathing: Mixing alcohol with opioids can cause breathing to become dangerously slow or even stop altogether, which can lead to oxygen deprivation, brain damage, or death.
  • Dizziness or lightheadedness: Both alcohol and opioids can cause dizziness or lightheadedness, which can increase the risk of falls and accidents. Again, this can be a precursor to slowed breathing, sedation, and respiratory depression. 
  • Nausea and vomiting: Opioids are hard on the stomach, especially if the person hasn’t eaten before taking the medication. Add alcohol to the mix, and the effect is even stronger, making nausea and vomiting a much higher risk.
  • Confusion and disorientation: Too much alcohol or a hefty dose of an opioid can cause confusion, disorientation, and impaired judgment. Combine the two and the likelihood is far stronger, and ultimately, risky behaviors and accidents may occur.
  • Blackouts: The combination of alcohol and opioids can cause blackouts, which can result in memory loss and an inability to recall things that happened during the blackout period. This is dangerous for many reasons, but especially because the person is not in control of their actions and choices during a blackout period and is at risk of being hurt.

How Long Should You Wait Between Drinking & Taking Opioids?

Anyone taking an ongoing prescription for opioids for the management of chronic pain should avoid drinking entirely. Most prescriptions are taken with the intent of maintaining a certain level of the substance in the blood at all times, which means it is never safe to drink alcohol. 

If the prescription is taken on an as-needed basis or if the opioid of choice is a street drug, it is essential to ensure that the drug is entirely out of the system before drinking any alcohol. Everyone is different, and the dosage will affect how long this takes, but at least several hours to a full day may be an appropriate timeline, if not more. 

The amount of alcohol ingested will factor into the question as well. A sip of wine will have less impact than a few shots, for example, especially when considering the damage done to the liver. 

Underlying medical conditions may also play a role when it comes to guessing how much damage will be done by combining alcohol and opioids. If there is already an underlying liver function disorder or respiratory issues already exist, any amount of overlap between taking alcohol and opioids could be deadly. 

Get Help Today

If you or a loved one is struggling with stopping the practice of mixing any substances, managing drinking, or misuse of opioids, help is available. 

There are ways to address the problem on an outpatient treatment basis with the support of medications designed to empower the individual in crisis to avoid drug misuse that could cause overdose or life-threatening accidents. Depending on the details of your experience, different medications may be more useful than others. Therapy will also be a core part of your treatment program.

With the right care, you can leave substance misuse in the past.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed March 2023.
  2. Trends in Prescribed Central Nervous System Depressant Medications Among Adults Who Regularly Consume Alcohol: United States 1999 to 2014. July 2019. Accessed March 2023.
  3. Neuronal Mechanisms Underlying Opioid-Induced Respiratory Depression: Our Current Understanding. Journal of Neurophysiology. May 2021. Accessed March 2023.
  4. Hypoxia. StatPearls August 2022. Accessed March 2023.
  5. More Than Half of People who Misuse Prescription Opioids Also Binge Drink. Centers for Disease Control and Prevention. June 2019. Accessed March 2023.
  6. Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. March 2022. Accessed March 2023.
  7. Alcohol-Medication Interactions: Potentially Dangerous Mixes. National Institute on Alcohol Abuse and Alcoholism. May 2022. Accessed March 2023.
  8. Opioid Overdose. Substance Abuse and Mental Health Services Administration. January 2023. Accessed March 2023.
  9. Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. Postgraduate Medical Journal. August 2018. Accessed March 2023.
  10. Use of Prescription Opioids and Initiation of Fatal 2-Vehicle Crashes. JAMA. February 2019. Accessed March 2023.

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