Mixing Heroin and Alcohol: Risks, Effects, and Overdose

Mixing heroin and alcohol can be extremely dangerous. Both substances can slow activity in the body, and using them together can increase the risk of dangerously slowed breathing, loss of consciousness, and overdose.

The risk is not always easy to recognize.

Someone who has used both substances may simply appear very sleepy or difficult to wake at first, while their breathing is becoming dangerously slow.

If you think someone may be experiencing an overdose, it is important to act quickly rather than waiting to see if they improve.

Heroin is an opioid that affects the brain and nervous system. Alcohol can also slow activity in the central nervous system. When they are used together, their effects can add to each other, increasing the risk of excessive sedation and breathing problems.

The CDC specifically warns that using heroin with alcohol or other drugs increases the risk of overdose, which can lead to coma or death.

Someone who has mixed heroin and alcohol may experience symptoms such as extreme sleepiness, dizziness, confusion and vomiting.

The effects can vary depending on how much was taken, a person's tolerance, whether other substances were involved, and other individual factors.

There is also an additional concern with the current illegal drug supply. The CDC reports that much of the heroin available in the United States is now combined with illegally manufactured fentanyl, which can further increase overdose risk.

Yes. Mixing heroin with alcohol can increase the risk of an opioid overdose.

An overdose happens when the effects of a drug become so strong that the body's vital functions are affected. With heroin, one of the biggest concerns is that breathing can become dangerously slow or stop. Alcohol can add to the sedating effects of opioids, making this combination particularly dangerous.

An overdose can happen even when someone has used these substances before without an obvious problem. Tolerance, the amount used, other substances, and changes in the drug supply can all affect risk.

If you are unsure whether someone is simply very intoxicated or experiencing an overdose, it is safer to treat the situation as an emergency.

The effects can range from significant impairment to a life-threatening overdose.

Possible Short-Term Effects

Someone who has used heroin and alcohol together may experience:

• Extreme sleepiness
• Dizziness
• Confusion
• Slowed reactions
• Poor balance and coordination
• Nausea or vomiting
• Difficulty staying awake
• Slowed breathing

The combination can also impair judgment, making accidents, falls, and other dangerous situations more likely.

Severe Effects

In more serious cases, a person may experience:

• Very slow or shallow breathing
• Loss of consciousness
• Unresponsiveness
• Choking or gurgling sounds
• Coma
• Respiratory failure
• Overdose and death

These are not symptoms to simply wait out. If someone cannot be awakened or is having difficulty breathing after using heroin, alcohol, or both, call 911 immediately.

It can be difficult to tell the difference between severe intoxication and an overdose. When opioids are involved, however, it is better to act if you are unsure.

Look for signs such as:

• The person cannot be awakened or is unresponsive
• Breathing is very slow, shallow, irregular, or has stopped
• The person makes choking, gurgling, or unusual snoring sounds and cannot be awakened
• Lips or fingernails appear blue, gray, or otherwise discolored
• The person's body is limp
• Pupils are very small or "pin point"

These are recognized warning signs of an opioid overdose.

If You Suspect an Overdose

Call 911 right away.

If naloxone is available, give it as soon as possible. Naloxone can temporarily reverse an opioid overdose and restore breathing. While waiting for emergency help:

• Give naloxone if it is available.
• Try to keep the person breathing and awake if possible.
• Place an unconscious person on their side to help prevent choking.
• Stay with them until emergency responders arrive.

If someone has knowingly or unknowingly mixed heroin and alcohol but is awake and does not appear to be experiencing an overdose, they should still be taken seriously.

Avoid letting them drive or take additional substances. Stay with them and keep an eye out for changes in their breathing, alertness, or responsiveness.

If they become difficult to wake, stop responding, or develop slow or abnormal breathing, call 911 immediately.

If you are unsure whether the situation is an overdose, treat it as one. If you or someone you know uses heroin or another opioid, having naloxone available can provide an important layer of protection in an emergency.

Naloxone is designed to reverse opioid overdoses temporarily and can be administered by bystanders.

If someone regularly uses heroin, alcohol, or both, stopping can be more complicated than simply deciding to quit.

Alcohol withdrawal is particularly important to take seriously. For someone who has been drinking heavily for a prolonged period, suddenly stopping alcohol can cause withdrawal symptoms that may become life-threatening.

These can include tremors, sweating, anxiety, nausea, changes in heart rate and blood pressure, seizures, and delirium tremens.

Heroin withdrawal can also be difficult and may involve symptoms such as anxiety, muscle aches, sweating, nausea, vomiting, diarrhea, and strong cravings.

Because withdrawal can vary from person to person, someone who is regularly using either substance should talk with a qualified healthcare or addiction professional about how to stop safely.

Medical professionals can assess the person's substance use and determine whether supervised withdrawal, medication, treatment, or another level of support is appropriate.

• Emergency: Call 911 if someone is unresponsive, having trouble breathing, or you suspect an overdose.
• SAMHSA National Helpline: 1-800-662-HELP (4357) Free, confidential, 24/7 treatment referral and information for mental health and substance use concerns.
• 988 Suicide & Crisis Lifeline: Call or text 988 for 24/7 crisis support, including support related to substance use or emotional distress.