Alcohol and Opioids (and Benzos) Don’t Mix!

aaaawarning

The Centers for Disease Control and Prevention (CDC) released a report in October of 2014 that analyzed data regarding the contribution of alcohol in opioid overdose deaths and in emergency department visits for opioid misuse. They also looked to see if alcohol was present in benzodiazepine overdose deaths, and emergency department visits related to benzodiazepine misuse. This information was gathered in 2010 by the Drug Abuse Warning System, (DAWN). [1]

The report found that alcohol was a contributing factor in at least twenty percent of the opioid overdose deaths. When they looked at emergency department visits for opioid misuse complications, alcohol was present in about eighteen percent of patients.

In other words, alcohol is a contributing factor in one-fifth of serious opioid overdoses deaths and near-overdoses.

The data was similar for alcohol combined with benzodiazepines; twenty percent of benzodiazepine-related deaths had alcohol present in the decedent’s body as a contributing factor. For emergency department visits related to benzodiazepine use, alcohol was present in over a fourth of these patients.

I don’t find this data to be surprising. If anything, I’d expect a higher percentage of decedents to have alcohol as a contributing factor to both opioid and benzodiazepine overdose deaths. Alcohol and benzos both act on the same type of brain receptors, and have the same sedative effect on the brain. They both also act of the portion of the brain that tells us to breathe while we are asleep. Since opioids have the same effect, particularly at higher doses, any combination of these three substances can result in death. The person goes to sleep, stops breathing, and dies.

Other bits of data in this report were interesting. For example, more men than women had alcohol as a contributing factor in opioid-related and benzodiazepine-related emergency department visits. That’s not a surprising finding, since men have a higher rate of binge-drinking than women.

In this study, older people were more likely to have used alcohol along with their opioid than younger people. Overdoses in people aged 40 to 59 had alcohol in around one-fourth of the deaths.

The study found people who used hydrocodone were more likely to consume alcohol. That’s an interesting finding. Maybe opioid addicts who have hydrocodone available, as compared to stronger opioids like oxycodone, tend to supplement with alcohol in order to boost the effect of the opioid. That’s merely conjecture on my part, but it’s based on conversations with opioid-addicted patients over the last ten years. Opioid-addicted patients will use anything to ease opioid withdrawal symptoms: alcohol, benzos, even cocaine or methamphetamine

For people who overdosed on benzodiazepines, twenty-eight percent were over age 60. There’s another good reason to avoid or reduce benzodiazepines in people over sixty.

I think this data shows we need to do a better job of educating patients not only of the danger of benzodiazepines and opioids mixed together, but that alcohol can be just as deadly with either benzodiazepines or opioids.

I really worry about my patients who drink alcohol while being prescribed either methadone or buprenorphine (Suboxone). Too many of my patients are cavalier about mixing alcohol with other drugs and medications. Many of them say they don’t see alcohol as a real problem, because they’ve been able to start and stop alcohol, unlike opioids. They say alcohol is legal, so what’s all the fuss? They say they don’t drink any more than their friends. Everybody drinks, don’t they?

No, they don’t. About thirty percent of the U.S. population doesn’t drink alcohol at all. Only fifty-six percent have had an alcoholic drink over the past month, which means nearly half of the people in this country haven’t had any alcohol over the last month.

One of my patients told me it was his right as an American to drink alcohol, and was angry at me when I told him of the dangers of mixing alcohol with methadone. I told him I didn’t know if drinking was a right or not; I was only telling him about how alcohol and drugs affect the body.

Sometimes I ask patients what they think about the warning label on their pill bottle that says, “Do not take with alcohol.” Some patients say they don’t believe warning labels because they’ve had alcohol with buprenorphine or other opioids before, and nothing bad happened. Some say they think the warning labels are put on all medicine bottles to protect the pharmacy from being sued.

Just because something has never happened before doesn’t mean it can’t or won’t happen in the future. Many factors can influence overdose risk, and it’s dangerous to assume an overdose can’t happen because it hasn’t happened before.

1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm

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5 responses to this post.

  1. He visto como el Equipo de Valoración de Incapacidades, daba como capaz a alguien que mezclaba 65 mg de metadona, 6 mg de alprazolam y 40 mg de fluoxetina. Después de eso, cualquier cosa, Aquí se puede conducir con metadona si te la recetó el medico, aunque fuese ex profeso para que no condujeras o como reducción de daños, estando desahuciado. Están locos. Y te sancionan por dar negativo, si descubren que días antes consumiste, aunque no vaya contra la ley, es pecado y no olvidemos que el Ministro del Interior es un Opusino, más que don José María Escribá y Alvaro del Portillo, juntos. Eso como Ministro, lo dejas en casa, así va Podemos. El PP, está fuera de juego. Hoy es una UDC o CDS. Y el PSOE un BLOQUE o ERC, nada más.

    Reply

  2. Posted by edpane on December 1, 2014 at 5:26 pm

    The potentiating effect of benzos or opioids with alcohol is something that takes many of my clients by surprise. I like to do some basic drug education about their drug of choice with everyone who I see. When reflecting on what we discussed, many were then able to identify people who they lost to these combinations, but didn’t understand why. Great installment on this blog, Doc.

    Reply

  3. I think this individual doesn’t know that mixing two different drugs at the same time may cause allergic reactions or other type of responses do you prepared being tested with different kinds of drug? Do you want to be the next victim of substance misuse? Or you don’t believe safety precautions because you think that you’re more knowledgeable than those who tested, approved and know it more than anyone else?

    The first thing is these safety labels are put for us to read, the second is that alcohol can weaken your immune system, a weak immune system means more prone to diseases and third don’t play with your life. No one is alone in this world and ending one’s own life just means defeat. It’s not hard to change.

    Alcohol addiction treatment centers Oregon

    Reply

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