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Mixing Opioids and Alcohol: Effects, Dangers, and Getting Help

Alcohol and opioids are substances that have the potential for misuse and addiction, due to their ability to alter the brain’s chemistry and produce pleasant or euphoric effects.1,2 3,4 Alcohol and opioids both can cause feelings of intense happiness (euphoria) and both substances have depressive effects in the brain that can cause sedation and affect respiration.3,5 When one mixes opioids and alcohol, these effects can be amplified, and the risks of serious negative health outcomes, including fatal overdose, are greatly increased vs. taking either substance alone. Understanding the dangers of mixing alcohol and opioids and what to do if you or a loved one is engaging in polysubstance use can be vital for making healthy, informed decisions about substances.

Dangers of Mixing Opioids and Alcohol

Substance or drug interaction occurs when one substance enhances or reduces the effects of the other, or the combination causes additional side effects not typically experienced with either substance alone.6 Alcohol intensifies sedation and respiratory depressive effects of opioids, which include illegal substances like heroin as well as prescription painkillers like oxycodone or morphine.5,7

However, using alcohol and opioids together can be very serious and even fatal.5 A study from 2020 found that alcohol co-involvement for all opioid overdose deaths increased from 12.4% in 1999 to 14.7% in 2017.9In addition, some prescription opioid medications, such as Norco, Vicodin, or Percocet, contain acetaminophen, which can be harmful to the liver in high doses.10 Taking these prescription opioids—especially at high doses—with alcohol increases the risk of liver damage.10

Dangerous Side Effects of Mixing Alcohol and Opioids

In short, there is no safe level of alcohol use when taking opioids. 8 Mixing alcohol and opioids can seriously increase side effects of sedation and respiratory depression, including:11

  • Dizziness or loss of coordination.
  • Drowsiness.
  • Slower breathing or breathing problems.
  • Memory problems.
  • Unusual behavior.

Overdose Risk of Mixing Alcohol and Opioids

An overdose of a drug means that there is more of the drug present in the body than it can safely handle.12 This is also referred to as drug or alcohol poisoning or toxicity.12 A person is at increased risk of overdose if they take opioids with alcohol or if they take opioids before or after drinking.13

Signs of an overdose include:14

  • Pale or clammy skin; lips, skin, and nail beds may turn blueish
  • Tiny “pinpoint” pupils.
  • Slowed, shallow, or stopped breathing.
  • Vomiting or gurgling noises.
  • Loss of consciousness, where the person does not react to your voice nor can be awakened.

An overdose is an emergency.14 If someone exhibits any of these signs, call 911 immediately and while waiting for responders to arrive:15,14

  • Don’t leave the person alone.
  • Administer Naloxone (Narcan, RiVive, Kloxxado), if available.
  • Follow the instructions of the 9-1-1 operator until help arrives.

Getting Help for Opioid and Alcohol Addiction

Alcohol use disorder (AUD) and opioid use disorder (OUD) often co-occur. About 20% of those with AUD also have OUD, with some studies suggesting that number to be as high as 40%.8 The good news is that treatment is available and can include outpatient therapy, inpatient rehabilitation, medication treatment, and behavioral healthcare.16

It is never too late to get help, and there are various ways in which you or a loved one can seek treatment, such as talking to your primary care provider, calling your health insurance company, or searching online. is a resource that American Addition Centers provides to help you or a loved one seek treatment. If you’re struggling with alcohol and opioid misuse or addiction, or you know someone who is, please contact American Addiction Centers at to learn more about addiction treatment options.

You can also look at the facilities listed below to see if they provide the program you are looking for:

Does Insurance Cover Alcohol and Opioid Addiction Rehab?

For those who have insurance, using health insurance to pay for rehab should cover at least some of the cost of addiction treatment. Coverage may vary depending on your needs and insurance plan. To find out if your policy covers rehab, click here, or fill out the form below. Your information is kept 100% confidential. You can also click here to find a rehab near me.

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