Taking 1 oxycodone tablet together with even a modest amount of alcohol increases the risk of respiratory depression, according to a study published online first in the journal Anesthesiology.
The study also found that elderly people were especially likely to experience this complication.
“Unfortunately, we’re seeing more fatalities and people in emergency rooms after having misused or abused legally prescribed opioids, like oxycodone, while having consumed alcohol,” said Albert Dahan, MD, Anesthesia and Pain Research Unit, Leiden University Medical Center, Leiden, the Netherlands. “Respiratory depression is a potentially fatal complication of opioid use. We found alcohol exacerbated the already harmful respiratory effects of opioids.”
For the study, the researchers examined the effect taking oxycodone in combination with alcohol had on breathing in 12 healthy young volunteers aged 21 to 28 years and in 12 elderly volunteers aged 66 to 77 years who had not been chronically taking or who had never taken opioids.
On 3 separate occasions, volunteers were given 1 oxycodone 20 mg tablet combined with an intravenous infusion of ethanol. To allow researchers to continuously evaluate the safety of participants, the amount of ethanol was increased with each visit — from placebo on the first visit, to concentrations of 0.5 g/L (~1 drink in women and 3 drinks in men) during the second visit and 1 g/L (~3 drinks in women and 5 drinks in men) during the third visit as measured through the volunteers’ breath.
Baseline respiratory measurements were taken before drugs were administered. Resting respiratory variables, minute ventilation, and the number of times volunteers temporarily stopped breathing were obtained at regular intervals during treatment.
One oxycodone tablet reduced baseline minute ventilation by 28%, while the addition of 1 g/L of ethanol caused minute ventilation to further decrease by another 19% — a total decrease of 47%. The combination of ethanol with oxycodone caused a significant increase in the number of times volunteers experienced a temporary cessation in breathing, ranging from 0 to 3 events with no ethanol versus 0 to 11 events at 1 g/L of ethanol (measured by breath).
Overall, researchers found a synergistic effect between opioids and alcohol on breathing and, most importantly, on the number of times an individual temporarily stopped breathing. This was especially true in the elderly population, who were more likely to experience repeated episodes where they temporarily stopped breathing. The authors note, this was likely due to the older volunteers’ inability to recover quickly and lack of physiological reserve.
“We hope to increase awareness regarding the dangers of prescription opioids, the increased danger of the simultaneous use of opioids and alcohol, and that elderly people are at an even greater increased risk of this potentially life-threatening side effect,” said Dr. Dahan. “Ultimately, people should know that it is never a good idea to drink alcohol with opioids.”