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Opioids include illegal drugs, such as heroin, and prescription painkillers, such as oxycodone. While prescription forms are safe when used as directed, misuse and abuse are becoming more common. Unfortunately, opioid use in the United States has become crisis level. 

In addition, co-occurring opioid and alcohol abuse is very prevalent. This creates an even greater health concern as this mix can be dangerous and life-threatening. In fact, many opioid overdose cases involve the co-occurrence of alcohol.

130 people die every day in the U.S. from an opioid overdose. This includes prescription pain relievers, heroin, or the synthetic opioid fentanyl.

National Institute on Drug Abuse

What are Opioids?

Opioids, or narcotics, are a class of drugs that originate from the opium poppy plant. However, some are also synthetic, or man-made. Opioids target the central nervous system by binding to receptors in the brain and spinal cord. This blocks pain signals within the brain, making you no longer feel in pain.

As a pain patient, it is crucial to follow your doctor’s instructions in order to avoid opioid misuse.

Doctors prescribe opioids as a strong pain reliever. When used as directed, opioids are very effective at controlling and managing pain. However, they are also highly addictive. For this reason, doctors should only prescribe pain medications when needed and for the shortest duration necessary.

Prescription Opioids

Doctors prescribe prescription opioids to treat moderate to severe pain that does not respond well to other treatments. Common prescription opioid medications include:

  • Oxycodone
  • Hydrocodone-Acetaminophen
  • Morphine
  • Fentanyl
  • Codeine
  • Methadone
  • Tramadol

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Illegal Opioids

Common illegal opioids, or street drugs, include heroin and fentanyl. Heroin is a natural opioid that comes from the seed of opium poppy plants. Common forms of heroin include a white powder, brown powder, or sticky black substance (black tar heroin). Heroin users typically smoke, snort, or inject the drug to achieve the “high.” Common heroin street names include Big H, Horse, Hell Dust, and Smack.

Fentanyl is a synthetic opioid similar to morphine but can be 50 to 100 times more potent. While doctors use prescription fentanyl to treat severe pain often associated with surgery, illegal street forms are common. In addition, Carfentanil is another synthetic opioid similar to fentanyl. Although, it is 100 times more potent than fentanyl. Common street names for fentanyl include Apache, China Girl, China White, Dance Fever, Goodfella, and Tango and Cash.

When it comes to illegal opioids, another problem exists. Unlike prescription opioids created uniformly, the dose of street opioids can be different every time. This increases the risk of complications and overdose. In addition, unknown ingredients or fillers are often mixed with the actual drug. This can also include a mixture of two opioids, such as heroin and fentanyl, creating a potentially life-threatening interaction.

Possible Opioid Side Effects and Signs of Addiction

While the goal of prescription opioids is to treat pain, opioid medications have side effects. Many of them also occur with illegal opioids. These side effects can include:

  • Relaxation and/or a “high”
  • Drowsiness
  • Mental fog
  • Nausea
  • Constipation
  • Slowed breathing

Opioid abuse and addiction, known as opioid use disorder, occurs with both prescription and illegal opioid use. Common signs of opioid addiction include:

  • Inability to control opioid use
  • Uncontrollable cravings
  • Changes in sleep habits
  • Weight loss
  • Regular flu-like symptoms
  • Decreased libido
  • Lack of hygiene
  • Body aches and pains
  • Isolation from family and friends
  • Illegal behavior, such as stealing from family and friends
  • Financial difficulties

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Alcohol Use and Alcohol Use Disorder (AUD)

Alcohol consumption is common in the U.S. It works as a central nervous system depressant by slowing down processes within the body. Effects of alcohol can include:

  • Drowsiness
  • Nausea and vomiting
  • Headaches
  • Slurred speech
  • Impaired hearing and vision
  • Impaired judgment
  • Decreased coordination and perception
  • Loss of consciousness

Moderate drinking is one drink per day for women and two drinks per day for men. When alcohol consumption exceeds this or includes regular binge drinking (four or more drinks for women and five or more for men in a two-hour period), it often turns to alcohol abuse or alcohol use disorder. Signs and symptoms of alcohol use disorder can include:

  • Inability to control your drinking
  • Spending most of your time drinking or recovering from alcohol consumption
  • Strong cravings for alcohol
  • Developing a tolerance to alcohol that requires drinking more in order to achieve the same results
  • Losing interest in favorite activities
  • Failing to meet school, work, or social obligations
  • Drinking even when it causes emotional, physical, or social problems
  • Having withdrawal symptoms when alcohol is not available

Combining Opioids and Alcohol

Alcohol and substance abuse are both common in the U.S. Because of this, the risk of a person mixing these two substances is high. Opioid abusers often drink alcohol because it can enhance the euphoric “high” they experience. Unfortunately, this has consequences. While it intensifies the “high,” alcohol also damages the body and brain.

Binge drinkers, according to a recent study, have a greater risk of opioid abuse compared to non-drinkers. In fact, their risk is twice that of non-drinkers. Of the over four million people that abused prescription opioids between 2012 and 2014, more than half were regular binge drinkers.

The Dangers of Mixing Opioids and Alcohol

Both opioids and alcohol work on the central nervous system. When you combine both substances, slower disposal rates and possibly higher toxicities may arise. While this may provide an initial increased “high,” the risks of life-threatening health complications are high.

Opioid overdoses are high in the U.S. In fact, around 66 percent of the 63,000 drug overdose deaths in 2016 involved prescription or illegal opioid use. Drinking alcohol while using opioids greatly increases the risk of overdose.

One way that risk increases is through respiratory depression. Because both alcohol and opioids affect the central nervous system, they can affect your breathing. When combined, this can cause breathing to become extremely shallow or stop altogether. And this doesn’t require a lot of alcohol or opioid use. A recent study showed that one oxycodone tablet with a moderate amount of alcohol greatly increased the risk of respiratory depression. Older adults are more likely than to have repeated episodes where they stop breathing.

Some other short-term effects of combining opioids and alcohol include:

  • Mental confusion
  • Numbness
  • Impaired motor control
  • Problems with memory
  • Reduced pulse
  • Low blood pressure
  • Reduced body temperature

Long-term opioid and alcohol abuse can cause other health complications. These can include:

  • Chronic constipation
  • Increased irritability and mood swings
  • Impaired vision
  • Liver disease
  • Complicated withdrawal

Signs of an Opioid and Alcohol Overdose

When someone uses opioids and alcohol, there is a high risk of accidental overdose. Knowing the signs and symptoms of an opioid overdose can help reduce the risk of death and get immediate treatment. These signs include:

  • Pale and clammy skin
  • Blue or purple color to the fingernails and/or lips
  • Vomiting or gurgling noises
  • Unconscious and unable to wake
  • Slowed breathing or breathing stops completely
  • The body goes limp

If an opioid and alcohol overdose occurs, the immediate administration of the medication naloxone, or Narcan, can help. This medication binds to the opioid receptors and blocks the opioid effects. This can reverse the overdose symptoms and help restore breathing to normal.

Is It Safe to Stop Drinking Alcohol and Taking Opioids On Your Own?

While stopping alcohol use and opioids is in someone’s best interests, it can be challenging and even dangerous to experience detox without medical help.

Opioid withdrawal symptoms may be severely challenging and unpleasant alone. But, when people who are also alcohol-dependent stop drinking suddenly, they may experience risky acute alcohol withdrawal syndrome.

In combined alcohol and opioid dependence, there is an increased likelihood of an additional complicated or severe withdrawal than attempting to quit either substance alone.

Symptoms of alcohol withdrawal, which can be severe and life-threatening in some cases, include:

  • Fatigue
  • Irritability
  • Mood swings
  • Sweating
  • Clammy skin
  • Headaches
  • Rapid heart rate
  • Chronic memory disorder
  • Anxiety
  • Depression
  • Sleep disturbances
  • Persistent shifts in mood and behavior even after acute withdrawal has finished
  • Seizures
  • Delirium tremens (a severe complication that can result in hallucinations, mental confusion, and disorientation)

Professional medical detox can help patients manage withdrawal from more than one substance. With supervision, support, and certain pharmaceutical interventions, expert medical detox for polysubstance use can help you comfortably and safely remove both substances from your body.

Treatment for Opioid and Alcohol Abuse

Treatment for opioid and alcohol abuse requires professional medical detox to minimize the risk of possible severe and life-threatening withdrawal symptoms. In some cases, treatment providers use Naltrexone. This medication prevents the activation of opioid receptors and helps decrease cravings and urges to use alcohol and opioids. Treatment for opioid and alcohol detox typically occurs in an inpatient or residential rehab facility. Outpatient treatment options that use medication-assisted treatment, as well as group therapy, are also successful.


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Benyamin, Ramsin, et al. “Opioid Complications and Side Effects.” Pain Physician, U.S. National Library of Medicine, Mar. 2008

Butanis, Benjamin. “Signs of Opioid Abuse.” Johns Hopkins Medicine, Based in Baltimore, Maryland, 27 Aug. 2018,

Cushman, P. “Alcohol and Opioids: Possible Interactions of Clinical Importance.” Advances in Alcohol & Substance Abuse, U.S. National Library of Medicine, 1987,

Kreek, M J. “Opioid Interactions with Alcohol.” Advances in Alcohol & Substance Abuse, U.S. National Library of Medicine, 1984,


National Institute on Drug Abuse. “Opioid Overdose Reversal with Naloxone (Narcan, Evzio).” NIDA, 4 Apr. 2018,

National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 22 Jan. 2019

“Opioid Misuse and Addiction.” MedlinePlus, U.S. National Library of Medicine, 16 Dec. 2019

“Opioid Use May Affect Treatment for Alcohol Dependence.” ScienceDaily, ScienceDaily, 6 June 2018

Preidt, Robert. “Opioids and Alcohol a Dangerous Cocktail.” WebMD, WebMD, 8 Feb. 2017

“What Are the Effects of Mixing Opioids and Alcohol?” Alcohol.org

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