Dangers of Mixing Fentanyl and Alcohol

Fentanyl misuse is dangerous on its own, but mixing it with alcohol presents additional dangers, particularly an increased risk of overdose.^{1, 2} This page will help you learn more about the dangers of mixing fentanyl and alcohol and how to find help if you are struggling with polysubstance use.

What Is Fentanyl?

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine.¹

There are two types of fentanyl: prescription fentanyl and illicitly manufactured fentanyl (IMF).¹ Prescription fentanyl is prescribed to treat severe pain after surgery or for chronic conditions where other opioids are no longer effective.^{1, 3} IMF is made in clandestine labs and sold on the illicit drug market. It is the type of fentanyl most associated with overdose.¹

Drugs like cocaine, heroin, methamphetamine, and pills made to resemble prescription opioids are often mixed with IMF.¹

A person may be unaware that they are taking a substance containing fentanyl as it doesn’t have a discernable look, odor, or taste, increasing the risk of overdose.¹ This is why people who use drugs are strongly advised to consider testing them with fentanyl test strips.¹

Mixing Fentanyl and Alcohol

When a person uses two or more substances at the same time or within a short time of each other—such as mixing fentanyl with alcohol—it is referred to as polysubstance use.⁴

A person may mix substances like fentanyl with alcohol intentionally to experience the combined effects, or unintentionally, if they do not know they are taking drugs that contain fentanyl or other substances.⁵

Adverse Health Effects of Mixing Fentanyl and Alcohol

Alcohol can potentiate the respiratory depressing effects of opioids, including fentanyl, increasing the risk of a potentially fatal overdose.^{2, 6}

Other adverse health effects that can occur with the combined use of alcohol and fentanyl include an increased risk of accidents and injuries due to slowed reaction time, such as car crashes and falls.⁷

People who use alcohol with other substances such as fentanyl increase their risk of developing a substance use disorder (SUD), also known as addiction, and other comorbidities such as anxiety disorders, mood disorders, as well as more intense drug consumption and cravings.⁴  

Fentanyl and Alcohol Overdose

Using fentanyl and alcohol together increases the risk of fatal overdose.⁸

In 2021, nearly 71,000 drug overdose deaths involving synthetic opioids other than methadone (primarily fentanyl) occurred in the United States—more deaths than from any other type of opioid.⁹ Fentanyl-involved death rates increased by over 22% from 2020 to 2021 and accounted for nearly 88% of all opioid-involved deaths in 2021. The number of overdose deaths involving synthetic opioids in 2021 was nearly 23 times the number in 2013.⁹

Alcohol co-involvement in opioid overdose deaths is common, and a cross-sectional analysis of alcohol-involved opioid overdose deaths in the U.S. between 1999 and 2017 found that the prevalence and mortality rates of each substance increased year over year.²

Signs of an overdose involving fentanyl and alcohol include:¹⁰

• Unconsciousness or inability to awaken.
• Slow, shallow, or stopped breathing.
• Blue or purple fingernails or lips.
• Pinpoint pupils.

An overdose requires immediate medical attention. If you suspect that someone is overdosing:¹⁰

• Call 911. Provide specific information about where you are and what substances the person took if you know.
• Administer naloxone or another opioid overdose reversal medication (OORM) if you suspect opioid involvement. Naloxone (Narcan, RiVive, Kloxxado) and nalmefene are antidotes for opioid overdose. If you suspect an overdose involving opioids, give an OORM as quickly as possible.
• Support the person’s breathing. Provide rescue breaths or follow the 911 operator’s instructions if you don’t have training. When breathing returns, gently roll the person onto their side with the top leg bent to support the position, which will keep the airway open and better allow them to breathe.,
• Wait for emergency medical services to arrive.

Treatment for Comorbid Substance Use Disorders

People struggling to control their alcohol and fentanyl use may benefit from specialized treatment for comorbid substance use disorders (having one or more substance use disorders). Treatment for substance use disorders can vary but may include a combination of behavioral therapy (e.g., cognitive behavioral therapy), counseling, and FDA-approved medications.⁸

Addiction treatment can include:

• Detox: Detox refers to a set of interventions designed to help people safely stop using substances. Detox can help prevent or address potential complications associated with withdrawal, help people achieve a medically stable state, and facilitate entry into treatment. For patients who use multiple substances, detox can address the varying timeframes for experiencing withdrawal symptoms for each substance.^{8, 11}
• Inpatient: With inpatient treatment, patients live at a rehab center and have access to around-the-clock care. This can be a beneficial option for patients with severe addictions who need 24/7 support.^{8, 12}
• Outpatient: With outpatient treatment, patients live at home but travel on a regular schedule to rehab, where they may participate in different types of therapies and treatments. This can be a beneficial option for patients with less severe addictions.^{8, 12}
• Aftercare: Aftercare refers to ongoing efforts to promote recovery after a patient completes an initial treatment period. This can include things like individual counseling or attending support groups like Alcoholics Anonymous. It is designed to support recovery, help monitor a patient’s progress, and address relapse.¹³

Finding Addiction Rehab

If you or a loved one are struggling to control fentanyl and alcohol use, American Addiction Centers can help. To learn more, call our free helpline at to speak with an admissions navigator about your treatment options. You can also use our directories tool to find a polysubstance use rehab near you and easily check your insurance coverage for treatment.