From reading the headlines, it’s easy to get the impression that fatal overdoses are almost always caused by opioids, especially heroin and potent synthetic opioids like fentanyl and carfentanil. While opioids are responsible for a large share of opioid deaths, they are rarely the only drug involved and a significant number of fatal overdoses don’t involve opioids at all. While using high doses of opioids is always a gamble, another major risk comes from mixing drugs. This can lead to unexpectedly strong effects, including fatal overdose. Here are the most dangerous drugs to use together.
Cocaine and alcohol
This is one of the most common drug combinations. People often use cocaine and alcohol together because each enhances the effect of the other. Using cocaine while drinking offsets the soporific effects of alcohol, allowing you party longer and the alcohol makes the high from the cocaine more intense and longer-lasting. Unfortunately, these enhanced effects also carry increased risks. Mixing alcohol and cocaine significantly increases your risk of heart attack and stroke. The combination is also more toxic in your liver. And using cocaine may let you keep drinking longer, but that also increases your chance of alcohol poisoning. Normally, you fall asleep when you’ve had too much to drink, but the cocaine keeps you awake and obscures your feeling of drunkenness. This makes it easier to drink a dangerous amount of alcohol.
Alcohol and benzodiazepines
Alcohol and benzodiazepines are both depressants. They enhance the activity of the inhibitory neurotransmitter, GABA. Since people use both alcohol and benzodiazepines to cope with anxiety, it’s common to use them together. However, using them together is a terrible idea. When combined, they can dangerously depress your nervous system, causing your breathing and heart rate to slow, sometimes to dangerous levels. You also build a tolerance to benzodiazepines relatively quickly, but you are slower to adapt to the suppressive effects. While overdosing on benzodiazepines alone is rarely fatal, adding alcohol into the mix significantly increases the danger.
Alcohol and opioids
As with combining alcohol and benzodiazepines, combining alcohol and opioids is essentially doubling up on depressants. However, it’s even more dangerous because an opioid overdose alone is enough to be fatal. What’s more, opioids bought on the street have unpredictable potency. A dose that might not be fatal on its own might become fatal if you’ve been drinking.
Opioids and cocaine
Mixing cocaine and opioids and injecting them together is called a speedball and is more addictive than either drug on its own because it creates a huge dopamine jackpot. Both drugs trigger a huge dopamine release, and the cocaine prevents the dopamine from being reabsorbed so it lingers longer in the synapses. As with mixing alcohol and cocaine, the cocaine can obscure the effects of the opioids, making you more vulnerable to overdose.
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