Medically Reviewed

The Dangers of Mixing Heroin with Other Drugs and Alcohol

4 min read · 6 sections

Heroin is an illicit opioid drug made from morphine, which is extracted from opium poppy plants.1  Used recreationally for its “rush” (of pleasure and euphoria), heroin can cause dependence, addiction, and death.2

In 2020, more than 900,000 people aged 12 or older reported heroin use within the past 12 months. Additionally, that same year, 691,000 individuals aged 12 or older had a heroin use disorder, the clinical term for heroin addiction.3 Furthermore, from 2019-2020, more than 13,000 individuals died from heroin-involved overdose.4

While heroin use poses dangers on its own, mixing it with other substances such as alcohol, benzodiazepines, cocaine, amphetamines, and other prescription opioids can increase the risk of serious health problems and the risk of overdose.5 Read on to see how heroin compares to other substances and what can happen when you combine them.

What is Heroin?

Heroin is classified as a Schedule I opioid drug under the Controlled Substances Act, which means that it has no approved medical use in the United States.6

Heroin comes in a white or brown powder or as a black sticky substance known as black tar heroin.2 Individuals inject, sniff, snort, or smoke heroin, which enters the brain quickly and binds to opioid receptors in areas that involve feelings of pain and pleasure and areas that control body functions such as heart rate and breathing.2

The Dangers of Mixing Heroin with Other Opioid Drugs

Prescription opioid pain relievers such as oxycodone and hydrocodone can produce effects similar to heroin. Research suggests that frequent misuse of prescription opioids may open the door to heroin use, but this is just one factor in the path to heroin use. Further research indicates that individuals whom transition to heroin tend to be polysubstance users, which means they use multiple substances.2,7,8

Additionally, fentanyl, which is 50 times more potent than heroin and relatively cheap and easy to manufacture, is commonly added to illicit drugs like heroin, cocaine, amphetamines, MDMA/ecstasy, and counterfeit pills intended to pass as legitimate prescription opioids.9 It takes very little fentanyl to induce a drug overdose. In 2020, more than 56,000 deaths involving synthetic opioids (mostly fentanyl) occurred in the United States.10 Individuals who use fentanyl-laced drugs may unknowingly take fentanyl and experience an overdose.9

Combining heroin with fentanyl or other opioids can intensify the effects of both drugs —including slowed or stopped breathing (known as respiratory depression), reduced heart rate, and an increased risk of overdose.11

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Take our free, 5-minute substance use self-assessment below if you think you or someone you love might be struggling with substance misuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

The Dangers of Mixing Heroin with Sedatives and Other CNS Depressants

Sedatives, tranquilizers, and other central nervous system (CNS) depressant substances, such as benzodiazepines and alcohol, can induce sleep and sedation and calm an overactive nervous system, making them useful for treating insomnia and anxiety.

Research indicates that individuals who use heroin also use sedatives to enhance the high, reduce opioid withdrawal symptoms, and to self-medicate their anxiety.12

Sedatives and opioids both cause respiratory depression, and using CNS depressants and heroin together can result in slowed or stopped breathing and can increase the risk of experiencing a life-threatening overdose.12

Mixing Heroin and Benzodiazepines

Although benzodiazepines alone do not typically cause overdoses, they have been linked to a growing number of overdoses and fatalities involving other drugs, including heroin. Combining benzos and heroin increases the risk of overdose because together, the substances cause sedation and respiratory depression that is greater than either of them alone, which can result in slowed or even stopped breathing.10 In addition, heroin users who are also dependent on benzos report greater use of anti-depressants and poorer general psychiatric health.13

In 2016, the U.S, Food and Drug Administration (FDA) added a boxed warning to both benzodiazepines and prescription opioids, cautioning against concurrent use, which can cause extreme sedation, respiratory depression, coma, and death.14

During the 5-month period of January-June 2020, one study found that approximately 20% of benzodiazepine overdose deaths also involved heroin.15

Mixing Heroin and Alcohol

Alcohol use is common among people who use illicit drugs, with research indicating approximately 91% of people who use heroin have reported a history of alcohol use or misuse.16

Alcohol is a CNS depressant as well. Studies show that mixing alcohol and heroin can cause overdose and death. In 2017, 15.5% of heroin overdose deaths also involved alcohol.17

The Dangers of Mixing Heroin with Stimulants

Taking heroin and stimulants—such as cocaine, methamphetamine, and prescription stimulants like Adderall and Ritalin—together can be dangerous. The effects can be unpredictable and even modify or mask the effects of one or both substances, tricking an individual into thinking the substances aren’t affecting them at all, which can increase the risk of overdose.18

Unfortunately, the co-use of stimulants and opioids is trending upwards in the United States. Studies indicate that intentional concomitant use can be attributed to a desire for a more euphoric high, to balance the effects of each of the individual drugs, and to manage the symptoms of opioid withdrawal.19 A rise in recent stimulant overdoses may be at least partially attributed to fentanyl-adulterated stimulant drugs and counterfeit pills (e.g., Adderall), which has increased in recent years, according to the Drug Enforcement Administration (DEA).20

Data indicates that overdose deaths involving methamphetamine or cocaine increased steeply in the decade between 2009 and 2019. In 2019, over 16,500 individuals died of an overdose involving meth and more than 16,000 died of an overdose involving cocaine. However, while overdose deaths rose sharply, stimulant use hasn’t experienced such a dramatic escalation, which means the increase is likely due to individuals using these stimulants in combination with opioids such as fentanyl and heroin.21 In 2018, over 50% of stimulant-related overdose deaths also involved opioids.22

Mixing Heroin and Meth

Between 2015 and 2019, past month methamphetamine use increased by 35% among individuals reporting past month heroin use. Similarly, past year methamphetamine use increased by 24.2% among individuals reporting past year heroin use.23

Another small study in Denver, Colorado, found that about half of the 710 participants injected both heroin and methamphetamine in the previous 12-month period. The research also indicated that these individuals were more likely to report sharing syringes, which increases the risk of transmittable diseases such as HIV and hepatitis C.16 Additionally, 18.6% of these individuals who injected both heroin and methamphetamine reported overdosing once in the year; 15.2% overdosed 2 or more times in the year.24

Mixing Heroin and Cocaine

Combining heroin and cocaine is known as “speedballing,” which involves the simultaneous administration of both cocaine and opioids, particularly heroin. This mixture can be more dangerous than using cocaine or heroin alone and can cause a de-compensation of vital functions throughout the body.25

Additionally, using the two substances together can be a lethal combination as the initial stimulating effects of cocaine can mask the symptoms of an impending opioid overdose.26 Since the two substances have opposite effects, an individual may inject more of one substance to decrease the effects of the other one, which can quickly lead to an overdose.25

Research indicates that the concomitant use of the two substances steadily increased in the United States from 2002-2017. In 2017, nearly 73% of cocaine-involved overdose deaths also involved heroin.26

Getting Help for Polysubstance or Heroin Use

Polysubstance use (the use of multiple substances at once) may be done intentionally, or unintentionally, but mixing heroin with any additional substance can be extremely dangerous and even fatal. While polysubstance use can complicate treatment for substance use disorders, help is available and recovery is possible.

Many treatment centers offer individualized treatment plans to address all of your needs, including the substances taken and any co-occurring mental health disorders as well.

As previously mentioned, individuals who use other substances and opioids concomitantly may be attempting to mitigate some of the unpleasant symptoms of opioid withdrawal, but in doing so, they increase their chances of overdose or experiencing other adverse effects.19 In treatment, which often includes medically managed detoxification, healthcare professionals may use FDA-approved medications for opioid use disorder (OUD) to safely eliminate or reduce opioid withdrawal symptoms and keep you as comfortable as possible. Two of these medications include methadone and buprenorphine.27

  • Methadone is a relatively long-acting full opioid agonist that lessens the symptoms of heroin withdrawal and cravings. When taken as part of an OUD treatment regimen, methadone can also blunt the profoundly rewarding effects of any other opioids to be misused, including heroin. Methadone can be initiated during detox and continued as a maintenance medication throughout longer-term recovery efforts.27
  • Buprenorphine is a partial opioid agonist, which helps lessen acute heroin withdrawal symptoms and cravings in long-term recovery. As a partial opioid agonist, buprenorphine does not elicit the euphoric highs associated with misused opioids, such as heroin. Like methadone, buprenorphine can be used during detox to reduce withdrawal symptoms.27

Beyond medications, treatment typically encompasses therapies to address the thoughts, emotions, and behaviors that led to substance misuse and teach you strategies to help you identify triggers, manage stressors, and prevent relapse.

If you or a loved one struggle with polysubstance or heroin misuse, reach out to one of our compassionate Admissions Navigators. Call

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