Heroin And Other Substances: The Most Dangerous Combos

10 Jan Heroin And Other Substances: The Most Dangerous Combos

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A byproduct of the US opioid crisis is an increase in heroin use, production, and overdose. Since 2010, we have seen the number of overdoses related to heroin quadruple. The reason for this influx is relatively simple. Opioids are the substance initially hooking addicts but eventually, as time goes on, they become either inaccessible or too expensive.

To satisfy their addiction, users turn to the next best thing; heroin. Not only is it cheaper, easier to find, and convenient, but it comes from the same family tree as its synthetic counterpart (opioids), meaning it works in the same pathogens of the brain. Paired with what we all know about heroin and its merciless nature, the idea that heroin is a viable ‘alternative’ should be terrifying. Not to mention depressing.

To that point, heroin’s depressive nature (and its notoriously impure additives) alone can lead to the signs of a heroin overdose. Coupled with other substances it becomes nothing short of lethal. In this article, we’re going to explain what happens when you mix heroin with other substances and just how dangerous the drug in isolation—let alone mixing it with other narcotics—really is.

Heroin & The Brain

Heroin is most commonly ingested in three different ways.

  • Intravenously
  • Through the nasal cavity (snorted)
  • Smoked

Being that our brain has mu-opioid receptors (commonly known as MORs), when heroin enters the bloodstream and eventually makes it to the brain, it binds with these structures that are responsible for communication. This is why heroin is an analgesic; by binding to these receptors it can block pain signals coming from any area in the body. Additionally, heroin stimulates the neurotransmitter dopamine—a chemical linked to our reward system that is most chiefly responsible for pleasure—releasing it in high volumes.

This is where the ‘high’ comes from, being that an overstimulation of dopamine creates feelings of euphoria, happiness, and a lack of ambition. In which case, not only is it a painkiller but it is also a depressant.

How Do Depressants Work?

Depressants affect the CNS (central nervous system) by slowing down its regulatory properties, decreasing its responsiveness, and blocking paths of communication. Often, when it comes to overdose spurred solely from the use of heroin, it is respiratory failure that occurs; the body is sedated to the point that it forgets to breathe. The entire body is affected during a heroin overdose, which eventually leads to unconsciousness or death.

With that being said, it is this depressive property that makes the entire body feel heavier and the brain drowsy. Accompanied with this feeling usually comes a dry mouth, warm skin, and heavier breathing. Paired with its euphoric effects, this is why heroin is attractive; not only does it produce feeling of pleasure, but it is also mistaken as a substance that can ‘relax’ the body, when it is actually slowing down its functionality.

What Happens When Heroin Is Mixed With Other Drugs?

The fact that heroin is a depressant by nature means it’s going to slow down the body. It’s that simple. When it’s influencing our anatomy, the CNS is going to wane. There is no ‘right’ way to use heroin but when the dosage taken is not lethal, this ‘slowing down’ will eventually wane after heroin has left the system and processes return to normal. Of course, in this period is when the user will feel sluggish, anxious, depleted, and sick (depending on their length of use). These negative feelings are typically the siren call for prolonged use, being that the user knows heroin will ‘fix’ the problem.

But when heroin is mixed with other drugs, its depressive nature increases in strength. Coupling heroin and another drug will do one of two things:

  • Double down’ on its depressive properties (if the added substance is also a depressant) and make it even more taxing on the CNS, or
  • Create an imbalance in the CNS (if the added substance is a stimulant) being that the heart and respiratory are in a sedated state and this new substance wants them to kick into gear

What Are The Most Dangerous Drug Combinations?

When it comes to heroin overdose, the two most dangerous substances to couple it with are alcohol and benzodiazepines. Unfortunately, as with most illicit activity, substance use begets substance use—no matter the type. Heroin users are typically not impartial towards drinking or supplementing other narcotics into the equation, which is why overdose can be the result of mixing substances.  

Heroin & Alcohol

It may come as a shock to you that—despite being the nightcrawler’s drug of choice—alcohol is also a depressant. Unlike heroin, however, it stimulates the inhibitory neurotransmitter gamma aminobutyric acid (GABA for short) rather than dopamine. Being that heroin and alcohol, while being depressants, stimulate different neurotransmitters, it can greatly enhance the experience of either drug in isolation. The point: using heroin and alcohol together is unlike using heroin or alcohol as standalones. This, unfortunately, is why the mixture is attractive to drug users.

Despite the feelings created by the mixture, what’s happening beneath the skin is not a happy tale. When heroin and alcohol mix, the effects include but are not limited to:

  • A Depressed CNS – the central nervous system now has two different substances working to inhibit its functionality, which takes a toll on the respiratory and cardiovascular system. This can lead to a drug overdose from respiratory failure or cardiac arrest. Yet, it is all-too-common for a user to mistakenly think nothing is wrong, as the physical effects wear a thicker mask when both heroin and alcohol are at play.
  • A Loss of Cognition – both drugs will work to slow down cognitive function; critical thinking, inhibitions, and reason go flying out the window. Attention and focus become difficult and memory-production comes to a halt. This ‘drowsy and lazy’ state is where heroin gets its famous ‘nodding off’ effect from. With alcohol, this amplifies.
  • Vomit Reflex & Safety – being that heroin can inhibit the body’s vomit reflex, it’s possible that a user drinks to oblivion without having the natural response to an oversaturation of alcohol. Furthermore, as they become more and more intoxicated, they may reduce themselves to partaking in risky activities; sharing needles, adding other substances into the mix, and so on.
  • Organ Failure – lastly, if overdose does not occur and the user finds an unhealthy balance of alcohol and heroin, over time the mixture can damage different organ systems. This is due to suppressing the respiratory system as these organ structures, in this state, starve for oxygen. Irreparable and chronic problems can develop.

Of course, the worst possible outcome of this mixture is overdose, which typically takes the form of respiratory failure. With that aside, eventually the body’s natural processes will be inhibited, and the lack of oxygen can cause permanent damage.

Heroin & Benzodiazepines  

Let us begin by first noting that more than 30% of opiate overdoses occur when coupled with benzodiazepines, prescription drugs (sedative) usually used for sleeping problems and anxiety. Similar to alcohol, benzodiazepines (benzos for short) work to stimulate the neurotransmitter GABA, which renders the user in a relaxed state—one in which they can function without anxiety creeping its way in. It’s also a depressant, seeing as its prescribed to patients battling insomnia.

The problem here is that both benzo pills and heroin depress the system and suppress our normal breathing patterns. In which case, respiratory failure is the most serious risk that can occur when mixing these two substances. Shockingly enough, opioids act the same way as heroin in this scenario and countless patients are prescribed both types of medication simultaneously. To remedy this deadly mixture, the FDA has added ‘black box’ warnings on all prescriptions of either family.

Yet, that does not stop heroin users from mixing their drug of choice with benzos. From 1998 to 2008, a decade-long study was conducted on patients hospitalized from benzo overdose. It concluded that over half of the overdoses were a result of both benzo addiction and opiates (heroin):

  • Enhance The High, Reduce The CNS – even further than alcohol’s mixture with heroin, benzodiazepines enhance heroin’s ‘high’ to a point that users may never want to use the two in isolation. Additionally, being that heroin can produce feelings of anxiety during the comedown period, users will take benzo prescription drugs, if they don’t have more heroin, to mitigate these feelings. All the while, the CNS is being a depressed state, suppressing bodily function. This ups the risk for overdose and is the reason why so many occur from this mixture.
  • Coma – aside from disrupting breathing patterns, the sedative mixture of heroin and benzo medications can also put users into a coma. Being that they lose consciousness and won’t respond to stimuli, the body then shuts down. This can also be dangerous if users lose consciousness from the standing position (or anywhere that could cause them harm if they are to fall).

Heroin & Cocaine

The mixture of heroin and cocaine is mistakenly thought to be, well, something of a leveler. The same phenomenon occurs with alcohol. Cocaine is thought to be a substance that can ‘sober up’ someone who is intoxicated, bringing clarity to their cognition and aiding them out of their drunken stupor. Beneath the surface, however, an entirely different thing is occurring.

Commonly known as ‘speed-balling,’ taking heroin and cocaine simultaneously is desirable to users because the opiate produces the euphoria and the stimulants allow them to stay awake longer to enjoy it. Perhaps one of the worst properties of cocaine is its ability to mask warning symptoms; with alcohol, one can drink into alcohol poisoning because they’re not ‘feeling’ the effects and with heroin, one can neglect the signs of overdose because of the stimulation. Common signs of heroin overdose are:

  • Confusion
  • Dotlike, Pinpointed Pupils
  • Difficulty Moving
  • Impaired Breathing
  • Slurring
  • Blurred Vision & Dizziness
  • Pallid Skin

Yet, when cocaine is mixed with heroin, the above can not only be ignored by the user but masked. Whereas they’d typically be slurring their speech, the cocaine fuels their cognition. Where they may have a difficult time moving—because their body is going limp—the stimulant helps them find purchase. This is all until it is too late and overdose sets in.

This also occurs from heroin’s side, too. Being that cocaine belongs the the category of stimulants, the most common type of overdose is cardiac arrest. What’s the primary warning sign of a heart attack? Pain and tightening in the center of the chest. What does heroin work to do? Block pain. In which case, if an overdose is brought forth by the stimulant the user risks not catching it due to heroin’s painkilling properties.

Lastly, people addicted to cocaine know that the drug  is quick-acting. It influences the system quickly but drops off with the same rapidity. This could mean that someone dealing with a failing CNS might only realize they are in a dire state once the cocaine wears off; as the stimulating properties were what fueled their system to hold on.

Unexpected Complications

With the three mixtures addressed above, it’s paramount that we also mention there are a plethora of things that can go wrong. From cocaine and heroin pulling at the CNS in different ways, to alcohol and heroin suppressing the respiratory system to a crawl, there are also a host of other side effects that can occur. These are largely related to the user’s health, the amount of drugs and prescription medications ingested, and the length of which they have been using.

Regardless, using any of these drugs and prescription painkillers on their own poses serious health risks. When coupled with heroin, those are heightened. Typically, it’s only a matter of time as to when the user will overdose from their substance abuse.

Help Awaits You

If you happen to be reading this because you or someone you love is mixing heroin with other drugs  (or abusing drugs at all), then know that the time to act is now. The situation our nation currently faces is a grave one. Drugs are stronger, users are daring, and the introduction of fentanyl has skyrocketed drug overdose.

It doesn’t have to be ‘only a matter of time.’ By acting today, reaching out, and formulating a plan for recovery, you or your loved one can brave the road ahead together. Whether you are addicted to alcohol or heroin, or any other substance for that matter, just know you can always get help. Call our drug rehab center today for more information on heroin addiction treatment in Georgia.


Griffin, Charles. “Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects.” NCBI. 2013. 15 Mar. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/

Hser, Yih-Ing. “Contrasting Trajectories of Heroin, Cocaine, and Methamphetamine Use.” 2008. 15 Mar. 2019.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821675/

“Overdose Death Rates.” NIH. Jan. 2019. 15 Mar. 2019.https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates


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