Alcohol is so common and normalized that many people don’t realize it can have serious drug interactions. But alcohol’s interactions with certain medications can be dangerous and sometimes even life-threatening. One such medication is buprenorphine. Buprenorphine is approved by the FDA to treat opioid use disorder (OUD).
Understanding the risks associated with mixing alcohol with certain substances is crucial for individuals undergoing treatment for OUD and their healthcare providers. This article discusses the dangers of mixing alcohol and buprenorphine and safety practices to avoid these risks.
What is buprenorphine?
Buprenorphine is primarily used to treat opioid use disorder (OUD), although it is also sometimes used (in lower dosages) to treat chronic pain. For OUD, it works by binding to the same receptors in the brain that opioids (heroin and prescription painkillers) do, blocking them off, and partially activating them. This helps to relieve the cravings and withdrawal symptoms associated with opioid addiction. As a partial agonist, buprenorphine produces a milder euphoric effect than other opioids, and most people with OUD do not experience euphoria or “high” from it.
Buprenorphine is available in various forms, including sublingual tablets, films, implants, and injections. It is often combined with naloxone (an opioid antagonist) to prevent misuse, relapse, and overdose. The combination product is commonly known by the brand name Suboxone.
Understanding the interaction between alcohol and buprenorphine
We strongly advise against mixing alcohol and buprenorphine. The following are the risks associated with mixing alcohol and buprenorphine:
Increased side effects
Like other medications, buprenorphine can have side effects. Combining alcohol and buprenorphine can significantly increase these side effects, including:
- Increased nausea, vomiting, and constipation
- Headache, blurred vision, dizziness, and fainting spells
- Increased sweating
- Irregular heartbeat or palpitations
- Increased or decreased blood pressure
- Impaired cognition and motor coordination
Respiratory depression
Both alcohol and buprenorphine depress the central nervous system (CNS), which controls vital functions such as breathing, heart rate, and consciousness. When taken together, they can significantly enhance each other’s sedative and depressant effects, leading to severe CNS depression. This interaction can result in dangerous respiratory depression.
Increased sedation and drowsiness
Alcohol and buprenorphine both have sedative properties. When combined, they can significantly increase sedation, leading to extreme drowsiness, dizziness, and profound sedation. This can impair cognitive and motor functions, increasing the risk of accidents and injuries.
Increased risk of overdose
The combination of alcohol and buprenorphine can significantly increase the risk of overdose even at lower doses of each substance. The sedative and depressant effects of alcohol can mask the signs of buprenorphine overdose, making it harder to recognize and respond to an overdose situation in time. (Note: if you suspect an opioid overdose, administer naloxone (Narcan) and call 911.)
Cardiovascular complications
Both alcohol and buprenorphine can affect cardiovascular function. Alcohol can increase blood pressure and heart rate, while buprenorphine can cause hypotension (low blood pressure). The combination of these effects can lead to cardiovascular instability, which can be dangerous, especially for individuals with pre-existing heart conditions.
Impaired judgment and risky behaviors
Mixing alcohol with any medication that affects the CNS can impair judgment and decision-making abilities. This can lead to risky behaviors such as engaging in unsafe sexual practices, driving under the influence, or using other substances. These behaviors not only endanger the individual but also pose risks to others.
Increased risk of liver damage
Both alcohol and buprenorphine are metabolized by the liver. Chronic use or abuse of alcohol, combined with buprenorphine can lead to liver damage, including conditions such as fatty liver, hepatitis, and cirrhosis. It can also exacerbate pre-existing liver conditions.
Safe practices and recommendations
If you’re taking buprenorphine (either as part of a recovery program or illicitly), it’s important to avoid consuming alcohol. Alcohol can compound the effects of buprenorphine on the central nervous system, increasing the risk of adverse reactions and even death. Don’t skip a dose of buprenorphine because you want to drink alcohol; buprenorphine stays in your system for a long time, so you would end up in miserable opioid withdrawal before the buprenorphine wears off enough to make drinking safe.
Alcohol is not the only possible interaction concern. Consult your healthcare provider before combining buprenorphine with other substances. This includes other prescribed medications, illicit drugs, and even certain herbal supplements. Make sure all of your healthcare providers know you’re taking buprenorphine to avoid unexpected drug interactions.