From the Guidelines
Combining opioids with stimulants is extremely dangerous and should be avoided. Medications like oxycodone, hydrocodone, or fentanyl should never be mixed with stimulants such as cocaine, methamphetamine, or even prescription stimulants like Adderall or Ritalin. This combination creates opposing effects in the body - opioids slow down the central nervous system while stimulants speed it up. This opposition can mask warning signs of overdose and lead to severe respiratory depression, cardiac arrhythmias, or even death. The combination also increases the risk of developing dependence on both substances. Additionally, this mixture can cause unpredictable effects on blood pressure and heart rate, potentially triggering heart attacks or strokes.
According to the study published in the Annals of Emergency Medicine 1, the combination of opioids and other centrally acting substances can potentiate opioid-related respiratory depression, leading to increased mortality. Similarly, the CDC guideline for prescribing opioids for chronic pain 1 recommends avoiding the concurrent prescription of opioids and benzodiazepines, and considering the risks of concurrent use of other central nervous system depressants.
While there may be some instances where stimulants are used to manage opioid-induced sedation, as mentioned in the Journal of the National Comprehensive Cancer Network 1, this should only be done under close medical supervision and with careful consideration of the potential risks. In general, the risks associated with combining opioids and stimulants far outweigh any potential benefits, and this combination should be avoided whenever possible. If you're prescribed either type of medication, always inform your healthcare provider about all substances you're taking to avoid dangerous interactions. If you're struggling with substance use, seek professional help immediately rather than experimenting with these dangerous combinations.
Some key points to consider when prescribing or taking opioids and stimulants include:
- The potential for increased risk of overdose and death
- The risk of developing dependence on both substances
- The potential for unpredictable effects on blood pressure and heart rate
- The importance of close medical supervision and careful consideration of potential risks
- The need to inform healthcare providers about all substances being taken to avoid dangerous interactions.
From the Research
Combining Opioids with Stimulants
- There is limited research directly addressing the combination of opioids with stimulants, but studies suggest that combining opioids with other substances can increase the risk of adverse effects 2.
- A study on stimulant use among patients in opioid treatment settings found that providers face challenges in treating patients who use both opioids and stimulants, and that the rise in stimulant and synthetic opioid combination products is presenting an extraordinary challenge for providers 3.
- Research on atypical opioids suggests that they may be a safer option than conventional opioids for the treatment of pain, with a lower risk of respiratory depression 4.
- However, the use of opioids in combination with other substances, including stimulants, can increase the risk of respiratory depression and other adverse effects 2, 5.
- The combination of opioids with non-opioids, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the analgesic potency of opioids and reduce the development of tolerance and dependence, but the safety and efficacy of combining opioids with stimulants is not well established 6.