One in ten poisoning deaths in the United States are caused by drugs, whether illegal or prescribed. For Americans under age 50, drug overdose is the leading cause of death—more than car accidents, more than guns—and the death toll is rapidly rising. Most of these overdose fatalities are due to opioid drugs, like oxycodone or fentanyl, and many are a result of mixing prescription medications, or mixing pills with alcohol.
Prescription drug abuse can be deadly on its own. When prescription medications are mixed with alcohol or other pills, the risk exponentially increases, even for users who are not attempting to get high.
On September 20, 2017, the FDA issued a warning about the dangers of combining opiate replacement medications, like methadone and buprenorphine, with anti-anxiety prescription drugs, or any other drug that slows down the central nervous system. The reason being that the central nervous system includes the brain and the lungs, and mixing different CNS depressants can cause breathing difficulty, coma, and even death.
The list of CNS depressants is long, and includes commonly prescribed medications such as Xanax and Valium (for anxiety), Lunesta and Ambien (for insomnia), Zanaflex and Soma (muscle relaxants), and Saphris and Abilify (antipsychotics). While some of these drugs are being mixed intentionally by users, due to prescription drug abuse, sometimes patients undergoing Medication Assisted Treatment (MAT) with methadone or buprenorphine are also prescribed anti-anxiety medications or sleeping pills by doctors who are either unaware of the dangerous interactions, or unaware that their patient is undergoing MAT. If the patient is also unaware of the danger, overdose can easily occur due to oversight.
Experts insist that treatment of prescription pill addiction and other forms of opioid addictions with medication should not be discontinued due to the risk of drug interactions. Studies show that Medication Assisted Treatment, which combines pharmacological interventions with mental and behavioral health counseling, is the most effective approach to opiate addiction treatment, and is therefore a crucial part of most addiction treatment programs. Rather than discouraging MAT, addiction treatment providers need to fully inform and monitor their MAT patients, while carefully coordinating their care with other healthcare providers so that everyone is fully informed of the dangers.
Prescription Drug Abuse and Drug Mixing
Among Americans age 14 and older, prescription drugs are the most frequently misused substances after alcohol and marijuana. A recent four-year survey found that one in eight high school seniors have used prescription opioids recreationally, and among those users, seven out of ten report having combined opioids with at least one other substance. The most common mixer used was marijuana, at 58.5 percent, and the next was alcohol, at 52.1 percent. Young people put themselves at risk in this way without realizing what they’re doing. Not only are they usually unaware of the dangers of combining drugs, 50 percent of teens believe that prescription drug abuse is much safer than taking illicit street drugs.
The United States has a serious dependence on prescription drugs of all kinds. Of the 17 million Americans who report being heavy alcohol drinkers, one third also report using illegal drugs, with over 15 million Americans report prescription drug abuse. The U.S. represents only 5 percent of the world population, and yet the country consumes 75 percent of the world’s prescription drugs.
Awareness is Key
Medically assisted detox and recovery requires patients to take medications like buprenorphine and methadone. These drugs have been proven to be safe and effective when used as directed by the FDA, but they are still powerful drugs that can be incredibly dangerous if taken incorrectly, or if taken with substances that will counteract or amplify their effects.
Methadone is a Schedule II drug, same as oxycodone and hydrocodone. It can be a lifesaving medication when used as part of an addiction treatment plan, but it is also a drug of misuse. In 2009, one in three prescription opiate deaths was due to methadone, and every year, methadone overdose kills approximately 5,000 people.
Methadone treats opiate addiction by binding to the opioid receptors in the patient’s brain, blocking drug cravings and symptoms of withdrawal. It also stops the effects of other opiate drugs, so that a person on methadone maintenance treatment will not be able to experience euphoria if they take heroin or any other opioid drug. If individuals who don’t fully understand how methadone functions in the body attempt to use heroin, they are likely to immediately take more heroin when they don’t feel any effects from the first dose. The combination of all those opioids in the brain can lead to fatal overdose.
On the appropriate daily dose of methadone, patients will function normally without sedation or euphoria, partly due to their preexisting tolerance to opiate drugs. When taken recreationally by users without a tolerance, methadone can create a high similar to heroin, but lasting much longer, due to its longer half-life. Methadone combined with benzodiazepines or alcohol will enhance the intensity of the high, as well as greatly increase the risk of fatal health complications and overdose. And because methadone has direct effects for twenty-four hours, but remains in the body for two and a half days, interactions and overdose can occur even after the drug’s noticeable effects have worn off.
The Dangers of Mixing Drugs
Prescription pill addiction can lead individuals to make risky choices, such as mixing pills with heroin, alcohol, or benzodiazepines like Valium, Xanax, or Klonopin. Fatal overdoses are usually the result of mixing more than one substance.
Drugs that depress the central nervous system have different mechanisms to create sedation in the brain and body, as well as mechanisms to protect the user’s brain and respiratory system from shutting down. When mixed together, the different mechanisms of these different drugs overlap, amplifying the drug’s intoxicating effects while also canceling out any safeguards the individual drugs may have had on their own. A person with Valium in their system could take a relatively small dose of oxycodone and overdose, or a person taking hydrocodone for pain could take Lunesta to sleep and wind up slipping into a coma.
Some people mix illicit drugs, like heroin and cocaine. This is called speed-balling, and while you might think the combination of a depressant with a stimulant would cancel out the CNS effects of both drugs, it instead increases the user’s risk of overdose.
Another problem with mixing substances is that the result is unpredictable. All substances can have different effects, depending on individual body chemistry. It’s why some people can’t tolerate certain drugs, or have unusual reactions and side effects. When you combine two or more different substances, the range of reactions and interactions multiply exponentially, which can easily lead to unforeseen problems.
Accidentally Ingesting Fentanyl
Sometimes overdose occurs when someone with a prescription pill addiction takes a counterfeit drug laced with fentanyl, a synthetic opioid that is 50 times stronger than heroin. Fentanyl is a fine-grained powder that can cause overdose when someone with no tolerance simply touches it or inhales it. It is also easy to mix with other drugs. It can mix with or be made to resemble powdered heroin, it can be used to make counterfeit prescription drugs like hydrocodone or oxycodone, or it can be mixed with stimulants like cocaine. Most people who die of fentanyl overdoses didn’t even know that the drug they took contained fentanyl.
Fentanyl is so very potent that a large amount of product can be shipped in an inconspicuously small envelope from illegal manufacturers in China or Mexico. Dealers can then take that small amount and produce a large amount of counterfeit product that will still get users as high, or higher, than they expect. The problem is, without quality control, the dilution of the product is inconsistent. One pill might have a tiny dose of fentanyl in it, while the dose in the next pill could be fatally high.
The Dangers of Mixing Pills with Alcohol
Alcohol on its own can make you drowsy, sleepy, and lightheaded. It can impair concentration and motor skills. When you mix pills with alcohol, these effects can be amplified—and in turn, the alcohol can amplify the effects of the pills. The CDC reports that twenty-two percent of fatal prescription painkiller overdoses also involve the use of alcohol.
Mixing pills with alcohol can lead to:
- Impaired judgement and coordination
- Abnormal behavior
- Irregular heart rate
- Blood pressure changes
- Internal bleeding
- Respiratory distress
Alcohol can also make some medications useless, while making others toxic. These harmful interactions can happen even if you don’t ingest the pills and the alcohol at the same time.
Mixing pills with alcohol is particularly dangerous when the pills are opioids. Prescription pill addiction is widespread, and many people who engage in prescription drug misuse also drink alcohol. Even someone who drinks a small amount of alcohol while taking an opiate drug as prescribed runs the risk of an unexpected degree of intoxication, health complications, and possible overdose. This is because alcohol enhances the effects of the opiate, and vice versa. The two should never be mixed.
The most likely side effect of mixing pills with alcohol is depressed respiration. The opiate and the alcohol can easily combine to slow the user’s rate of breathing until they are no longer getting enough oxygen. As a result, the user’s organs will begin to shut down, and they run the risk of suffering brain damage, coma, or death from lack of oxygen.
Women are even more at risk of these interactions than men. For one thing, there are more women who misuse prescription painkillers than men, and for another, alcohol affects women differently. Alcohol mixes with water in the body, and women tend to have less water in their bodies than men, therefore alcohol will be more concentrated in a woman’s system. This means a man and a woman could drink the same amount of alcohol, and the woman would have a higher blood alcohol content.
Older people also have a greater risk when mixing pills with alcohol. As people get older, their bodies process alcohol more slowly, so that the alcohol remains in their systems much longer. Anyone mixing alcohol with oxycodone or other prescription painkillers is at risk of severe falls due to loss of balance, but older adults are even more so. And not only are they more likely to fall, they are more likely to injure themselves badly when they do fall. Mixing pills with alcohol can also lead to memory loss and increase the symptoms of dementia.
Mixing Alcohol and Methadone
Methadone is an opiate, and therefore, mixing it with alcohol has all the same risks as it would with any other opiate drug. In addition, drinking alcohol with methadone greatly increases a person’s chance of becoming addicted to alcohol, which is the last thing a person in recovery wants to happen. The combination of methadone and alcohol creates a much stronger level of intoxication, putting the user at greater risk of both addiction and overdose.
Alcohol also reduces the therapeutic effect of methadone, because it can alter the metabolism of the drug. A person who drinks alcohol on methadone maintenance is likely to feel the need for another dose while the medication is still at peak levels in their system. Methadone and alcohol can also increase the heart rate when taken in conjunction, which can lead to cardiac problems, even in individuals with no history of heart trouble.
Don’t Mix Your Pills
No matter what drug you are taking, or whether you are taking it by prescription or recreationally, you should never mix pills with alcohol or other drugs. Speak with your doctor or pharmacist if you have any concerns about your medications and the possible interactions. If you are on methadone or buprenorphine maintenance treatment, make sure that each one of your healthcare providers is aware of this, so they can treat you safely and effectively.