Certainly, the illicit use of mega-powerful synthetic opioids like fentanyl is what’s driving the latest wave of opioid-related deaths in this country. People who have been prescribed opioids and are shopping for additional prescriptions are also part of this story.
However, a growing contingent of users who abuse opioids with alcohol or other drugs are succumbing to death more often, now more than ever. Overdose from opioids and benzodiazepines, for example, have risen every year since 2012, according to the National Institute on Drug Abuse (NIDA).
When it comes to polysubstance abuse involving opioids, benzodiazepines or “benzos” and alcohol are the most common companion substances.
Evidence of this trend can be found anecdotally in some recent celebrity deaths. In 2018, rapper Mac Miller succumbed to what a Los Angeles coroner described as “mixed drug toxicity.” The substances that claimed the 26-year-old rapper’s life were a cocktail including fentanyl, cocaine, and ethanol (alcohol). In November 2017, rapper, singer, songwriter, and model Lil Peep died from an accidental Xanax-fentanyl overdose, according to medical examiners. The deaths of acclaimed actors Philip Seymour Hoffman and Heath Ledger, in 2014 and 2008, respectively, also drew attention to this unfortunate phenomenon.
Opioids depress the central nervous system (CNS). When they are combined with other CNS depressants like alcohol and benzodiazepines, the effects of those substances are amplified. Yet, the likely outcome is respiratory depression, which is when your breathing just stops.
This is the chief concern that comes with taking opioids with drugs like benzodiazepines or alcohol. There are other concerns and grave health complications that come with this kind of polysubstance abuse.
OxyContin, along with other opioid medications like Vicodin (hydrocodone), morphine, Tramadol, and codeine, acts on receptors in the brain that ultimately block pain signals. When people use these medications, they tend to feel little to no pain. They can also experience an opioid high.
Because OxyContin spikes levels of dopamine, a brain chemical that controls the brain’s reward and pleasure centers, users report a rush of pleasure and euphoria, making them feel “high.”
In varying degrees, opioids induce these sorts of sensations, along with their pain-blocking properties.
When users take opioid medications as prescribed, there may be a risk developing an opioid use disorder. However, the specter of addiction becomes real when people take opioid medications more often than prescribed or use them outside of their intended purpose like crushing up pills to snort them.
According to the National Institute on Drug Abuse, about 21 percent to 29 percent of people who have been prescribed opioids for chronic pain misuse them, and between eight percent and 12 percent develop an opioid use disorder. Also, 80 percent of people who use heroin first misused prescription opioids.
When users abuse prescription opioids, they tend to experience the following symptoms:
All opioids, to some degree, cause users to experience nausea, vomiting, itching, constipation, and drowsiness. These effects are magnified when these opioids are combined with alcohol or benzodiazepines. Death is a more likely outcome.
Alcohol and drug dependence go hand in hand. When drugs are taken with alcohol, they can inflict severe physical, mental, and behavioral complications. Users engage in this sort of polysubstance abuse out of a desire to self-medicate so they can manage a mental health issue and/or because it amplifies the effects of both substances.
What they don’t account for, however, are the dangerous interactions between these substances. Alcohol is a depressant. When it is misused or consumed a long time, it can inflict grave effects in and of itself.
Drinking a lot during a long period or on a single occasion can cause you to experience an irregular heartbeat, stroke, and high blood pressure. Excessive alcohol use can damage your liver and pancreas leading to health complications such as cirrhosis, alcoholic hepatitis, fibrosis, and pancreatitis.
Extensive research supports a connection between alcohol use and a variety of cancers, including head and neck, liver, and colorectal cancers. What’s more, alcohol weakens your immune system to such a degree that it makes you susceptible to diseases like pneumonia and tuberculosis.
When opioid painkillers are introduced to the mix, the effects are perilously amplified, particularly in the liver. Opioid and alcohol use often lead to liver disease and life-threatening respiratory depression.
While there is not much information on the combined effects of opioids and alcohol, there is data that speaks to the gravity of this potentially lethal cocktail. When the U.S. Centers for Disease Control (CDC) and the U.S. Food and Drug Administration (FDA) analyzed data from drug-abuse related emergency department visits in 13 states in the U.S., they found an astonishing correlation between opioid and alcohol abuse and hospitalizations.
They found that alcohol was involved in 18.5 percent of abuse-related emergency visits involving opioid pain relievers. Alcohol was also involved in 22.1 percent drug-related deaths involving these type of opioid medications. The numbers suggest that alcohol plays a significant role in opioid pain reliever abuse and the dire outcomes of hospitalization and death.
Benzodiazepines, which include brand name drugs such as Xanax, Valium, Klonopin, and Ativan, are sedative-hypnotics prescribed for anxiety and panic disorders, insomnia, and seizures. It is also prescribed for its muscle relaxant properties. Benzos act on the body by raising the level of gamma-Aminobutyric acid (GABA), the body’s primary inhibitory neurotransmitter located in the brain.
Like opioids, they provide sedative effects that endow a sense of euphoria. People age 65 and older comprise the biggest contingent of benzodiazepine users. Thus, they are most prone to abuse them, particularly with alcohol.
However, there is growing evidence that as benzodiazepine prescriptions increase, more people who have pain and sleep or anxiety disorders, take these drugs concurrently, putting them on track to experience life-threatening respiratory depression.
One study that focused on 300,000 continuously insured patients from 2001 to 2013 found that the percentage of them receiving both opioid and benzodiazepine prescriptions rose by 8 percent. The study showed that when people take these two drugs, they are at a greater risk for going to the hospital for a drug-related emergency. In fact, more than 30 percent of opioid overdoses, involve benzos.
The internal damage users inflict on their bodies from opioid and alcohol or benzodiazepine use is just one certain outcome. The other comes from the profound sedative effects of these medications and how they impact users when they drive or walk around.
Each of these medications, on their own, impair motor function to such a degree that intoxicated users at risk for getting into traffic accidents, participating in violence, assaults, and murders.
Being under the influence of any of these substances can lead to the loss of inhibition where users will engage in risky behavior that puts them at risk for injury, hospitalization, disease, or prison.
They also can experience thoughts of suicide, particularly if there is a history of mental illness or substance abuse present.
When these substances are used concurrently, these aforementioned social and behavioral risks are heightened to an even greater degree.
When people abuse substances like opioids and/or alcohol or other drugs, it is common for them to also have a mental health disorder. Opioid medications and alcohol are among the most commonly abused substances for people with mental health disorders.
The National Survey on Drug Use and Health estimates that 20.3 million people aged 12 or older had an SUD in the past year.
When people have mental disorders such as bipolar disorder, depression, borderline personality disorder, post-traumatic stress disorder (PTSD), schizophrenia, or anxiety disorder, they might manage their symptoms by engaging in polysubstance abuse, which is referred to as self-medicating.
If you have a substance addiction and mental health disorder, then you would be eligible for professional dual diagnosis recovery treatment. Patients with this diagnosis receive treatment for both disorders, which affords them the best chance at recovery.
For people who abuse opioids with alcohol or another substance, professional addiction treatment not only gives them the best chance at recovery, but it can also save their lives.
Professional treatment begins with medical detoxification, a process in which both substances are removed from the body, along with any other toxins. This process is medically supervised, and patients receive around-the-clock care to ensure a safe and comfortable detox.
For people with co-occurring use disorders or dual diagnosis designations, a residential treatment program where they can receive ongoing care at a facility is the next, most effective step. In residential treatment, they receive an experience that is both specialized and personalized for their particular recovery track. Residential treatment includes access to therapy services such as:
Once they complete this program, they will be provided with an aftercare plan to help them manage their sobriety and avoid relapse.
Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths – United States, 2010. (2014, October 10). from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm
Alcohol's Effects on the Body. (n.d.). from https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body
Lynne.walsh. (2015, June 16). Common Comorbidities. from https://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities
National Institute on Drug Abuse. (2018, March 15). Benzodiazepines and Opioids. from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids#Reference
Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19‑5068, NSDUH Series H‑54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. from http://www.samhsa.gov/data/report/2018-nsduh-annual-national-report
Oxycodone: MedlinePlus Drug Information. (n.d.). from https://medlineplus.gov/druginfo/meds/a682132.html