Mixing alcohol with opiates can be extremely dangerous. Because both alcohol and opiates are central nervous system depressants, combining them can have an additive effect that leads to overdose.

For this reason, the FDA has mandated a boxed warning about the risk of combining the agents since 2016. Some FDA-approved opiates and opioids that carry this warning include:

  • Hydrocodone (Hysingla ER, previously Lorcet, Norco, Vicodin)
  • Hydromorphone (Dilaudid)
  • Oxycodone (OxyCONTIN, Oxaydo, Roxicodone, Xtampza ER, Percocet)
  • Tramadol (ConZip, Qdolo, previously Ultram)
  • Buprenorphine (Belbuca, Butrans, Sublocade, Suboxone, Zubsolv)
  • Fentanyl (Subsys, previously Duragesic)

Mixing Alcohol With Hydrocodone, Oxycodone and Other Opiates Can Prove Fatal

Depressants slow down your body’s systems. When you take two substances that slow down your body’s systems, there is a danger of suppressing your body too much. This can slow or even stop your breathing. 

Even if you do not misuse hydrocodone, drinking alcohol while taking it can be dangerous. For those who misuse hydrocodone, the risks of overdose intensify. This is especially true if you take long-acting forms of hydrocodone, as alcohol can speed up the release of the drug into your bloodstream, further increasing your overdose risk.

Consequences of mixing opiates like hydrocodone with alcohol include:

  • Drowsiness
  • Dizziness
  • Lightheadedness
  • Problems concentrating
  • Impaired thinking 
  • Problems with judgment
  • Low blood pressure
  • Breathing problems
  • Fainting
  • Coma
  • Death 

Another reality of mixing hydrocodone with other substances like alcohol is that it can lessen the chances naloxone (Narcan) would effectively reverse an overdose. This is because naloxone only works on opioids, not alcohol or other substances. So an overdose from multiple agents would not be able to be reversed by naloxone, with only the opioid part of the overdose potentially responding.

Overdose is common when you mix alcohol and opioids. Studies show that many Americans die of an overdose from combining these agents. Specifically:

  • In 2017, 14.7% of opioid deaths involved alcohol.  
  • Overdoses involving alcohol and opioids increased 5.5-fold from 1999–2017.
  • From 2015–2017, 17.2% of fatal opioid overdoses among men and 10.5% of fatal opioid overdoses among women also involved alcohol. 
  • Between 2015–2017, alcohol was involved in 15% of all overdose deaths, including:
    • 16.5% of all heroin overdose deaths
    • 10% of all methadone overdose deaths
    • 14.2% of all prescription opioid deaths
    • 14.9% of all synthetic opioid (like fentanyl) deaths

Drug overdose can be fatal. If you suspect someone is experiencing an overdose, call 911 immediately. Do NOT be afraid to seek help. If you cannot access a phone, contact Poison Control for online assistance.

Can’t I Just Have One Drink With Opioids?

There is no safe amount of alcohol that can be taken with opioids. Alcohol, in some cases, can even make opioids release faster into your bloodstream, increasing your risk of overdose not only from the alcohol but from an unexpectedly high amount of the opioid. Ask your doctor if you have any questions about mixing alcohol and opioids in your particular situation.

How Long Should I Wait To Drink After Taking Opioids?

You should wait to drink until the opioid you have taken is completely out of your body. That said, every opioid is different and will last longer in people’s systems based on factors including the drug dose you take, your age and your overall health. Some opioids, like heroin, may take just a few hours to leave your system, while other opioids, like methadone, are longer-acting and may take days or even weeks to leave your body. Your doctor can best advise you about how long to wait based on the opioid you take and your specific medical history.

Are Any Painkillers Safe To Mix With Alcohol?

No painkillers are safe to take with alcohol. Even over-the-counter alternatives like acetaminophen (Tylenol) are dangerous. In fact, half of acute liver failure cases in the U.S. and 20% of liver transplants are due to people drinking while on acetaminophen. Even NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Motrin), aspirin, and naproxen (Aleve) are unsafe to take while drinking, as mixing them increases your risk of gastrointestinal bleeding significantly.

Signs of Alcohol and Opioid Overdose

When you mix alcohol and opioids and start to overdose, you will likely show some overdose signs as your body begins to shut down from the additive depressant effect of the substances. If you experience any of the following signs or symptoms, you should seek immediate medical attention for a possible hydrocodone and alcohol overdose.

  • Shallow breathing or rapid heartbeat
  • Confusion
  • Cold, clammy skin
  • Severe weakness or dizziness
  • Lightheadedness or faintness
  • Seizures or convulsions
  • Stumbling
  • Blue tinge to fingernails or lips
  • Gurgling in the throat or vomiting

An overdose is a medical emergency. If you suspect someone is overdosing on alcohol and opioids, you should:

  • Call 911
  • Give naloxone (Narcan) for the opioid part of the overdose
  • Keep the person awake if possible
  • Turn the person on their side to prevent choking on their saliva or vomit
  • Stay with the person until the ambulance arrives

Treatment for Alcohol and Opioid Use

If you or a loved one mix opioids and alcohol, this can be a sign that you struggle with these substances. This is especially true if you’ve ever needed emergency services or treatments like naloxone to stop an overdose. You’re not alone: hydrocodone misuse is common among those struggling with chronic pain. In many cases, it can be treated with the help of a team of compassionate, concerned medical professionals.

Seeking treatment is the best way to avoid an overdose risk with alcohol and opioids. From medical detox that weans you off these substances to rehab that helps keep you off them for good, help is available. Contact The Recovery Village at Palmer Lake today to discuss your needs and available treatment options. Don’t wait: call us today to learn more.

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Editor – Theresa Valenzky
Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more
Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more

Food and Drug Administration. “FDA Drug Safety Communication: FDA warns[…]ts strongest warning.” August 31, 2016. Accessed May 29, 2023.

Tori, Marco E.; Larochelle, Marc R.; Naimi, Timothy S. “Alcohol or Benzodiazepine Co-involvement[…]ed States, 1999-2017.” JAMA Network Open, April 9, 2020. Accessed May 29, 2023.

Drugs.com. “Drug Interaction Report: ethanol, hydrocodone.” Accessed May 29, 2023.

ARUP Laboratories. “Drug Plasma Half-Life and Urine Detection Window.” September 2022. Accessed May 29, 2023.

ARUP Laboratories. “Therapeutic Drug Monitoring.” February 2023. Accessed May 29, 2023.

National Institute on Alcohol Abuse and Alcoholism. “Alcohol-Medication Interactions: Potentially Dangerous Mixes.” May 6, 2022. Accessed May 29, 2023.

Centers for Disease Control and Prevention. “Polysubstance Use Facts.” February 23, 2022. Accessed May 29, 2023.

Medical Disclaimer

The Recovery Village at Palmer Lake aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.