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Dangers of Abusing Alcohol with Opiates

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 25, 2019

Mixing alcohol with opiates is dangerous in several ways, including the fact that each increases the negative effects of the other. Alcohol increases the depressant effects of opiates, while opiates can increase the body’s rate of absorption of alcohol—enhancing alcohol’s sedative properties. While an alcohol/opiate combination can cause increased intoxication and decreased motor skills, the biggest danger of combining alcohol and opiates is the lowering of the heart rate and shallowness of breathing. This combination can lead to unconsciousness, coma, and even death.

What Are Opiates?

Technically, the word “opiate” refers to drugs that are derived from opium, which itself is harvested from poppy plants. However, current clinical terminology usually uses the word “opioid,” which includes both opium derivatives and synthetic drugs that provide the same benefits and effects as opiates. Pain relief is the primary medical use for opioids and opiates. Opiates and opioids (and alcohol) slow down, or depress, the central nervous system.

Opiates Vs. Opioids

Opiates have been known and used for thousands of years, both for medicinal and recreational reasons. The most common opiates include opium, morphine, heroin, and codeine. Opioids are either partially synthetic opiate-based drugs, or fully synthetic drugs manufactured to mimic the pain-relieving properties of clinical opiates. Common fully or partially synthetic opioids followed by examples of common brand names include:

What Are The Effects Of Alcohol And Opiate Abuse?

Both alcohol and opioids are depressants. Although alcohol intoxication and opioid/opiate intoxication present different symptoms and dangers, combining the two exaggerates the effects of both drugs. Taken alone, alcohol can cause short-term symptoms such as slurred speech, loudness and inappropriate laughter, confusion and impaired reasoning, decrease or loss of fine motor coordination, staggering, glossy eyes, and constricted pupils.

At high doses, sometimes called acute intoxication or alcohol poisoning, the dangers become much more severe. In combination with opiate use, these symptoms can lead to serious dangers and even death. Among the dangers are:

  • A decreased heart rate (bradycardia)
  • Lowered blood pressure rate (hypotension)
  • Decreased respiration rate (respiratory depression)
  • Irregular breathing
  • Lowered body temperature (sometimes resulting in the skin taking on a bluish tinge, called cyanosis)
  • Seizures
  • Nausea and vomiting
  • Unconsciousness
  • Coma
  • Death

Alcohol tolerance is much lower when mixed with opiates, which are central nervous system depressants. This increases the danger of alcohol poisoning. Conversely, the dangerous effects of opiates and opioids also are increased by the presence of alcohol.

Ethanol is the chief mind-altering ingredient in alcohol, and the body recognizes the introduction of alcohol into the body as a poison. The body then tries to metabolize the ethanol by basically turning all its attention to doing so. Because the liver is spending the majority of its time dealing with the presence of alcohol, other drugs like opiates are not metabolized (or are metabolized very slowly), and can cause grave damage.

Opiate abuse causes many symptoms similar to alcohol abuse. Long-term abuse can also lead to conditions such as:

  • Chronic constipation
  • Rhabdomyolysis, or the degeneration of muscle tissue
  • Kidney failure (often due to rhabdomyolysis, because chemicals produced by muscle degeneration can produce a domino effect of damage to the body’s organs)
  • Brain damage, usually due to hypoxia, or the lack of oxygen to the brain

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What Are The Dangers Of Overdose?

According to a 1999 report by American University, “The Interrelationship Between the Use of Alcohol and Other Drugs: Overview for Drug Court Practitioners,” 98 percent of reported opiate overdoses involved the mixing of alcohol and/or other central nervous system depressants.

Combining alcohol and opiates brings out the worst in both drugs. The dangers of both alcohol poisoning and drug overdose are increased. Alcohol use with opiates also causes an increased tolerance to opiates, which often results in increased abuse and dangers of overdose. This could also lead to different delivery routes, like snorting, smoking, or injecting the drug, further increasing the dangers.

Heroin And Alcohol

Heroin is the most widely abused opiate both worldwide and in the United States, although its use is dwarfed by the abuse of prescription opioids, according to the National Institute of Drug Abuse. The 2014 article stated, “It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.”

It’s also estimated that 70 percent of all heroin-related deaths involve the co-use of alcohol. While drinking alcohol minus the presence of opiates doesn’t always result in dangerous conditions like lowered blood pressure or decreased respiration, alcohol can seriously impair a person’s reasoning skills and lead to a possible overdose when using an opiate like heroin.

Alcohol’s ethanol molecule is unusual, as it can travel to most parts of the body quickly. Twenty percent of alcohol can be absorbed directly through the stomach, reaching the brain within a minute and affecting the:

  • Frontal lobes, impairing thought, memory, cognition, and judgment
  • Cerebellum, which controls movement and balance, resulting in impaired physical abilities like walking
  • Medulla oblongata, the part of the spinal cord responsible for heart and lung functions

Heroin remains in the bloodstream even when a person may not have used heroin recently. If alcohol is then consumed, an interaction with heroin may occur. Also, someone who doesn’t experience the full impact of excessive drinking because of heroin use can much more easily suffer alcohol poisoning.

By drinking alcohol in combination with opiates, not only are the body’s physical functions affected, but a person’s judgment also is impaired. This could lead to a bad decision such as consuming a drug—like heroin—that one normally wouldn’t use. It also may lead to using more of a drug and a possible overdose.

How Does This Impact Addiction?

The combination of alcohol and opiates also seems to have grave implications of addiction. Although alcohol and opiate addictions are serious problems in their own rights, combining the two drugs appears to lead to even more severe issues. According to an article by the National Institutes of Health published by the US National Library of Medicine, “Mixed opioid and alcohol abusers did poorly in standard alcohol abstinence treatment, compared to matched alcoholics without opiate abuse histories. Opiate addicts in general and on methadone maintenance treatment appear to have unusually high rates of recognized alcoholism.”

Clinical tests also indicate that alcohol use may modify or damage opioid receptors in the brain, while opioids may also impact drinking behaviors. Additionally, chronic alcohol use causes problems and dangers relating to how a person’s body respond to drugs, including opiates, which may be necessary for treatment of serious medical conditions.

How To Get Help

If you suspect that you, or someone close to you, may be experiencing a problem with alcohol and/or opioid abuse, don’t panic. We can aid you in finding help about substance abuse, rehab centers, treatment options, or financial issues. Or maybe you’d just like to talk with someone. Contact us today at

U.S. National Library of Medicine - Western Journal of Medicine: Drugs of Abuse – Opiates

U.S. National Library of Medicine - The Open Neuroimaging Journal

U.S. National Library of Medicine - The Effects of Alcohol Intoxication on Neuronal Activation at Different Levels of Cognitive Load

U.S. National Library of Medicine - Illicit Opioid Intoxication: Diagnosis and Treatment

Mayo Clinic - Alcohol Poisoning

MedlinePlus - Opioid intoxication

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