Vicodin is a prescription painkiller made up of hydrocodone and acetaminophen to reduce moderate pain; it also reduces fever and some swelling. This medication is typically prescribed after surgery or serious injury, such as breaking a bone. It is not intended for long-term use. The Drug Enforcement Administration (DEA) lists hydrocodone as a Schedule II substance, so it has a medical use, but it is tightly controlled.
Alcohol is a legal intoxicating substance derived from fermented sugars, like fruit or grain. Most countries allow alcohol consumption over a certain age, although there are limits on how much a person can consume before performing other activities, like driving. The DEA has not scheduled alcohol, although the Food and Drug Administration (FDA) regulates alcohol safety.
Both alcohol and Vicodin are central nervous system (CNS) depressants, meaning they typically create a relaxed sense of wellbeing or sleepiness when a person ingests them. By slowing brain activity, they can reduce pain and anxiety. However, both Vicodin and alcohol are potent and can cause intense intoxication in large doses, which can lead to overdose.
Combining Vicodin with alcohol can cause a person to become intoxicated faster and compound negative side effects, including increased risk of overdose. There are also specific dangers to combining alcohol and Vicodin that do not exist with most other prescription painkillers. Mixing alcohol and Vicodin is considered one of the deadliest combinations of intoxicating substances.
The Dangers of Mixing Alcohol and Vicodin
These two substances alone can cause any of the above side effects; together, they enhance each other’s side effects, potentially to a dangerous level.
The most dangerous effect of both of these CNS depressants is reduced breathing. Opioid drugs are known to depress breathing, making it slower or shallower. This reduces the amount of oxygen the body receives, which can lead to damage to organ systems over time. If a person takes a large dose of a narcotic, this effect on the breathing can cause the person to stop breathing. With less oxygen, the brain begins to shut down organ systems and eventually begins to die. Alcohol increases the relaxing effects in Vicodin and other narcotics, which can lead to depressed or stopped breathing as well.
Both of these substances affect the liver, and they can therefore cause liver damage. Long-term alcohol abuse is linked to cirrhosis and liver failure, while too much acetaminophen – the other active ingredient in Vicodin – can cause liver toxicity and failure. Combined, acetaminophen and alcohol are dangerous, although in a different way from the opioid part of Vicodin.
Alcohol and opioid painkillers, like Vicodin, are both very habit-forming substances. Alcoholism is the leading addiction in the US, while the Centers for Disease Control (CDC) has declared opioid abuse to be an epidemic. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 16.3 million American adults ages 18 and older were considered to have an alcohol use disorder in 2014. Alcohol is the fourth leading cause of preventable death in the US. Opioid painkiller addiction is an increasing cause of death as well, with 52 deaths per day on average from opioid medication overdoses in 2014 alone.
Who Is at Risk for Mixing Alcohol and Vicodin?
There is limited data on people who specifically abuse Vicodin and alcohol together, but there are some people who are more at risk than others. For example, people who have received a prescription for Vicodin, and do not understand the severity of combining this potent painkiller with alcohol, are at a greater risk of ingesting alcohol while Vicodin is still in their system. Vicodin’s painkilling effects typically last about 4-6 hours, but the substance can build up in the body as the person takes more over time. Its half-life is about three hours, so one dose of the medication will likely be eliminated within 6-8 hours. If a person is taking low doses of Vicodin and then consumes alcohol, they may become drunker faster, or they may experience some dangerous side effects like loss of coordination leading to falls, blackouts, or reduced breathing. This accidental combination is why doctors and medication warning labels advise to avoid mixing Vicodin with alcohol.
A study published by the University of Michigan reported in 2008 that people who struggled with alcohol use disorders were 18 times more likely to abuse prescription medications, including Vicodin, for recreational or nonmedical reasons. In that study, the largest group of prescription drug and alcohol abusers were between the ages of 18 and 24. Of 4,580 study participants, 12 percent of those individuals had abused both alcohol and prescription drugs together in the past year.
A different study surveyed 248 people struggling with alcohol abuse who entered a treatment program. Of this group, 68 percent reported using other drugs, both illicit and prescription drugs like Vicodin, in the 90 days prior to admission. The study also noted that 67 percent of people who entered a treatment program for opiate abuse, including abuse of Vicodin, also reported consuming alcohol at the same time as the narcotic in the 90 days prior to their admission.
People who struggle with polydrug abuse are more likely to combine alcohol and Vicodin. The 2010 DAWN report on emergency room visits involving alcohol and prescription medications showed that alcohol was involved in 18.5 percent of opioid drug-related hospital visits. Although several of these were an accidental combination of the two substances, according to data from West Virginia, young adults are more likely to combine both narcotics and alcohol. Data from the state in 2006 showed that 20 percent of overdose cases among those ages 18-24 involved both alcohol and opioid overdose.