A Deadly Mix: Opioids and Alcohol

By Pat Anson, Editor

Taking one oxycodone tablet together with alcohol significantly raises the risk of respiratory depression and possible death, according to a new study by Dutch researchers. Elderly people were more likely to experience this complication, researchers found.

The study, published in the journal Anesthesiology, is one of the first to address the effect of alcohol and opioids on respiratory depression, which causes breathing to become extremely shallow or stop altogether.

"Unfortunately, we're seeing more fatalities and people in emergency rooms after having misused or abused legally prescribed opioids, like oxycodone, while having consumed alcohol," said lead author Albert Dahan, MD, a professor of anesthesiology at Leiden University Medical Center in the Netherlands.

"Respiratory depression is a potentially fatal complication of opioid use. We found alcohol exacerbated the already harmful respiratory effects of opioids."

Dahan and his colleagues studied the effects of oxycodone and alcohol on breathing in 12 healthy young volunteers (ages 21 to 28) and 12 elderly volunteers (ages 66 to 77). On three separate occasions, the volunteers were given one 20 mg oxycodone tablet combined with an intravenous infusion of ethanol (alcohol).

The amount of alcohol was increased until blood-alcohol levels reached 0.5 g/L on the second visit and 1.0 g/L on the third visit, as measured through the volunteers' breath. A man would need to consume about 5 alcoholic drinks to reach the latter level.

Taken alone, one oxycodone tablet reduced respiratory ventilation – the amount of air the volunteers breathed per minute -- by 28 percent. Adding 1.0 g/L of alcohol caused ventilation to further decrease by another 19 percent - a total decrease of 47 percent.

The combination of alcohol and oxycodone also caused a significant increase in the number of times volunteers temporarily stopped breathing. This was especially true in the elderly volunteers, who were more likely to experience repeated episodes where they temporarily stopped breathing.

"We hope to increase awareness regarding the dangers of prescription opioids, the increased danger of the simultaneous use of opioids and alcohol, and that elderly people are at an even greater increased risk of this potentially life-threatening side effect," said Dahan. "Ultimately, people should know that it is never a good idea to drink alcohol with opioids."

Although warning labels for oxycodone and other opioids caution against using them with alcohol, it’s common for the two to be mixed. A recent study by the Centers for Disease Control and Prevention found that alcohol was involved in about 15 percent of drug overdoses, including deaths associated with oxycodone, hydrocodone, morphine and fentanyl.