Alcohol and Methadone Don’t Mix!!

Just like benzodiazepines, alcohol can be fatal when consumed by a patient who also takes methadone.

These two substances interact in several ways.

Worst of all, alcohol inhibits the area of the brain that keeps us breathing while we sleep. So do opioids of all sorts, including methadone. But when alcohol and methadone are both in the blood stream, the effects are greater than expected, due to synergy. In other words, 1+1=3, instead of 2, as we would expect. This interaction is unpredictable. This is how overdose deaths occur with the combination of alcohol and methadone.

Besides this potentially fatal interaction, alcohol also induces, or speeds up, the metabolism of methadone. Both alcohol and methadone are metabolized by the same enzymes in the liver, and alcohol can prime the pump of the metabolic rate. Alcohol gooses the liver, speeding the metabolism of methadone, which means a patient on a previously stable dose of methadone may suddenly notice that his dose isn’t holding for the full 24 hours. This patient may ask for a dose increase, when in truth, he really needs to stop drinking alcohol completely.

Over the long term, alcohol can cause a buildup of methadone to a toxic level, if the drinking goes on long enough to cause liver scarring and shrinkage, called cirrhosis. If this condition develops, liver metabolism slows for any drug or medicine processed by the liver.

Addiction is cunning, baffling, and powerful. It’s incredible to think of a person, finally able to stop using opioids after years of addiction, be defeated by alcohol. Cross addiction, which means switching from one addictive drug to another, happens all too frequently. Sometimes it’s hard to convince patients they need to stop the use of all addicting drugs, and that does include alcohol and marijuana.

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34 responses to this post.

  1. Posted by christy on July 20, 2010 at 10:45 am

    I would like to use this post as a handout ??

    Reply

  2. Posted by amanda horsman on April 4, 2011 at 12:19 am

    can it be harmful still if you are on a low dose.i am only on 6 mg if i drank could that cause a overdose

    Reply

    • I’ll never say it’s safe to mix the two, no matter how low the dose, but no, I think it’s unlikely to cause an overdose when you are on six milligrams of methadone.

      But I would ask why are you on six milligrams and drinking? If you are completing a successful taper to get off methadone, you need to know that drinking alcohol – any amount – puts you at greater risk for a relapse back to opioid use. And if you’ve done all the work to get that far, please don’t fumble at the one yard line and have to start all over. That would be disappointing, to say the least. I have the hardest time convincing people that if you are an opioid addict, using alcohol or any other “pleasure drug” increases risk of relapse.

      Think of another example: some people enjoy smoking cigarettes more when they drink alcohol, for the same reason. Plus, alcohol does not improve our decision making abilities.

      If you aren’t tapering successfully, either switch to another form of treatment if you can’t stop drinking, or talk to your counselor about strategies to help you quit drinking so you can safely stay on methadone, and go up to a dose that will really help.

      Best wishes.

      Reply

      • im on 50ml/day liquid methadone and though i tend to be a solo addictive type (?) and dont drink except on v rare occaisions. is it still safe to have the odd lager or glass of champers at a wedding or bday do? if so, what does anyone think? id appreciate any feedback however `hazy`., just as a guideline.

        peace,

        plug

      • Any amount of alcohol can be dangerous with methadone, so I always recommend patients not drink at all.

  3. Posted by me on August 25, 2012 at 3:54 am

    methadone isnt only used for addictions to drugs its also being currently used for pain managment………..just saying dont assume that if someone is on methadone that they are a drug addict , never ever assume

    Reply

    • You are right, of course.

      Reply

    • Posted by Missy on July 27, 2013 at 9:13 pm

      That is how I started on the road to becoming an addict. These doctors don’t care that we are pain not a single doctor that was treating me during my accident, surgery and then recovery ever told me that methadone or hydro’s are addicting. Now after all my recovery from crushing my face I have to endure rehab. so you may think that you are not an addict and maybe not yet but with in 4 months of taking any narcotic pain medicine daily……you will be an addict and not even know it. Been there done that and I wish anyone the best of luck with this problem. God Bless

      Reply

  4. Posted by gary shaw on December 14, 2012 at 3:22 pm

    dont drink with methadone i had one beer and 10 mil of methadone went to bed at midnight and was so week the next day I sleep through it 24hrs to recover.

    Reply

  5. I’m currently on 75mg of methdone/Day as well as 30mg prescribed diazepam and illicit benzos up to 100mg nitrazepam. I’ve recently started drinking and its rapidly getting out of control.
    I weigh 11stones, 40yrs old and until recently didn’t drink vodka q heavily or so moke or do any benzos.
    My question is whats a ballpark figure of how close to od’ing am I?

    Cheers

    Reply

    • What you are doing is very dangerous. You could die any day. I don’t know if anyone can give you a ballpark date of death, but I urge you to get help – addiction is a treatable illness

      Reply

      • Hi, Thx for your comments and advice. I’ve never been a big drinker b4 and have a high opiate tolerance. Same with benzos. I’m in active treatment and understand my issues to a large degree. I have some pharmacology understanding, tho not too any high grade hence the original question.my main issue with treatment is lack of help available or being labeled as drug seeking behavior, when in truth I have self reduced all my prescribed meds but its the hit and miss problem I find tends to put a spanner in my plans with health professionals, who in nearly every case just want to either put me on antidepressants which I am totally against, believing the placebo effect and time will do the job without another addiction added to my list; else refuse to offer any real help that I might explicitly ask for. It feels like a constant uphill struggle though I never give up trying, when I’m in a bad place I do feel why bother.
        Anyways thanks again for your time.

        Rgds. C.

      • The right anti-depressant ( I’m not talking about addictive benzodiazepines which make depression worse) in the right patient can be life-changing, though it may take months to see the full benefit. It does require patience.
        And alcohol is a depressant. some patients who look depressed are much better after they stop drinking; I wonder if you have seen any improvement in mood if you’ve stopped for more than a few weeks??

      • Hi, quick answer-yes, I’m having more good days than bad, moodwise since cutting right back to maybe 5 units a wk. I understand the depressant fx of alcohol, but after using a panopoly of substances;,both prescribed and illicit as crutches over my lifetime, its almost more than a reflex to turn to something to ease a mental pain. I don’t like the fx of booze tbh and h8 the fact its so v dangerous to all your organs, I’m kind of grateful I used opiate for past 12yrs not alcohol, as id be either dead or in a much worse state than I am know with a pickled liver to boot, lol.

        Thx for all your thought thru comments.

    • Posted by plugmucker on May 5, 2013 at 5:49 pm

      Well I’ve cut down the booze somewhat, since I found a source of PHENOBARBITOL, which is far better at numbing oneself. I’m sure its easier to od on the stuff bit its finding the right level I guess.

      Reply

    • Posted by plugmucker on May 5, 2013 at 6:01 pm

      Oh, btw, in my experience of incompetent (and I don’t use that word lightly) gps and health ‘professionals’, who I’ve seen a v wide selection are dead wrong in bleeting out how addictive behavior or self medication in my opinion is treatable. It just prolongs pain and does nothing but worsen my own condition to the point of suicidal tendencies. Given the option id like to live my life with least amount of emotional pain, than be told by someone who hasn’t had around 35yrs of worsening
      depression ‘its just a treatable condition’ – like I have dandruff or something. Im not after dying b4 my times up, but living my lifestyle is the only way I’m going to do so.

      Reply

      • Both addiction and depression are treatable, and now we know best results are seen when both are treated at the same time. Please don’t give up.
        BTW, both alcohol and phenobarb are depressants, will make depression worse.

      • Posted by plugmucker on May 6, 2013 at 10:06 am

        Please don’t presume to know my own body and mind better than myself. I know through much experience and mistakes what works and what doesnt. Its that labeling mentality trays part of the problem with depression and self medication.
        Simple rhetorical q.- would those who love and care about me sooner me use my substance of choice and stay alive or that I subscribe to the scarcely questioned rote, trotted out by so called professionals on the subject and end up spiraling into suicidal depression yet again and end up doing the rounds of psyche wards or dead?

  6. Posted by David on June 4, 2013 at 7:40 pm

    “plugmucker” should try medical marijuana: it’s non-toxic and helps many people get off opioids AND alcohol. If you MUST have something, let it be medicinal cannabis, and you will live much longer. I know from experience that most addiction treatment professionals despise marijuana, but always because they are ignorant. Good luck!

    Reply

  7. Posted by chris on June 19, 2013 at 12:55 am

    my wife is on methadone sometimes ,it seems about every 3 or 4 months she gets violenty ill for 4 days or more at a time throwing up until nothing to throw up and still getting sick took her to the Dr & they cant find anything wrong could it be the methedone making this happen ?

    Reply

    • Since I can’t offer specific medical advice I’d recommend you talk with her doctor about this. Methadone gives some people a bit of heartburn…but would that cause her to be violently ill? I don’t think so, but everyone is different.

      Reply

  8. Posted by Neil Stoneman on September 4, 2013 at 7:29 am

    A dear friend of mine, a recovering alcoholic in his 40’s, died a few weeks ago from this very combination… After a family member unaware of his alcohol battle gave him methedone to help him treat headaches and sleeplessness… He died in his sleep. Please don’t place yourself in the same position.. We’re just heartbroken.
    .

    Reply

  9. Posted by Ruthie on September 20, 2013 at 1:27 pm

    Neil, i’m assuming the same thing happened to my boyfriend in late June. How he got a doctor to prescribe methadone for pain knowing his history of heavy drinking i’ll never know. He died at home and wasn’t found for several days – no autopsy could be performed. i had begged him to get help but he said the alcohol was just a “habit” and he just had to stop. Two weeks after he said that he was dead. I understand your heartbreak and you have my deepest sympathy.

    Reply

  10. marijuana. now uve gone too far alcohol fatal forsure makes sense but mary jane addicting not even close bro or sis

    Reply

  11. Posted by Lisa Marie on January 15, 2014 at 9:55 pm

    My husband has sciroses of the liver on 90mg methadone and takes sceraquil, he drinks vodka heavily. he is so moody so angry, He is also taking wellbutrin. also testrorum injections. he has sleep problems not able to breath holds his breath he sleeps all day and drinks all night smoke two packs a day. they have him in rehab out pt. he goes when feels like it he is over the age of 50. I am so worried and scared not to mention being newly married by one year he is so mean to me. what is happening to him why is he doing this.

    Reply

    • No easy answers. Can you get him to agree to allow you to be part of his recovery at the outpatient rehab? I assume that’s the place prescribing methadone. Most opioid treatment programs welcome the opportunity to include the patient’s spouse in counseling. You have valuable information for his treatment providers.
      And don’t forget to take care of yourself – please see my blog of Spetember 14, 2012.

      Reply

  12. Posted by ConcernedDaddy on February 23, 2014 at 10:36 pm

    I was reading your post about the effects of alchohol and methadone. So are you saying that alchohol causes a person to in essence burn their methadone out of their system faster by consuming alchohol? My son was on methadone for 3 years for a back injury but three weeks ago decided he wanted to break free of his dependency. He was prescribed to take 40mg a day, but usually only took 1 a day, sometimes two, but normally stuck well to his 10mg max. (I hated that he took them, but was very proud at how well he stayed away from abusing them). There is no doubt he is addicted to them, but I am very proud of the steps he has taken to stop. He does drink a bit, or has been the last few days, a beer here and there. It is important to him to be done with this, and have it out of his system. How long does it take to get it out of his system, and with it being 18 days since his last dose, should he not drink, or will it help clear out faster? With all the things I have read, I am so confused and have no idea how to talk to him about this. Thank you for your time.

    Reply

    • If it’s been 18 days since his last dose of methadone, alcohol won’t influence his blood level at this point. However, it is common for people with addiction to become addicted to any drug that produces pleasure, and this includes alcohol. Your son’s best and safest course would be to stop drinking. It’s great he’s been able to stop opioids, but he doesn’t want to slip into alcohol addiction after coming so far.

      Reply

      • Posted by confussed father on February 24, 2014 at 2:47 am

        I know he is at a fragile state, and I will steer him clear of beer wine and spirits then. He wants to take a screening, and I dont want him to be shattered. Do you think I could give him one and he would pass it, or should I tell him to wait a day or two? I dont think a + result would destoy him, I just want to be as sound as I can be with him. Thank you so much for taking the time to reply to me

      • I don’t understand why he wants to take a drug screen?

      • Posted by confussed father on February 25, 2014 at 2:01 pm

        I think its a combination of self asurrance AND vindication. I also think he wants to get out on the job market and not have to explain his journey perhaps. Today is day 19 or 20 of being rid of them.

      • I’d wait another week to be sure.

      • Posted by confussed father on February 25, 2014 at 3:35 pm

        That would be day 25 clean. I am proud of him, the day he picked up his script he came home and just gave them to my wife, put of the blue, and said he didnt want to take them. My wife put them away just in case. On day 8 he asked if she had them, she said yes, do you want or need them. He said no, please flush them down the toilet, his mind was made up. She flushed then, and he is on the right path.

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