How to Prevent a Deadly Cocktail of Opioids and Alcohol

By on May 19, 2017

By Dr. Anita Gupta, DO, PHARMD—

Getting older often comes with aches and pains; unfortunately, it is part of the territory. While staying fit and eating right can help reduce some issues, there can be problems with arthritis or accidents that cause inflammation, swelling and pain. Getting medical relief for these issues should not exacerbate the problem, though that is sometimes the case. For this reason, it’s important for seniors to understand their chronic pain and the dangers of opioid use in older adults. While these medications can offer pain relief, they don’t always come without complications, especially for people who drink alcohol on occasion.

What Older Adults Should Know About Opioid Use

While opioid pain relievers can offer older adults some much-needed respite from chronic pain, it’s important that the “cure” is not worse than the symptoms. I can provide this cautionary advice on how best to talk to a physician about relieving pain: let your doctor know how bad the pain is and that relief is needed, but also that addicting medications are not welcome. Many people simply take their doctor’s advice and the prescriptions prescribed, rather than trust their own instincts and knowledge about their bodies and what they feel would be best.

Mixing medications can cause even bigger problems; often, an attempt to mix opioids and alcohol in older adults ends disastrously. A new study has shown that opiate painkillers in combination with alcohol can have severe consequences. Respiratory depression can cause breathing to become really shallow or temporarily stop. Opioids, like oxycodone, cause respiratory depression by themselves, and adding alcohol creates a bigger problem.

Oxycodone is the prime ingredient in brand-name drugs like Percocet and OxyContin, and these are widely prescribed for pain. In fact, over two million Americans abuse opioid medications, and every day, 78 people die from opioid overdoses, according to the U.S. Centers for Disease Control and Prevention. Reports show that many of these deaths involve other substances like alcohol or other prescription medications like benzodiazepines, which include Valium, Ativan, Halcion and Xanax, among other brand names.

Dr. Albert Dahan, of the Anesthesia and Pain Research Unit at Leiden University Medical Center, conducted a study of 24 volunteers. Half were aged 21 to 28, half were 66 to 77, and none had previously taken opioids. The study found that taking one oxycodone tablet with a small amount of alcohol increased the odds of respiratory problems, and that the older volunteers had more problems with respiration and breathing stoppage than the younger volunteers.

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

Non-Opioid Options for Older Adults

Because of the risk of respiratory depression in older adults, safer pain-relieving medications for the elderly are needed. In an ironic twist, doctors have conventionally prescribed opioid medications because they believed them to be safer. Nonsteroidal anti-inflammatory drug (NSAID) medications such as Celebrex, naproxen, ibuprofen, ketoprofen and aspirin are an alternative, and the latest findings say these medications are typically safer for most people to use. A study at Brigham and Women’s Hospital in Boston showed that people taking opioids had higher risks for fractures, cardiovascular problems and death when compared to over-the-counter (OTC) medications.

Patients with chronic pain need to be fully aware of all the potential side effects of any medications they are taking. Even more, they must understand the interactions of different drugs in combination and the inherent risks to avoid serious problems and possible death.

Must Knows to Prevent Adverse Outcomes with Medications 

1. Read all labels every time you take a new medication. 

2. Discuss the medications you take, even OTC medications, with your doctor, pharmacist and loved ones and any caretakers.

3. Make sure to take your meds as directed, and always consult your doctor first before consuming alcohol while taking any medications.

4. Make sure you know the general risks associated with drinking alcohol and what happens to your liver when you mix medication and alcohol.

5. Know how your body reacts to different medications. Everybody metabolizes and responds to medications differently, so make sure to share your responses to medications with your doctors clearly so they can adjust or alter medications if needed.

6.  Medical conditions such as hormonal issues, poor metabolism, poor sleep, high blood pressure, or stomach conditions can change the effect and effectiveness of your medications. It is important to inform your doctors about any other conditions you have so they can tailor a plan best for you.

7.  Lifestyle factors such as obesity, inactivity, or smoking can impact many medical conditions and the way your medications work. Losing weight, increasing physical activity, and moderating alcohol consumption as needed can help to improve your health. Making changes to your lifestyle and lowering your risk for disease may help to control your medical condition and improve the effects of your medication.

8.  Eating an improper diet or certain foods can adversely interact with your medications, affecting how medications work to control your condition or reducing the effect of your medication in general.  A registered dietitian can teach you to read nutrition labels so you can spot these parts of your diet, such as sodium and carbohydrates, to better manage your intake.

9.  Other drugs may interact with your medication, which could change how the medication works in your body. Your medication can adversely interact with products besides prescription drugs or alcohol, such as vitamins, herbal products, or dietary supplements. Keeping your doctor or pharmacist informed about everything you are taking can help to avoid these problems.

ABOUT THE AUTHOR: Dr. Anita Gupta, DO, PHARMD serves as the co-chair, ad hoc committee on prescription and opioid abuse for the American Society of Anesthesiologists. She is also involved in pain medicine education at Drexel University’s College of Medicine and Hahnemann University Hospital for medical students and residents.

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How to Prevent a Deadly Cocktail of Opioids and Alcohol