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Mixing Heroin & Alcohol: Dangers & Risks

People who misuse substances often use more than one at a time, a practice known as polysubstance use.1 According to a 2020 study, 11.3% of people who are diagnosed with a substance use disorder have concurrent alcohol and illicit drug use disorders.1 This same study also reports that people who misuse alcohol are twice as likely to become dependent on heroin.1

In addition, the Centers for Disease Control and Prevention (CDC) reports that opioids were involved in 80,411 overdose deaths in 2021; specifically, there were 9,173 deaths in 2021 from overdoses that involved heroin.2,3 According to one 2023 report, 30% of all synthetic opioid related deaths in the U.S. also involved heroin.4

The potential for experiencing illness and death becomes more common when alcohol and opioids are being used concurrently.5 Misusing heroin and alcohol is a dangerous practice that can lead to negative health outcomes. This article will help answer several questions, including “can you drink alcohol with heroin?” Additionally, it will cover heroin’s adverse effects, the dangers of using alcohol and heroin together (including overdose risk), and how to find help for polysubstance misuse and addiction.

What is Heroin?

Heroin is a highly addictive opioid drug that is derived from morphine, a naturally occurring opiate alkaloid harvested from the poppy plant.6 Heroin is illicitly manufactured, and commonly sold as a white or brown powder.6 Black tar heroin, on the other hand, is sticky and tar-like or hard like coal.6 This type of heroin, which is most commonly seen in areas west of the Mississippi River, is typically dissolved into a liquid solution and then injected.6 Powder forms of heroin can also be injected, but are also commonly smoked or snorted.6

Both forms of this opioid can be laced with other dangerous and potentially deadly substances, such as fentanyl.4,6 Despite these and other risks, heroin is still widely used, primarily for the ‘rush’ or intense, euphoric high that it produces.7

Adverse Effects of Heroin

Heroin use is associated with numerous adverse effects.7 The various adverse and potentially dangerous effects of heroin may depend on several different factors, such as how much heroin the person used, how often they use it, what routes of administration are used (i.e., smoking, injecting), and whether or not they use other substances.8

Some of the immediate adverse effects of heroin use include:7

  • Drowsiness.
  • Decreased level of consciousness.
  • Altered mental functioning.
  • Nausea and vomiting.
  • Severe itching.
  • Slowed breathing, which can progress to fatal respiratory arrest.

While heroin use can cause the above-mentioned adverse effects, chronic use can result in several other effects, including the development of tolerance and dependence.9

Dangers of Using Heroin and Alcohol Together

Mixing alcohol with other substances is unsafe and can lead to unpredictable outcomes.10 Drinking while using heroin or other opioids can have dangerous health risks, including death.1,5 People who simultaneously use both may experience additionally dangerous effects of alcohol and heroin than those associated with using just one substance at a time.10

Some of the health risks of comorbid conditions like using heroin and alcohol together can include dangerously slowed heart rate and respiratory rate, coma, and potential death.11 Additionally, polysubstance use that involves alcohol can lead to the following dangers:10

  • An increased risk of injuries.
  • Violence.
  • Risky sexual behaviors.
  • Increased likelihood of contracting chronic infectious diseases like HIV.

Polydrug use that involves alcohol has been associated with additional comorbidities, such as a higher likelihood of mood disorders (like depression), anxiety disorders, more severe alcohol use, and more intense drug use and craving.1 Additionally, when alcohol is used with heroin or other opioids, the most significant danger is overdose.10

Alcohol and Heroin Overdose

Using heroin and alcohol at the same time can increase the risk of experiencing an overdose.10 An overdose occurs when someone has used enough of one or more substances to cause serious and potentially life-threatening symptoms.12

Combining opioids like heroin with alcohol use is dangerous because they can both suppress brain activity that is responsible for vital life functions, such as breathing.12 Even if a person is drinking moderate amounts of alcohol, they may still be at an increased overdose risk of alcohol and heroin when using both substances simultaneously.12

Alcohol and heroin are both respiratory depressants that can cause hypoxic respiratory failure.13 Hypoxia refers to a lack of oxygen delivery to tissues, which can result in stroke, brain and other organ injury, neurological deficits, and other serious issues.14 The combination of heroin and alcohol can lead to synergistic effects, or an amplification of the risks that are already present with each substance alone, further increasing the risk of fatal overdose.13

Signs of Alcohol & Heroin Overdose

If you or another person are experiencing an overdose, call 911 right away and administer naloxone immediately.15 It’s not always easy to tell if someone is overdosing, however, it’s best to take these immediate actions if you are at all concerned that an overdose is occurring.16

Someone who is overdosing on substances like alcohol and heroin may exhibit certain signs. These may include signs of an opioid overdose such as pinpoint pupils or pupils that do not react to light, as well as signs that may be seen in either an alcohol or heroin overdose, such as:12,11

  • Loss of consciousness or an inability to be awoken.
  • Slowed, shallow, or irregular breathing.
  • Skin that feels cold, or extremely low body temperature.
  • Blue or purplish fingernails or lips.

Get Help for Heroin and Alcohol Addiction

If you or a loved one are struggling with alcohol or heroin addiction, know that help is available. Polysubstance addiction treatment can help people safely stop using heroin and alcohol, allow them to regain control of their lives.17

No matter how things might seem right now, there is always hope. Please call our free and confidential helpline at any time of day or night to speak to a caring admissions navigators about our treatment and rehab options. You can also use our online directory to find alcohol rehabs near you, and immediately check your insurance coverage for treatment.

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