Combined Drug Intoxication Page

Combined Drug Intoxication (CDI) is a potentially fatal condition caused by the simultaneous ingestion of multiple psychoactive drugs, including alcohol. CDI is also known as multiple drug intake, co-occurring drug intake or lethal polydrug/polypharmacy intoxication. Combined Drug Intoxication differs from drug overdose in that overdose typically refers to ingestion of lethal amounts of a specific drug. Conversely, the amount of any single drug present in a person who dies from mixed drug intoxication may not be lethal by itself. Instead, the combined effects of multiple drugs in tandem leads to fatality.

Death from Combined Drug Intoxication results from the combination of multiple drugs, including prescription, over-the-counter and recreational drugs. Alcohol often exacerbates severity of symptoms, and most instances of death from CDI involve alcohol. Reasons for toxicity may vary depending on the mixture of drugs and alcohol. Typically, most victims die after using two or more drugs which suppress or compromise breathing, lowering blood oxygen levels and causing brain death.

Unfortunately, deaths from Combined Drug Intoxication are on the rise. The National Institute on Drug Abuse report that hospitalizations from combined drug and alcohol overdoses increased 76% between 1999 and 2008 for people between the ages of 18 and 24. Deaths from CDI have nearly doubled in the decade since these statistics were released, showing the upswing in abuse of synthetic opioids having a direct contribution. Drugs are often taken together  recreationally to enhance a high, but results are unpredictable. Combining opiates with stimulants, such as cocaine, methamphetamines or alcohol, can have fatal results. In this article, we will discuss some of the most common drugs abused in combination, as well as signs and symptoms of Combined Drug Intoxication.

Common Drugs Associated with Combined Drug Intoxication


Heroin is an illegal, highly-addictive drug. Heroin (like opium and morphine) is made from the resin of poppy plants. Once heroin enters the brain, it is converted into morphine, binding rapidly to opioid receptors. Opioids can hinder breathing by altering neurochemical activity in the brain stem. They also reinforce addictive drug behaviors by altering the limbic system, which is responsible for the control of emotions.



Cocaine is derived from the coca plant, native to South America. It is most commonly available in a white powder form, but has other forms as well. When ingested, cocaine sends high levels of dopamine, a natural chemical messenger, into the parts of the brain responsible for pleasure sensations. Short term effects include intense happiness and energy. However, long term use significantly alters the brain’s chemistry. The mind and body develop a strong reliance on cocaine with extensive use, elevating risks for heart, stomach and lung problems for users.


Prescription Drugs

The three most commonly abused prescription drugs include pain relievers, tranquilizers and sedatives and stimulants. Prescription pain relievers encompass the opioid class of drugs, such as hydrocodone (i.e. Vicodin), morphine, fentanyl, codeine and oxycodone (i.e. OxyContin). These drugs are meant to block the brain’s perception of pain, but when abused, they can be highly addictive and particularly dangerous when combined with alcohol.

Tranquilizers and sedatives work as central nervous system depressants and are typically prescribed to treat anxiety, sleep disorders and panic attacks. The most common are Xanax, Valium and Librium. When abused, these drugs can slow breathing and heartbeat to dangerous levels, especially when combined with alcohol and over-the-counter medications. Prolonged use leads to withdrawal and even seizures if discontinued.

Stimulants, like Ritalin, Dexedrine and Adderall, are meant to increase alertness, energy and attention spans. They are typically prescribed for health conditions such as attention-deficit or hyperactivity disorders, depression and narcolepsy. Stimulants increase dopamine and norepinephrine levels in the brain, producing a sense of euphoria. When abused, they can be highly addictive. Abuse can lead to extreme elevations of body temperature and can even cause seizures and irregular heartbeat.



Methamphetamines are a strong and highly addictive drug affecting the central nervous system. They are often produced in crystal form and  known as crystal meth. There is no legal use for the drug, which is a man-made stimulant that has been produced for decades. When ingested, meth creates a false sense of well-being and elevates energy levels, causing users to push their body’s to inhuman levels. Users typically experience a severe crash or breakdown once the drug wears off. Long term use causes irreparable damage to the liver, kidney, lung and cardiovascular systems.



Many people may not view alcohol as a likely candidate for a dangerous component of combined drug intoxication. However, alcohol acts as a depressant drug. When ingested, it slows down bodily functions including heart rate, blood pressure and breathing. Alcohol is commonly used in combination with other illicit drugs, especially cocaine and heroin. Combining alcohol and drugs increases the risk of experiencing adverse effects of both substances.


Potential Adverse Effects of Various Drug Combinations

Any combinations of drugs can be dangerous, although there are some combinations that tend to be more lethal than others. There are also specific combinations which are appealing to those engaging in polydrug behaviors for their effects. For example, some people may blend a depressant drug with a stimulant drug to intensify the results of both. Cocaine and heroin are commonly abused together for this reason. Let’s look at some of the most common drug combinations and their effects.


Alcohol and Prescription Drugs

Mixing opioid painkillers and alcohol exhibit similar adverse effects to that of heroin and alcohol abuse. This is due to the similar chemical structure between heroin and prescription opioids, although painkillers are legally prescribed medication. When alcohol is mixed with sedatives, like Xanax, both stimulate a sedative effect in the body, which slows breathing. Sometimes, the simultaneous effects of both can intensify to the point of stopping breathing altogether.  

Alcohol is also often mixed with antidepressants, which fall under the class of medications known as selective serotonin re-uptake inhibitors or SSRI’s, which regulate serotonin levels in the brain. Mixing alcohol and SSRI’s may result in pathological intoxication, which may result in a lowered inhibition to committing violent or sexual acts. Severe memory impairment is associated with the the combined use of alcohol and all three classes of prescription drugs— opioids, sedatives and stimulants.

Adverse effects of mixing prescription drugs and alcohol can include mood swings, impaired judgement, drowsiness, slurred speech, incoordination and more. This combination often has dangerous life-threatening consequences, with an increased risk for overdose.


Alcohol and Opiates

Opiates, like heroin, typically cause servers respiratory depression or slowed breathing. When combined with alcohol, these depressant effects are greatly amplified. Users are at a much greater risk of overdose, respiratory failure and death. Other common symptoms of drug intoxication from alcohol and opiates include slowed movement and thought, memory and coordination impairment, slurred speech, and drowsiness. Long-term use will significantly deplete physical and mental health of users, with developing withdrawal symptoms if usage is stopped.


Alcohol and Stimulants

Mixing alcohol with stimulants, whether illicit or prescription, can have dangerous adverse effects. Stimulants, like cocaine or meth, or prescription drugs, such as Ritalin, speed up or stimulate the brain and central nervous system. Often a sense of euphoria and energy is experienced. However, alcohol works in an opposite manner as a depressant. Users may choose to abuse cocaine or other stimulants in tandem with alcohol to intensify the stimulating effects and decrease the feeling of drunkenness. However, this combination produces a toxic substance in the liver called cocaethylene, which causes arrhythmias and heart damage. Other side effects include chest pain, stroke, seizures, confusion, anxiety and sometimes death.


Stimulants and Opiates

Opiates include heroin and prescription drugs like OxyContin. Stimulants may range from cocaine to amphetamines to prescription stimulants, such as Adderall and Ritalin. When users combine an opioid, whether heroin or prescription, with an amphetamine or other stimulant, the effects are both dangerous and unpredictable. There is also a seriously increased risk for addiction. Because each drug creates opposing effects, the side effects may be masked by the stimulating effects of the other. The body, brain and organs are pulled in opposite directions, which leads to impairment of all systems. Even though the body may not feel the effects acutely, the body may still be under serious strain. This dangerous combination of drugs may lead to heart failure, stroke and interrupted breathing.


Stimulants and Prescriptions

Stimulants include cocaine, amphetamines and prescription stimulants. Prescription drugs cover a wide range of uses, but opiates and stimulants are some of the most commonly prescribed and abused drugs in the United States. Prescription opiate drugs, like hydrocodone and fentanyl, are intended to depress your central nervous system functions. Prescription tranquilizers and sedatives, such as Valium, are also meant to slow the body’s functions.

Conversely, stimulants such as amphetamines cause your central nervous system to speed up.

When taken together, both drugs deliver conflicting information to your body—sometimes referred to as speedballing. Because of these conflicting signals, the body’s breathing, blood pressure, temperature and heart rate are being told to rise and fall, simultaneously. These mixed signals leave both the cardiovascular and respiratory systems vulnerable to dangerous side effects and overdose.

On the other hand, when stimulants such as cocaine and amphetamines are combined with prescriptions that are also stimulants, the body’s functions can be pushed into overdrive. The body’s heart rate, blood pressure, respiratory functions and other basic regulatory functions responsible for life support may be pushed to fatal levels. Both stimulants and prescription drugs have a high potential for abuse. When both are taken together, there is a significant increase for dangerous, addictive behaviors.


Signs and Symptoms of Combined Drug Intoxication

Drug toxicity can occur when a person accumulates too much of a drug in their bloodstream or when a mixture of drugs lead to combined adverse effects on the body. Signs and symptoms of drug intoxication vary on the drug, but also depend on whether toxicity is acute (a single ingestion by someone who has not previously taken the drug) or chronic (effects of a slow buildup of drugs to toxic levels). Over time, the combined effects of drugs will negatively affect the liver and kidneys, reducing their effectiveness at filtering dangerous substances out of the body.

There is not a single set of symptoms to identify whether a person is suffering from combined drug intoxication. Effects vary depending on the composition of drugs taken, the quantities ingested and whether that person has developed a tolerance to said drugs. Opiates such as heroin and prescription painkillers when combined with alcohol or antidepressants may lead to someone seeming incapacitated with slurred speech or difficulty standing upright. Conversely, when stimulants like cocaine are combined with alcohol or opiates, the user can appear less intoxicated, prompting further consumption of drugs and alcohol.

The physical and psychological signs of combined drug intoxication and drug overdose vary depending on the drugs taken and in which combinations they were taking. However, there are some common signs and symptoms to be aware of which are common to most including:

  • Abnormally high body temperature
  • Dilated pupils
  • Disorientation or confusion
  • Nausea or vomiting
  • Severe difficulty breathing, shallow breathing or stopped breathing
  • Agitation or paranoia
  • Unresponsiveness
  • Convulsions, tremors or seizures
  • Gurgling sounds indicating a person’s airway may be blocked
  • Unconsciousness
  • Death

These are some of the most common symptoms of combined drug intoxication and overdose. If you cannot get a response from someone, do not assume they are asleep. Sometimes, it can take hours for a person who has overdosed to die. An overdose is a medical emergency and requires immediate medical attention. If you believe someone is exhibiting signs of overdose, call an ambulance immediately. In addition to unconsciousness, you should also call for emergency help if someone is:

  • Experiencing severe headache
  • Experiencing chest pain
  • Experiencing breathing difficulties
  • Extremely paranoid, agitated and/or confused


Support and Treatment

Often, people who mix and combine drugs, whether illicit or prescription, can seem difficult to reach. Sometimes, they believe their habits are keeping them safe or making them more energetic and effective. They may even suggest they are in complete control of their habits as things begin to fall apart around them. It can be difficult to break through this system of denial, but it is important to get help.

Drug abuse is dangerous at any level, but combined drug use is especially perilous. Many people do not realize the excessive danger associated with combining alcohol with prescription drugs. When stimulants like cocaine or opiates like heroin are added into the mix, a fatal cocktail of drugs can easily be obtained.

Treatment programs for addiction use various types of tools to foment change. People suffering from poly-drug addictions may need more intensive therapy. Combined drug abuse affects change and harms the brain over time due to the hyper-active stimulation of the body’s respiratory and cardiovascular systems. Mixing drugs harms the brain in ways that abuse of one single drug cannot, and those suffering from co-addictions may need extra help for this reason.

Those with an enduring habit of abusing multiple drugs will likely have suffered significant brain damage. Their addictive behaviors are incredibly difficult to turn off. To regain sobriety, they need skilled intervention and a support team who can help them change their ways.

If someone you love suffers from combined drug addictions, contact Blu by the Sea. We provide a complete program of recovery therapies to help people past their addictions. We are also especially knowledgeable and skilled in helping people recover from more than one addiction at a time. We strongly believe the most effective treatments are tailored to each individuals needs. Our clinical professionals and addiction specialists work one on one with each patient. All therapies we provide are evidence based and include cognitive behavioral therapy, dialectical behavioral therapy and family therapy.

Do not hesitate to call Blu by the Sea, today so we can help you get your loved ones suffering from addictions into our life changing programs.