The Dangers of Mixing Opioids With Alcohol & Other Drugs

Using more than one substance at a time, a practice known as polysubstance use, can increase the already-present risks associated with drug and alcohol misuse. In particular, mixing opioids with other substances, especially those with depressant effects such as slowed breathing, can be dangerous and potentially result in death.^1,2

Keep reading to learn more about the effects of using opioids with alcohol or other drugs and treatment options for polysubstance use disorder.

Mixing Drugs

Polysubstance use among people who use opioids is common and can be intentional or unintentional.

For example, one study reports that between 30%–80% of heroin users also use cocaine. In addition to intentional combinations of certain substances, people who use street drugs, including cocaine or meth, may be unknowingly combining these substances with fentanyl, which is increasingly being used as an adulterant in the illicit drug supply.^1,3,4

Polysubstance use is a dangerous practice that increases the risk of serious consequences, including overdose, , and addiction.^1,4

According to the Centers for Disease Control and Prevention (CDC), there were significant increases in overdose deaths involving synthetic opioids that also involved prescription opioids, heroin, and other illegal or prescription drugs from 2010–2016, and in 2020, approximately 40% of deaths involving illicitly manufactured fentanyl (IMF) also involved stimulants, whether illicit or prescription.³

Research shows that the risk of developing heroin dependence is twofold for people who misuse alcohol, threefold for people who misuse cannabis, 15-fold for people who use cocaine, and 40-fold for people who misuse prescription drugs.¹

In addition to opioid addiction, people who mix opioids with other drugs can also develop an addiction to the other substances they use, which is known as a polysubstance use disorder. One report found that 11.3% of people with an addiction to one substance have concurrent alcohol and illicit drug use disorders.¹

Mixing Opioids With Alcohol

Mixing different opioids with alcohol, including combinations such as hydrocodone and alcohol, oxycodone and alcohol, or morphine and alcohol, is dangerous because both substances have sedating effects and the potential to slow or stop a person’s breathing. People who drink alcohol and use opioids together are placing themselves at a high risk of serious effects.^4,5

Fentanyl mixed with alcohol, or using other painkillers and alcohol, significantly increases the risk of fatal overdose. People who drink alcohol and use fentanyl at the same time can suffer from severe respiratory depression (i.e., slowed or stopped breathing), which can lead to brain and other organ damage.⁵

Opioids and Adderall

Prescription stimulants like Adderall and drugs like cocaine, as well as heroin and prescription opioids, can alter several physiological processes. Using heroin or other opioids with stimulants like Adderall, cocaine, or meth can lead to dangerous and potentially lethal effects.^1,6

This is because the combination of opioids and stimulants places enormous stress on a person’s cardiovascular, respiratory, and central nervous systems.⁷

Combining opioids like heroin and cocaine (known as “speedball”) or heroin and meth (known as “bombita” or “goofball”) is a common practice, perhaps because some people believe that stimulants can offset opioid withdrawal symptoms or that heroin can help them avoid the overstimulation associated with cocaine or meth.^1,6

However, opioids and stimulants may not entirely counter one another, although stimulants can sometimes mask the effects of opioids and vice versa. People who use both may be at increased risk of cardiac arrest and respiratory depression.⁷

Additionally, using any type of opioid, not just heroin, with a psychostimulant like Adderall, meth, or cocaine is dangerous because it can increase the risk of overdose.⁶

Fentanyl and Xanax

Xanax is a benzodiazepine and central nervous system depressant medication that can slow breathing at certain doses. Fentanyl and other opioids can also cause respiratory depression. This means that combining fentanyl and Xanax can further potentiate the risk of respiratory depression and lethal overdose.²

In 2016, the U.S. Food & Drug Administration (FDA) released a boxed warning—their strongest type of warning—advising against the use of opioids and Xanax or other benzos, due to the risk of serious side effects, including unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, and unresponsiveness, which can lead to death.²

Opioid Overdose

Opioid overdose is a potential risk for anyone who misuses opioids, whether prescription or illicit, but this risk is greatly increased if a person combines opioids with certain types of substances.⁴

An opioid overdose is a medical emergency. If someone is overdosing, you should immediately administer naloxone (Narcan) and then call 911 right away. As naloxone can wear off after 30–90 minutes, it is important that people still receive prompt medical attention because opioid overdose effects may return.⁴

Common symptoms of opioid overdose include:⁴

• Unconsciousness or inability to awaken.
• Pinpointed pupils or pupils that don’t react to light.
• Slow or shallow breathing or difficulty breathing that may sound like choking, gurgling, or snoring.
• Fingernails or lips turning blue/purple. Lighter-skinned people may turn bluish purple, while people with darker complexions may turn pale/grayish or ashen.

Opioid Addiction Treatment in Oxford, MS

If you or a loved one is struggling with polysubstance use involving opioids, know that help is available. Proper treatment can reduce the risk of overdose and help people recover from addiction.⁴

Treatment for polysubstance use, including detox, inpatient rehab, or outpatient treatment, can involve evidence-based approaches like medication and behavioral therapies to help people achieve optimal treatment outcomes.⁹

Oxford Treatment Center, an inpatient drug and alcohol rehab in Mississippi, provides all levels of addiction treatment, including medical detox, which ensures patients undergo opioid withdrawal as safely and comfortably as possible.

Call us at to learn more about our programs. Admissions navigators are available around the clock to answer any questions you may have about your treatment options, paying for rehab, or using insurance to pay for rehab.

You can also quickly verify your insurance coverage by completing our confidential .

It’s never too late to get the help you deserve. Start treatment and begin the path to recovery today.