Dangers of mixing opioids with alcohol

In many people struggling with addictions, polysubstance substance dependence can occur. It’s important to know what the effects and risks are when combining two very strong substances.

In the UK, there are more people accessing drug and alcohol service for opioids (52%) and alcohol (28%) than other substances. Of all people in treatment, 48% have alcohol problems.(1) This means that there are many people mixing opioids with alcohol.

Analgesics or pain relievers are commonly used to help manage pain. The most common over-the-counter pain relievers in the UK are paracetamol, ibuprofen, and aspirin. Whatever type of medication a person takes and whether it’s prescribed or not, medical advice should be sought before considering whether to have a drink while the medication is in the system.

It’s reported that 57% of people in the UK drink alcohol.(2) According to the British Pain Society around 8 million people suffer from chronic pain and this is without considering those who experience mild and moderate pain. With this amount of people drinking and living with pain, it’s safe to assume there are more people mixing opioids with alcohol than is even reported by those accessing treatment.

What are opioids?

Opioids are strong medications used to treat moderate and severe. They include (but aren’t limited to) the following:

Codeine
Tramadol
Heroin and Morphine
Oxycodone
Fentanyl
Methadone

What are opioids used for?

Opioids are generally prescribed after a seriously painful injury, surgery, or during conditions or illnesses which have increased pain, such as cancer.(3)

People also use opioids in order to cope with or mask emotional pain. This can include feelings related to traumatic events such as unexpected bereavement, domestic abuse, or sexual abuse.

When people take opioids there are a number of side effects that can take place, including:

Euphoria
Drowsiness
Feeling sedated
Slurred speech
Nauseous
Vomiting
Respiratory problems
Lower heart rate and blood pressure

There’s conflicting information on how long opioids stay in the system. Some sources state 3 days, some 4, some say 30. The type of opioid and how much is taken will influence this. For prescribed medication, it’s advisable to ask your doctor for this information. If you take non-prescribed opioids then local drug services can give you more help around this (contact us to find out who your most local drug and alcohol services are).

Opioid dependence and addiction.

One report states that it’s difficult to tell how many people are opioid-dependent in the UK. But it said “the estimate of those who might be OP (opioid painkillers) dependent varies wildly from tens of thousands to nearly a million”.(4)

The reason this number could be so high is that opioid dependency is fairly under-researched in the UK, despite the number of people who are prescribed opioids treat pain. The reality of dependency and addiction to opioids could be far higher than imagined.

Physical dependence can occur in people being prescribed opioids too, although health professionals often state that those who are prescribed opioids for pain shouldn’t develop dependence or addiction.

When a person is dependent on opioids, they can experience withdrawal when the substance is leaving the system. Symptoms of opioid withdrawal include:

Sweating
Shaking
Pain and discomfort
Nausea
Vomiting and diarrhea
Hallucinations

Interesting, some of these symptoms can occur for those who are addicted to alcohol when experiencing withdrawal.

On its own, alcohol is responsible for over 3 million deaths a year in the world. The situation is so serious that the World Health Organisation has accelerated an action to plan to reduce “the harmful use of alcohol”.(5)

Considering the amount of alcohol and opioid use in the UK, it’s likely that those experiencing polysubstance dependence and addiction is probably a lot higher than what’s reported. This is why sharing facts on how the two interact and what a person can do to access treatment is very important to individuals as well as the general public.

Why do people mix the two?

There are various reasons people might use opioids at the same time as alcohol. It could simply be accidental in the case of a person taking codeine for the first time and not realising that having a beer with it is inadvisable. At the other end of the scale, a person might purposefully combine the two in order to enhance the effects of each substance.

When both opioids and alcohol are taken at the same time, it increases feelings of sedation and drowsiness. Perhaps, euphoria. However, there are huge risks when taking both of these depressive substances.

Interesting note: drinking alcohol can change how effective a medication is. It can stop medication from being absorbed so well into the body.

Risks of using opioids and drink

Both opioids and alcohol have a depressant effect on the central nervous system (brain and spinal cord). They also slow down the heart rate and blood pressure. One study showed how taking one oxycodone tablet with alcohol increases the risk of respiratory failure.(6)

The two combined can be fatal causing the body to slow down to the point of shutting the various systems down. This can mean death.

Aside from the effects at their most dangerous, there are other risks involved with mixing opioids and alcohol. When a person’s system is sedated they have slower reaction times and aren’t as safe in terms of functioning. Hence, operating machinery and driving should be avoided.

With long-term abuse of the two, both memory loss and a substance abuse type of dementia can occur as well.

There is some evidence to suggest that women experience the effects of mixing the two more than men. Some sources suggest that this is due to women holding less water in their bodies and metabolism differences.

For older people, there’s an even greater risk of respiratory failure and there’s also the risk of more mature adults being more likely to fall over when under the influence. This is linked to it being harder for the body to itself of toxins as it gets older.

Ultimately, the mixing of the two can cause brain damage, coma, and at its most devastating death.

Polysubstance dependence and addiction

When a person uses more than one substance at the same time, polysubstance dependence and addiction can develop. This might start to happen without much thought, however, when a person mixes the two, they might experience new sensations and feelings.

In the case of opioids and alcohol, the effects can enhance each other. Although people might have intended this outcome, there can be incredibly dangerous outcomes of mixing the two. Not only do the side effects of the two become more dangerous, but the addictive potential of the two combined is also increased. This means that people can go on to seek the two together to maintain the habit.

Treating opioid and alcohol dependency

There are many treatments available. They can be either privately or government-funded depending on how much a person might have to invest in treatment.

Rehabilitation programmes cover both inpatient and outpatient services. This means that people can opt for a residential stay at rehab or alternatively access one-to-one and group support at a rehab centre while living at home. Both types of treatment work for different types of people.

When a person enters treatment for opioid and alcohol dependency they will have an assessment and be spoken with by a trained professional. It’s important for a person who wants to be treated that they identify what they want to achieve from accessing treatment. Some people might want harm reduction advice whereas others might want to start a life of abstinence.

Depending on what a person wants, what their lifestyle looks, like and what they’re able to invest psychologically, emotionally, and financially will affect the types of treatments thet might opt for. Treatments in the UK commonly include:

Medical treatments for physical detox include both Librium and Subutex.
Cognitive Behavioural Therapy.
Dialectical Behavioural Therapy.
Mindfulness.
12 Step work.
Motivational Interviewing.
Holistic therapies.

How do I access treatment?

If you’re interested in starting treatment for opioid and alcohol use then you can contact your local GP or contact us for information about your local drug and alcohol services.

Contacting our team, you’ll be met with a friendly and professional advisor who will speak with you in a completely non-judgemental manner. You’ll have the change to ask all the questions you want and any information you share will be treated in confidence.

Final thoughts

Many people become addicted to alcohol and opioids. It can even take place when people have been prescribed opioids by their doctor for pain. If you’re unsure whether it’s safe to drink when prescribed medication, speak with your GP.

When opioids and alcohol are combined, they can enhance the desired effects people are looking for. The effect can make a person feel euphoric and it can ease the pain. However, the depressant negative effects of the two combined in the body are extremely dangerous. At their worst, the substances can lead to death.

People are able to recover from opioid and alcohol use and any addiction that might thereafter develop. Treatments are available and there are options for you. Whether you want to know about harm reduction or have the goal of abstinence, drug and alcohol workers are only a phone call or email away for you to ask for more information.