Over the past decade, the number of people seeking treatment for a combination of narcotic pain relievers and benzodiazepine shot up a tremendous 569.7%. This is according to recent statistics released by SAMHSA (The Substance Abuse and Mental Health Services Administration). These figures make it clear that there is much work to do when it comes to educating the public about the dangers of combining two different types of drugs. It also makes it obvious that there is a very specific public health and safety threat because of the abuse of prescription drugs. We need to take a closer look at why people combine illicit substances and what the results may be.

How Do Drug Combinations Work?

When a person combines two substances, whether they are illicit substances, narcotics, prescription medication or a combination of the available options, there are three possible effects:

• The substances act independent of one another – In this case, there is no specific danger to mixing the two substances together. For example, if a woman takes oral contraceptives or takes a vitamin supplement and mixes it with alcohol, the two do not interfere with one another. There is no reaction, neither positive nor negative.
• It increases the effect of both – This happens when both drugs increase concentration of the other in the body or affect the brain in the same way. An example would be mixing antihistamines and alcohol together; both are central nervous system depressants. Because both slow down the central nervous system, it may lead to an increase in the desired effects (a decrease in self-consciousness) and the side effects (in this example, drowsiness). When the user mixes two of the same types of drugs, it can be extremely dangerous. Because this compounds the effects, it increases the risk of possible side effects and quite possibly a fatal overdose.
• It decreases the intended effects – In this situation, one substance will prevent or “block” the other from working altogether. That can also happen when you have two different substances that both have a different effect on the brain. One example would be alertness caused by caffeine versus drowsiness caused by alcohol. This is why mixing prescription medication with alcohol or illicit substances may cause the medication to work differently from how it is supposed to work.

Why Do People Do This?

Sometimes people accidently mix prescription drugs because they are not aware of any possible side effects. However, many users do this to offset unwanted side effects or make the effects stronger. One example is the famous “speedball,” which is a mixture of cocaine and heroin.

Dangerous Combinations

In order to provide a better overview of what combinations may be dangerous, we are providing a list of potentially dangerous combinations.

• Alcohol and benzodiazepines/prescription painkillers – Even though benzodiazepines and prescription painkillers are both in different categories, in combination with alcohol, it is extremely dangerous. According to a DAWN report published in 2009, a fifth of drug and alcohol-related hospital visits were associated with the use of benzodiazepines. The possible result here is a high risk of overdose accompanied by coma, loss of coordination or even death; all because of a dramatic slowdown of the central nervous system.
• Cocaine and opiates – This is the aforementioned “speedball.” This combination is directly responsible for the deaths of River Phoenix, Chris Farley and John Belushi. With this dangerous combination, there is much that can go wrong. The opiates lead to respiratory depression while the cocaine leads to an unregulated body temperature, strokes, heart attacks, or seizures. Especially when taken together, it may be harder to recognize the impact of one substance.
• Cocaine and ecstasy – Just as combining two central nervous system depressants can exacerbate the effects of both, the same goes for combining two stimulants. When taken by itself, ecstasy may already lead to problems with body temperature regulation and damage to the cardiovascular system. Cocaine may have a similar effect. If a user is dancing at a summer music festival or at a hot nightclub, it is a recipe for a stroke or the body to dramatically overheat.
• Alcohol and cocaine – This is quite a common combination for users who want to have a ‘party weekend’. However, the combination is not only likely to put the user in the hospital, but the long-term consequences are serious as well. When the user combines alcohol and cocaine for some time, it leads to the formation of cocaethylene, (ethyl ester of benzoylecgonine) a combination chemical. This very toxic chemical may damage the heart, liver and other vital organs.
• Sleeping pills, narcotic painkillers and benzodiazepines – The combination of any central nervous system depressant, whether it is heroin, alcohol, Xanax, OxyContin, or anything similar, can lead to fatal consequences. Even though the user may not notice right away, the addictive effects suppress breathing.
• Multiple prescription painkillers – This combination has a high incidence of addiction and likelihood of respiratory failure. Because the body begins to adapt to the intake of prescription medication after about six weeks, people start adding other substances or take more than what was prescribed in order to achieve their desired effects. Users may also experience a false sense of security because these pills are prescribed by a doctor and thus considered safe. However, as the statistics show, this is a very false sense of security indeed.

Why It is Important to Be Alert

As previously mentioned, sometimes the user has no idea that they are ingesting an unsafe combination of drugs. A patient may be taking a sleeping pill after they have consumed alcohol, not fully realizing that the combined effect of the two can be dangerous. That is exactly why further education is necessary so patients understand that the wrong combination may not only be dangerous, but possibly even fatal.

The truth is that avoiding mixing drugs altogether is the only possible way that a person can completely protect themselves from these interactions. Many of the aforementioned prescription medications may be taken together in a safe way, but it is important to let your pharmacist or doctor know before you take anything. We know that even professional pharmacists have to check and double-check to ensure that a patient is not given a dangerous combination. If you take something that you bought from someone and combine it with another illicit substance, you are not only opening yourself up to the individual dangers of the drugs, but may even do more harm to your body than you realize.