Fentanyl and Alcohol: How Do They Interact?

Content medically reviewed by Vicky Magobet, PMHNP-BC, on April 24, 2023.

It's no secret that alcohol is an accepted, easily accessible substance. It's there when you grab dinner with co-workers after work. It's there when you attend a housewarming party at a friend's new place. It may even be there when you go to a movie theater. Therefore, many people don't think twice about the role it plays in their lives.

However, alcohol use can turn into misuse — and more than 14 million people in the U.S. have alcohol use disorder. That's a concern on its own. But what happens when an illicit substance like fentanyl comes into the mix?

Here's a look at how and why alcohol and fentanyl are a dangerous pair.


What Is Fentanyl?

Fentanyl is a synthetic opioid, meaning it's an artificial drug. For comparison, similar drugs like opium and heroin are natural opioids. These drugs have related effects, but fentanyl is known to be much more powerful, as it's 80 to 100 times stronger than morphine.

This drug was originally developed as a legal anesthetic. Since its initial use in the 1960s, people have illicitly produced fentanyl for illegal recreational purposes. Doctors can either administer it intravenously or via a pain patch. Those who use fentanyl illicitly either snort it, smoke it, ingest it in pill form or take it on blotter paper. It's possible to obtain legal doses to use illicitly through injection or a pain patch.

Why do people misuse fentanyl? It comes with strong, addicting side effects. The drug makes users experience feelings like relaxation, euphoria and pain relief. However, fentanyl can also cause dizziness, nausea and vomiting — but users like the good effects so much that they don't mind the downsides. Fentanyl can sometimes go by street names, which include "Apache," "China Girl" and others.

While some users may explicitly seek out fentanyl, users may come across fentanyl accidentally when they take other drugs. For example, cocaine and heroin may include fentanyl to increase the drug's effects. This combination can increase the user's risk of overdose and death.

How Addictive Is Fentanyl?

Fentanyl is highly addictive because of its potency. Even if an individual takes their fentanyl prescription according to their doctor's instructions, they can still develop a dependence and experience withdrawal symptoms. While a person can depend on a drug without an addiction, high reliance leads directly to addiction.

Individuals with fentanyl addiction can begin experiencing severe withdrawal symptoms within a few hours after their last dose. These symptoms can be highly uncomfortable, further contributing to fentanyl's addictive qualities. Some main fentanyl withdrawal symptoms include:

  • Muscle and bone pain
  • Sleep problems
  • Severe cravings
  • Cold flashes

Why Is Fentanyl Abused?

Fentanyl has a massive addiction risk and is a common misused drug due to its strength and ability to create an intense sense of euphoria and relaxation. Fentanyl abuse is especially dangerous for individuals without opioid tolerance. If an individual overdoses on fentanyl, they may experience these symptoms:

  • Chest pain
  • Seizure
  • Slowed breathing
  • Bluish complexion

If an overdose occurs, administering naloxone or Narcan® will reverse its effects. Naloxone is available as an over-the-counter drug in a fast-acting nasal spray or syringe. Even if you are not a health care professional, you can administer naloxone to someone experiencing a fentanyl overdose.

Risks of Fentanyl Abuse

Fentanyl is dangerous for all individuals due to reasons like:

  • Fentanyl has no smell or taste, making it impossible to tell if a powder or pill contains fentanyl. A dealer may not know how strong the dose is or what they are selling.
  • Since fentanyl is so potent, there is a slight difference between a safe and deadly dose.
  • You can still overdose even if you know your dosage since everyone handles fentanyl differently.
  • If you are using multiple drugs at the same time, this can heighten your risk for an overdose.

Signs of a Fentanyl Addiction

Many individuals do not believe drugs such as fentanyl have significant addictive qualities, making them more likely to abuse this drug. Fentanyl impacts the body's central nervous system and causes excess dopamine. Due to these changes in brain chemistry, someone with a fentanyl prescription might become dependent on it and look for ways to continue using it after reaching their prescribed amount.

The Risks of Fentanyl Misuse

Fentanyl is a controlled substance, which means only physicians can legally prescribe the drug under explicit instructions and guidelines. These regulations control the dosage amounts to ensure a healthy recovery without addiction risk. That said, any potentially addictive, lethal substance carries risks.

For fentanyl, users may experience the following risks:

  • Dosing: When legally prescribed, medical professionals precisely calibrate the required dose based on the drug's indication and the individual patient. When used illegally, users determine how much they take. It's easy to misjudge how much fentanyl to use, which means there's a risk for an overdose.
  • Misuse: Fentanyl is often misused. If you use fentanyl outside your doctor's prescription and instructions, you're misusing the drug. The illegal versions of fentanyl tend to be more potent than the drug used in a medical setting, increasing the risk of future misuse and addiction.
  • Addiction: Fentanyl, like other opioids, affects the brain. When you take it, you can feel pleasurable effects like euphoria — and over time, your body adjusts to the effects, good and bad. Eventually, your body develops a physical dependency, and you have to take more fentanyl to feed that craving.
  • Withdrawal: The inability to access or a desire to stop taking a drug you're addicted to will lead to the stages of withdrawal. Your body will crave the drug, experiencing symptoms like pain, insomnia, sweating, nausea, vomiting and diarrhea during withdrawal.
  • Overdose: Over the past year, fentanyl overdoses have increased in part due to the pandemic. As such a potent and addictive drug, fentanyl carries a substantial overdose risk. During an overdose, users experience a slower heartbeat and breathing, while also feeling cold to the touch and becoming unresponsive.
  • Mortality: Fentanyl misuse can be fatal. In 2021, more than 70,000 people in the U.S. died from synthetic opioid overdoses. While people may knowingly take fentanyl, others can accidentally ingest fentanyl when they use another drug like heroin, so the risk is high.

Alcohol's Effects as a Depressant

Alcohol can lift your spirits and boosts your energy, so it has some stimulant-like effects. It can increase your heart rate and affect your inhibitions, making it easier to chat and relax. That said, alcohol is primarily a depressant. It influences the chemicals in your brain, effectively slowing down the nervous system.

As a result, users can experience effects like:

  • Slowed speech: A telltale sign someone is drunk is slowed or slurred speech. Alcohol affects gamma-aminobutyric acid (GABA) levels in the brain. More of this chemical kicks off a slowdown of processes in the body, which can lead to slurred speech.
  • Slowed reaction time: The more alcohol you drink, the more your body's reaction time changes. When someone is drunk, they may stumble or even fall. This depressant effect is part of why it's so dangerous to get behind the wheel of a car when drunk.
  • Changes in body temperature and breathing: If you drink too much alcohol, it can begin to affect your breathing and body temperature. Breathing can slow and the body's temperature can drop. This effect typically happens when someone has consumed enough to cause alcohol poisoning.

The Risks of Alcohol Misuse

Misusing alcohol can have a serious impact on your health in the short and long term. The risks of alcohol misuse include:

  • Injury: Alcohol affects your judgment, motor skills and reaction time. Excessive drinking can lead to falls or other accidents. If you drive while drunk, you put your life at risk and could hurt or kill passengers in your car and other drivers.
  • Alcohol poisoning: A single episode of binge drinking can result in alcohol poisoning. If not properly addressed, alcohol poisoning can be fatal.
  • Addiction: If you misuse alcohol, you may become addicted. Your body can physically depend on alcohol, experiencing severe withdrawal if you stop drinking. This addiction can also have a psychological component, as people may feel they need alcohol to manage negative feelings, like stress.
  • Relationship damage: Drinking can harm personal and professional relationships. If you prioritize drinking over your family, friends and colleagues, you can ruin those relationships.
  • Liver damage: Liver damage and alcohol abuse are synonymous. Approximately 10 to 15% of heavy drinkers will develop alcohol-related liver disease at some point in their lives. Long-term heavy drinking can cause fatty liver disease, cirrhosis and acute hepatitis.
  • Increased risk of other health problems: While liver damage may be the most prominent alcohol-related health issue, you can experience other serious conditions that put your health at risk. Over the years, heavy drinking increases the risk of certain cancers and affects your blood pressure and heart health.

The Potential Dangers of Mixing Fentanyl and Alcohol

Mixing fentanyl and alcohol is dangerous. The result of fentanyl and alcohol interaction can depend on how much of each substance you use, but they'll result in heightened depressive effects no matter how much you take. When combined, these substances increase your chances of experiencing an overdose.

The risks of mixing fentanyl and alcohol include:

  • Drowsiness: Alone, fentanyl or alcohol can cause the user to feel drowsiness and confusion. When used together, this effect will likely become more intense.
  • Nausea: Nausea and vomiting is an unpleasant, albeit relatively mild, effect of using both fentanyl and alcohol.
  • Slurred speech and impaired motor functions: Slurred speech, stumbling and slower reaction times are all common side effects of heavy drinking. The risk and severity of these effects are greater when both alcohol and fentanyl are in your system. Impaired motor functions can lead to serious accidents, like falling down and hurting yourself.
  • Irregular heartbeat: Combining fentanyl in drinks can cause an irregular heartbeat. It's possible for these two substances to slow your heart rate to the point where you feel dizzy and out of breath. You may even faint because your heart isn't pumping enough blood throughout your body.
  • Respiratory depression: Respiratory depression is one of the dangerous consequences of mixing fentanyl and alcohol. This condition occurs when your breathing slows significantly and your body is not effectively removing carbon dioxide. In the early stages of respiratory depression, you may notice shallow breathing and feel increasingly tired. As this condition continues, it's possible to experience seizures.
  • Loss of consciousness: The effects of fentanyl mixed with alcohol can cause the user to lose consciousness. This effect can be extremely concerning when the user is alone, as they can experience other symptoms like vomiting and respiratory depression. If you lose consciousness while experiencing those symptoms, your life could be at risk.
  • Coma: Mixing alcohol and fentanyl has the potential to cause the user to slip into a coma.
  • Death: Even a very small amount of fentanyl can be incredibly strong. When mixed with alcohol, its effects can increase to the point of becoming lethal.

Fentanyl Patch and Alcohol Interactions

Mixing a fentanyl patch with alcohol is just as risky as combining any other form of fentanyl with drinking. Physicians can prescribe fentanyl as a transdermal patch to help manage severe pain. The patches are designed to stick on the skin, much like a nicotine patch. It's simply a different way to administer the drug, rather than ingesting or injecting it through another form.

While using a fentanyl patch, you should avoid drinking alcohol. Alcohol and fentanyl will still interact with your system, regardless of the delivery method of the fentanyl. The same risks of mixing fentanyl and alcohol apply in the case of using a patch. If you're using a fentanyl patch, it's important to know and watch for the risks of using this drug and the risks of mixing it with any other substance.

Contact your doctor as soon as possible if you notice any harmful side effects while wearing a fentanyl patch.

What Can Happen When Mixing Fentanyl and Other Drugs?

Fentanyl and alcohol interact, but that's not the only risky combination. Mixing fentanyl and other drugs can be just as dangerous.

When making cocaine or heroin, manufacturers may add fentanyl to the mix to help amplify and prolong the effects of the drug. Often, users are not informed that the substance they're using contains fentanyl. This addition can significantly increase the risk of overdose. Mixing any other opioid, such as heroin or oxycodone, with fentanyl will increase the effects of the drugs in your system and lead to a potentially dangerous outcome.

It can also be risky to mix fentanyl with other drugs, whether obtained for recreational use or legally prescribed. For example, mixing certain anti-depressants with fentanyl can cause an adverse drug reaction known as serotonin syndrome. While this reaction is rare, it's potentially fatal, so it's best to avoid combining fentanyl with other drugs even when you're taking it legally.

Mixing fentanyl with benzodiazepines, such as Xanax, can also lead to serious issues. The risk of addiction and overdose increases. Additionally, users are more likely to experience a fatal overdose when mixing fentanyl and benzodiazepines.

If you're using fentanyl under the supervision of a doctor, always ask about potential medication interactions. This way, you can ensure you're taking the drug as safely as possible to treat your health condition. If you're using fentanyl recreationally, carefully consider the risks of adding more substances into the mix.

Fentanyl Withdrawal

Withdrawing from fentanyl after an extended period of use can be challenging. Your withdrawal symptoms can start as early as 12 hours after a dose and typically last a week. The first three days are often the worst, as you can experience symptoms such as:

  • Chills and excessive sweating
  • Watery eyes 
  • Runny nose
  • Irritability
  • Diarrhea
  • Insomnia
  • Bone and muscle pain

Options for Fentanyl and Alcohol Treatment

When you're ready to ask for help, fentanyl and alcohol addiction treatment programs are available. Recognizing you need assistance is a critical first step to help you on your journey toward recovery. Whether you're using fentanyl legally or illicitly, you shouldn't hesitate to reach out when you notice certain habits forming, like combining your use with drinking alcohol.

Once you enter substance use disorder treatment, you can expect:

  • Medically assisted detox: Withdrawal from fentanyl and alcohol can be dangerous. The cravings for those substances will be intense. In severe cases when detoxing from alcohol or fentanyl, hallucinations and seizures are possible. Seeking professional treatment ensures you can safely undergo medically assisted detox. Your medical team at your treatment facility will monitor you and prescribe any necessary medication while you overcome your misuse.
  • Therapy: Therapy is an important part of treatment. You may attend one-on-one cognitive behavioral therapy sessions, group therapy sessions and counseling sessions with family members to help you fight your addiction and maintain your journey to sobriety. During treatment, you'll work with therapists who specialize in addiction.
  • Long-term support: Addiction is a challenging battle to fight, one that takes time and dedication. However, you don't have to do it alone. A part of treatment is learning how to build strong support group networks and the coping skills you need to maintain sobriety. Recovery happens in steps, and treatment can show you how to get help along the way.

Contact Diamond House Detox for Alcohol and Fentanyl Rehab Programs

Fentanyl addiction or alcohol addiction alone is tough to manage, but beating a reliance on both substances can be even harder. Fighting addiction is difficult, and withdrawal from fentanyl and alcohol is scary, painful and potentially dangerous. Thankfully, you don't have to face this fight alone.

Diamond House Detox offers support specifically for fentanyl addiction and alcohol addiction. We understand that everyone's journey to recovery will be different, and our health care providers treat each person as an individual who needs a customized treatment plan. Call us at (800) 205-6107 or contact us online to take the first step toward releasing the grip alcohol and fentanyl have on you or your loved one.

Learn More About Alcohol Addiction Treatment

Learn More About Fentanyl Addiction Treatment


Linked sources:

  1. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  2. https://www.dea.gov/factsheets/fentanyl
  3. https://www.cdc.gov/niosh/topics/fentanyl/
  4. https://diamondhousedetox.com/services/fentanyl-rehab/ 
  5. https://diamondhousedetox.com/services/alcohol-detoxification/
  6. https://diamondhousedetox.com/contact-us/
  7. https://www.commonwealthfund.org/blog/2021/spike-drug-overdose-deaths-during-covid-19-pandemic-and-policy-options-move-forward
  8. https://www.alcohol.org/effects/slurred-speech/
  9. https://www.healthline.com/health/alcoholism/liver-disease
  10. https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/serotonin-syndrome-fentanyl-and-selective-serotonin-reuptake-inhibitor-interactions.pdf?sfvrsn=be2f44b1_2
Psychiatric Mental Health Nurse Practitioner at Diamond House Detox
Vicky is a board certified Family Psychiatric Mental Health Nurse Practitioner, certified by the American Nurses Credentialing Center. She began her nursing career in healthcare by working in the intensive care unit, and then an inpatient psychiatric hospital. After realizing the mental health needs of both the patients and the families she served, she became a Psychiatric Nurse Practitioner. Throughout her experience working with clients, she has developed a passion for those with dual diagnoses and specializes in helping individuals recognize the issues driving their substance use. This recognition has been crucial to the individual’s success in treatment. Vicky opened Diamond House Detox so that she can address these issues early on in a therapeutic environment to allow clients to transition to the next level in their recovery.
Vicky Magobet
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