Effects of Mixing Stimulants and Opioids

Polysubstance use involves a person using two or more substances at once. Stimulants and opioids are two types of drugs frequently used together. However, mixing stimulants and opioids can be deadly.1

This page will cover the effects of opioids and stimulants, the dangers of mixing these substances together, common combinations, and available treatment options for polysubstance addiction.

Differences Between Opioids & Stimulants

Opioids and stimulants are two distinct classes of drugs that produce different effects on the body.2 When comparing stimulants vs opioids, the two types of drugs have quite different, if not relatively opposite pharmacological effects. For example:2,3

  • Stimulants can have effects like increased energy and alertness, though they are also associated with potentially harmful cardiovascular stress and other adverse health issues.
  • Opioids act on opioid receptors and inhibit pain signaling to aid with pain relief, however they can also cause drowsiness, mental confusion, and dangerously slowed breathing.

There are several different types of opioid drugs. These include illegal drugs like heroin and illicitly-made fentanyl, as well as various prescription opioids.2

Prescription opioids are commonly prescribed for a number of pain management needs.3 Examples of prescription opioids include the following:3

  • Oxycodone (OxyContin, Percocet)
  • Hydrocodone (Vicodin)
  • Morphine
  • Codeine

Stimulants are central nervous activating drugs with effects such as elevated heart rate, blood pressure, and feelings of increased energy and wakefulness.3 Their misuse can lead to serious health problems like heart attack, stroke, and seizures. Like opioids, there are both illegal and prescription stimulant drugs.2

Though cocaine and methamphetamine are both Schedule II drugs, with limited pharmaceutical use, the misuse of these drugs predominantly involves illicitly sourced or manufactured products.4

Examples of prescription stimulants include:2,3

  • Methylphenidate (Ritalin, Concerta)
  • Dextroamphetamine/amphetamine (Adderall)

Prescription stimulants are typically prescribed to treat conditions like attention-deficit hyperactivity disorder (ADHD) and narcolepsy.3

Both stimulants and opiates—regardless of whether they are prescription or illicit—are commonly misused and carry potential risks of physiological dependence, addiction, and overdose.3

Adverse Effects of Opioids

In addition to their pain relieving properties, opioids can have undesirable effects like:2,3

  • Drowsiness.
  • Dry mouth.
  • Nausea.
  • Vomiting.
  • Constipation.
  • Itchiness.
  • Decreased heart rate.

Additionally, many opioid drugs have profound respiratory depressing properties—meaning that they can slow down breathing—which can result in fatal overdose in severe cases.1,3

Adverse Effects of Stimulants

In addition to some perceived positive effects such as increased energy and alertness, stimulants can have several adverse effects, including:2,3

  • Anxiety.
  • Paranoia.
  • Erratic behavior.
  • Restlessness.
  • Decreased appetite.
  • Increased heart rate, blood pressure, and body temperature.

Is Mixing Stimulants & Opioids Dangerous?

Yes, mixing stimulants and opioids together can be dangerous and could increase the risk of medical complications and even death. Polysubstance use is a dangerous practice because combining drugs together can:1

  • Result in unpredictable effects.
  • Intensify the effects of the drugs.
  • Increase the risk of dangerous outcomes, like overdose and drug toxicity.

Some people incorrectly assume that because these two classes of drugs cause very different effects, taking them together somehow “cancels” each other out. This is not necessarily the case, however.1

In fact, mixing stimulants and opioids can cause one drug to mask the effects of the other. This can lead to using more and more of each, making overdose toxicity to one or both substances more likely.1

Potential effects of mixing opioids and stimulants include:5

  • Dehydration.
  • Overheating.
  • Kidney failure.
  • Cardiovascular problems.
  • Respiratory depression or arrest.
  • Overdose.

Overdose is a serious risk of mixing opioids and stimulants together. One study found that people who used opioids and stimulants together were twice as likely to experience a fatal overdose compared to those who only used opioids.6

Since 1999, the number of overdose deaths involving stimulants and opioids has increased significantly.7 One study of a portion of the United States found that nearly one-third of overdose deaths involved both opioids and stimulants.8

In 2018, 74.2% of cocaine-related and 50.5% of psychostimulant-related overdose deaths also involved opioids.9 Of note, from 2015 to 2019, overdose deaths involving stimulants other than cocaine (many involving methamphetamine) rose 180%, with concurrent opioid use involved in many of the cases.10

Additionally, both stimulants and opioids have a known risk of physiological dependence and addiction, and when these substances are taken together, certain brain processes may be impacted differently compared to when each drug is taken alone.11

For example, studies have found polysubstance use of methamphetamine and morphine results in greater rewarding effects and higher reinforcing effects than each drug produces on its own. This can make stopping drug use even more difficult.11

The repeated use of both stimulants and opioids together can also result in a situation of polysubstance dependence and an associated combined drug withdrawal syndrome that can be additionally challenging to experience and/or complicated to manage at the point that drug use stops.12

Because of the serious risks associated with stimulants and opiates, there really is no safe way to mix these substances together for nonmedical misuse.1

Common Stimulant & Opioid Mixtures

Stimulants and opioids may be purposely combined for several reasons, some of which include the following:1

  • To produce effects greater than either drug can produce on its own.
  • To produce unique effects that may result from the combination.
  • To decrease either the active or “comedown” effects of the other drug being used.

Some substance users think taking stimulants with opioids can help prevent an overdose, but this is a myth.6

In certain cases, people may unintentionally consume stimulants and opioids together. Drugs like methamphetamine and cocaine may be cut with fentanyl by street dealers. Many of these drugs are sold in powder form and appear similar, so they can be easily mixed. A person can accidentally consume a dangerous cocktail of drugs without even realizing it.1

Common combinations of opioids and stimulants include:

  • Opioids and cocaine.
  • Opioids and meth.
  • Opioids and amphetamines.

Any combination of opioids and stimulants is dangerous, regardless of whether they are illicit or prescription.1

Treatment for Polysubstance Use Disorder

If you or someone you know is struggling with stimulant and opiates use, treatment is available. Polysubstance addiction treatment can help you or your loved one safely detox from stimulants and opioids and develop the insight and tools needed to maintain long-term recovery.5

Detox is typically the first step in addiction treatment for opioids and stimulants. When a person has been using multiple substances, withdrawal timelines and symptoms may vary, which makes treatment planning more complex.5

A supervised medical detox is strongly recommended for people who are addicted to both stimulants and opioids.5 This type of treatment focuses on helping a person safely and comfortably go through the withdrawal process by closely monitoring a person’s symptoms, providing medications when needed, and encouraging rest.12

Once detox is complete, it is recommended that people continue their treatment by transitioning to another level of care, such as inpatient addiction treatment or outpatient rehab. While detox primarily focuses on the withdrawal process, continuing treatment can help people achieve long-term recovery by addressing the underlying causes of an addiction and providing tools for maintaining recovery.13

Treatment for polysubstance addiction to stimulants and opioids typically involves medications to treat opioid addiction, such as methadone, buprenorphine, or naltrexone, along with evidence-based therapies, including contingency management and counseling.5

At Desert Hope Treatment Center, a drug rehab in Las Vegas, we offer several different levels of addiction treatment. Our compassionate, highly skilled clinical team is trained in providing medication for addiction treatment and evidence-based therapies for polysubstance use disorder.

We believe in customizing treatment to each person’s individual needs. Specialized programs and support are available for Veterans, first responders, and members of the LGBTQ+ community.

Desert Hope is in-network with several health insurance plans that cover treatment. You can quickly and securely now. If you do not have health insurance, Desert Hope also offers other ways to pay for rehab, including financing plans.

For more information about Desert Hope Treatment Center or to start the admissions process, call us at to speak to an admissions navigator today.

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