The Dangers of Mixing Hydrocodone and Alcohol: What You Need to Know

 

What is Hydrocodone?

Hydrocodone is a prescription opioid pain medication classified by the Drug Enforcement Administration (DEA) as a Schedule II controlled substance, indicating it has a high potential for abuse that may lead to severe psychological or physical dependence.

Common brand-name medications containing hydrocodone include Vicodin, Lortab, and Norco. In 2014, the DEA rescheduled hydrocodone combination products from Schedule III to Schedule II due to rising misuse and addiction concerns.

Misusing hydrocodone—such as taking it without a prescription, taking larger doses than prescribed, or sharing it with others—is illegal and carries serious legal and health consequences.

Understanding Prescription Opioid Misuse

Prescription opioid misuse remains a significant public health concern in the United States. According to the 2022 National Survey on Drug Use and Health, approximately 8.9 million people aged 12 or older (3.2%) misused opioids in the past year.

People may develop hydrocodone addiction after being prescribed the medication for legitimate pain management. Some misuse the drug by taking larger or more frequent doses, continuing treatment beyond the prescribed time, or obtaining it from others or illegal sources. Others use hydrocodone recreationally for non-medical purposes to experience euphoria.

Why is Hydrocodone Addictive?

Hydrocodone works by binding to opioid receptors in the brain and spinal cord, blocking pain signals while also triggering the release of dopamine and other neurotransmitters that create feelings of relaxation, euphoria, and well-being. These pleasurable effects can drive people to take more of the drug once its effects wear off.

With continued use, tolerance develops—meaning a person needs increasingly higher doses to achieve the same effects. This can progress to psychological and physical dependence, characterized by intense drug cravings and uncomfortable withdrawal symptoms when attempting to stop use.

Why Do People Mix Alcohol with Hydrocodone?

People combine alcohol and hydrocodone for various reasons:

• Enhanced effects: To intensify feelings of relaxation and euphoria from both substances
• Compensating for tolerance: When the effects of one substance have weakened over time
• Self-medication: To numb emotional distress or manage severe pain
• Risk-taking behavior: Experimentation with drug combinations
• Dual addiction: To satisfy cravings when both opioid and alcohol addiction are present
• Preventing withdrawal: To avoid withdrawal symptoms from either substance

Why is Mixing Hydrocodone and Alcohol Dangerous?

The combination of hydrocodone and alcohol is particularly hazardous because both are central nervous system (CNS) depressants that work by increasing the activity of GABA, a neurotransmitter that slows down brain activity. When combined, their effects are additive and unpredictable, significantly increasing the risk of life-threatening complications.

Unfortunately, there is often insufficient awareness about these dangers because both substances are legal—alcohol is widely available, and hydrocodone is commonly prescribed for pain management. This legality can create a false sense of security.

Main Dangers of Mixing Hydrocodone and Alcohol

Respiratory Depression

Respiratory depression is the most life-threatening opioid-related side effect, caused by opioids affecting respiratory centers in the brain stem and leading to hypoventilation or complete cessation of breathing. Mixing opioids with another depressant such as alcohol increases the chance of overdose and respiratory depression.

The FDA warns in opioid labeling requirements that concomitant use of opioids with other CNS depressants including alcohol may result in profound sedation, respiratory depression, coma, and death.

Even a single combined dose can cause sudden breathing difficulties without warning. This risk is particularly high for older adults or those with underlying health conditions.

Liver Damage

Both opioids and alcohol can independently damage the liver, and their combination significantly increases this risk.

Many hydrocodone products contain acetaminophen (such as in Vicodin), which adds another layer of danger. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), chronic heavy alcohol consumption increases activity of the CYP2E1 enzyme, which leads to increased formation of NAPQI, a toxic metabolite of acetaminophen that damages liver cells.

The FDA warns on acetaminophen labels that severe liver damage may occur if an adult has three or more alcoholic drinks every day while using acetaminophen products. When alcohol is consumed with hydrocodone-acetaminophen combinations, the risk of acute liver injury or complete liver failure rises sharply because both substances are metabolized by the liver, potentially overwhelming the body’s detoxification capacity.

Increased Risk of Dangerous Behaviors

Alcohol use is associated with increased risky sexual behaviors, violence, injuries, falls, drownings, and motor vehicle accidents. This risk multiplies when alcohol is combined with prescription opioids like hydrocodone. The combination can also be used to incapacitate individuals before crimes such as robbery or sexual assault.

Substance Use Disorders

Both alcohol and hydrocodone are habit-forming substances. Misusing or abusing these substances together carries a high risk of developing both alcohol use disorder and opioid use disorder.

Fatal Overdose

People who combine alcohol and hydrocodone face significantly higher risk of fatal overdose due to the compounded CNS depressant effects on breathing and heart function.

Psychosocial Consequences

Polysubstance abuse (using more than one substance) is associated with increased rates of physical health problems, mental health issues, suicide attempts, relationship difficulties, financial troubles, and legal problems including arrests and incarceration.

How Long After Taking Hydrocodone Can You Drink Alcohol?

Hydrocodone stays in the system for 18-24 hours. Therefore, you should wait at least 24 hours after your last dose of hydrocodone before drinking alcohol. Note: Hydrocodone can be detected in your body with drug tests for longer than 24 hours (up to 4 days with a urine drug test and up to 90 days from a hair sample).

The safest approach is to avoid alcohol entirely while taking hydrocodone.

Recognizing Signs of Overdose from Mixing Hydrocodone with Alcohol

Critical Warning Signs

Seek immediate emergency medical help (call 911) if someone exhibits:

• Slow or stopped breathing (fewer than 8 breaths per minute or no breathing)
• Very pale, clammy, or bluish skin, lips, or fingernails (indicating oxygen deprivation)
• Unresponsiveness or severe confusion
• Pinpoint pupils or difficulty focusing
• Severe nausea or vomiting
• Extreme drowsiness or inability to stay awake

What to Do in an Overdose Emergency

1. Call 911 immediately – Time is critical
2. Administer naloxone if available – Naloxone (brand name Narcan) is an FDA-approved medication that rapidly reverses opioid overdose effects and is now available over-the-counter without a prescription
3. Place the person in the recovery position if unconscious but breathing (on their side to prevent choking)
4. Stay with the person until emergency responders arrive
5. Provide information to emergency personnel about what substances were taken

According to NIDA’s naloxone research, naloxone only works for 30 to 90 minutes, so it’s possible for a person to experience overdose effects again after naloxone wears off, especially with potent opioids. Multiple doses may be needed.

Understanding Naloxone: A Life-Saving Tool

Naloxone is an FDA-approved medication designed to rapidly reverse opioid overdose by binding to opioid receptors and blocking the effects of opioids such as hydrocodone, heroin, fentanyl, and morphine.

In March 2023, the FDA approved Narcan 4mg naloxone nasal spray for over-the-counter use—the first naloxone product approved without a prescription requirement. This makes naloxone accessible in drug stores, convenience stores, grocery stores, and online.

Naloxone is safe for people of all ages and can be administered by anyone, even without medical training. If administered to someone not experiencing an opioid overdose, it generally won’t cause harm.

Who Should Have Naloxone Available?

The FDA recommends that naloxone be available to people who are prescribed opioid pain relievers, people prescribed medications for opioid use disorder, people at increased risk of opioid overdose (such as those who also use alcohol or benzodiazepines), and caregivers of people at risk.

Help is Available

Combining alcohol and hydrocodone is extremely dangerous and can be fatal. However, recovery is possible with professional help.

If you or a loved one is struggling with addiction to hydrocodone, alcohol, or both, experienced healthcare providers at Discover Recovery Addiction Treatment Center can help. We offer comprehensive, evidence-based treatment programs including:

• Medical detoxification with 24/7 monitoring
• Inpatient and outpatient rehabilitation programs
• Medication-assisted treatment (MAT) for opioid and alcohol use disorders
• Dual diagnosis treatment for co-occurring mental health conditions
• Comprehensive aftercare planning for sustained recovery
• Evidence-based withdrawal management to ensure safety and comfort

Our treatment approach addresses both the physical and psychological aspects of addiction, providing you with the tools and support needed for long-term recovery.

Take the first step toward a healthier future. Contact Discover Recovery today to learn more about our treatment programs and how we can help you or your loved one overcome addiction.

Frequently Asked Questions

Is it ever safe to mix hydrocodone and alcohol?

No. There is no safe way to combine hydrocodone and alcohol. Both are central nervous system depressants, and their combined effects can cause respiratory depression, coma, and death.

How long does hydrocodone stay in your system?

Hydrocodone’s effects last 18-24 hours, but the drug can be detected in urine for up to 4 days and in hair for up to 90 days. Wait at least 24 hours after your last dose before considering alcohol, though complete avoidance is safest.

What should I do if I accidentally mixed hydrocodone and alcohol?

Seek immediate medical attention if you experience any concerning symptoms such as extreme drowsiness, difficulty breathing, confusion, or slow breathing. Call 911 if symptoms are severe. If naloxone is available, it should be administered while waiting for emergency services.

Can naloxone reverse an overdose from mixing hydrocodone and alcohol?

Naloxone reverses opioid effects but does not reverse alcohol intoxication. However, it can restore breathing that has been slowed or stopped by the opioid component of the overdose. Emergency medical care is still essential.

What are the signs someone is addicted to hydrocodone?

Signs include taking larger doses than prescribed, using the drug for longer than prescribed, unsuccessful attempts to quit, cravings, withdrawal symptoms when not using, continued use despite negative consequences, and obtaining the drug from multiple sources.

References and Resources

Federal Resources:

• Drug Enforcement Administration (DEA) Drug Scheduling
• DEA Hydrocodone Rescheduling Final Rule
• FDA Information on Opioid Medications
• FDA Information on Acetaminophen
• FDA Information on Naloxone
• FDA OTC Naloxone Approval Announcement
• NIDA Naloxone DrugFacts
• NIAAA Harmful Interactions: Mixing Alcohol with Medicines
• SAMHSA Opioid Overdose Prevention
• National Survey on Drug Use and Health (NSDUH) 2022
• StatPearls: Opioid-Induced Respiratory Depression

Emergency Resources:

• SAMHSA National Helpline: 1-800-662-4357 (24/7, free and confidential)
• Poison Control: 1-800-222-1222
• Emergency: 911