Why is Polydrug Abuse so Dangerous?

There’s not just one factor that makes polydrug abuse so dangerous. There are several different ones. The tragic thing is that when a person is living an addicted lifestyle, he is far from caring whether or not he is harming himself. He’s just driven by his cravings and the overwhelming need he feels to get more drugs.

Polydrug Statistics

While a person’s health and age get involved in whether or not certain combinations will be harmful, there are still specific combinations that can be far more harmful and dangerous than the abuse of a single drug by itself. Here are some of the most dangerous combinations.

Alcohol & Cocaine

This combination results in the formation of an entirely new chemical in the body — cocaethylene. In other words, when cocaine is broken down in a body that is also intoxicated with alcohol, the long-lasting chemical cocaethylene forms instead of the usual cocaine products that would be swiftly eliminated from the body.

  • Cocaethylene has a similar psychoactive effect as cocaine. But cocaethylene is associated with liver damage, seizures and immune system damage.
  • The risk of immediate death is approximately 20 times higher from cocaethylene than cocaine.
  • Alcohol and cocaine together also results in higher levels of cocaine in the blood. Tests show that these levels can increase as much as 30%. This increases the strain on the cardiovascular system.
  • Increases in violent behavior and suicidality have been reported when cocaine and alcohol are used together.

Alcohol & Ecstasy

Alcohol may moderate the high you get from Ecstasy, and you may not feel as strong an effect as usual. But then it is likely that you will feel much worse when you come down off these drugs.

  • Both Ecstasy and alcohol cause dehydration which can increase one’s chances of heatstroke when dancing in a hot environment for hours
  • There is a greater strain on a person’s liver and kidneys, which may lead to nausea and vomiting.
  • Both drugs cause an impairment of a person’s judgment. Risky and dangerous decisions and actions may result.

Alcohol & Other stimulants

Alcohol abuse may be combined with Ritalin, Adderall, methamphetamine or amphetamine. Some diet pills, over the counter cold remedies and even strong energy drinks can also be dangerous.

  • As with cocaine, these stimulants can obscure the sedating effects of alcohol, enabling a person to get dangerously drunk without fully realizing it. The user may try to drive, which is dangerous to both himself and others nearby.
  • As with Ecstasy, overheating is more likely to occur which can lead to organ damage.
  • A person abusing this combination may lose his inhibitions but be irritable and aggressive. Emotions may run out of control. The results can be disastrous.

Ref: http://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-illegal-drugs

Alcohol & Benzodiazepines (Valium, Xanax, Klonopin, Ativan)

This combination loads the body with depressants which doubles up the sedating effects of the drugs. This can result in:

  • Dizziness
  • Confusion
  • Impaired memory
  • Irritability
  • Aggression
  • Loss of consciousness
  • Coma
  • Death

Opiates & Cocaine

Opiates and opioids (synthetic or partially synthetic opiates) are central nervous system depressants. Cocaine is a strong stimulant. Some people mix these two drugs so that they don’t nod off due to the opiate.

  • Cocaine is very stressful for the cardiovascular system. It increases the heart rate but constricts the blood vessels. This is a very dangerous combination that has led to blood vessel rupture, heart attack, stroke and cardiac arrest.
  • When opiates or opioids are added to cocaine abuse, the stress on the cardiovascular system increases even further.
  • Because cocaine negates the sleepy, drowsy effects of the opiates, a person can mistake how much heroin or prescription painkiller he has already used. Seeking more effect from the opiates, he may consumer more. This is one way that unintentional overdoses occur.

Cocaine & Ecstasy

Both these drugs are strong stimulants that can overwhelm the body’s defenses against heat and stress.

  • Cocaine speeds up the heart while it constricts the blood vessels.
  • Ecstasy is a form of amphetamine that also speeds the heart and causes the body to heat up.
  • The combination can damage the cardiovascular system or cause a stroke.
  • The severe overheating can cause organ breakdown.

A survey of young adults who frequented clubs in New York City showed that 92% engaged in polydrug abuse. More than 86% of clubbers were abusing Ecstasy and 85% were abusing cocaine.


Opioids & Benzodiazepines | Opioids & Benzodiazepines & Alcohol

All three of these drugs depress the central nervous system which causes the breathing to slow down. Using these drugs at the same time constitutes a triple-threat to one’s very survival.

  • A person who has these drugs in his body may be so sleepy and tired that his friends put him to bed to sleep off the drugs. But while he sleeps, he may very well just stop breathing.
  • Older drug users may break down benzodiazepines more slowly than younger users. This means that they may unintentionally overdose on this combination, when at an earlier time, they might have been able to survive the mix.

Alcohol & any other drug

This is the most common pattern of polydrug abuse. Alcohol has the ability to worsen a person’s reaction to other drugs that were taken, or it can damage a person’s health to the point that amounts of other drugs that would normally be tolerated become hazardous or fatal.

  • Alcohol is well-known for causing liver damage. Heavy alcohol consumption over time can create so much damage that the liver can no longer break down other drugs at the same rate. Blood concentrations of that other drug can then increase to fatal levels because they sit in the blood instead of getting broken down. When another dose of a secondary drug is taken, the person can overdose.
  • Alcohol severely impairs judgment. A person can easily lose track of how much of that second drug has been consumed.

Ref: http://www.emcdda.europa.eu/attachements.cfm/att_93217_EN_EMCDDA_SI09_polydrug%20use.pdf

Drug Combinations Frequently Land Abusers in the ER and Morgue

Emergency Room

When drug users wind up in the emergency rooms or morgues of hospitals, in the majority of cases, it is because of the abuse of multiple substances. Statistics on ER visits in the US are reported by the Drug Awareness Warning Network (DAWN), part of the Substance Abuse and Mental Health Services Administration (SAMHSA).

A summary of findings from their various reports ought to be enough to convince anyone that mixing alcohol, illicit and prescription drugs is one of the most dangerous activities they be involved in. Here are some of the most significant findings from DAWN.

Majority of ER Visits Due to Polydrug Abuse

When SAMHSA published the DAWN statistics gathered in 2011, it noted that 56.3% of all the emergency room visits due to drug abuse had involved multiple drugs.

Between 2004 and 2011, the profile of drugs involved shifted dramatically from illicit drugs to abused prescription drugs. The involvement of pharmaceutical drugs roughly doubled, whether they were being mixed with illicit drugs, alcohol or both.

Reference: http://www.samhsa.gov/data/2k13/DAWN2k11ED/DAWN2k11ED.htm

Further Reports from DAWN on Polydrug Abuse

In 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the outcomes of emergency room visits by people who had run into problems while they were abusing drugs and alcohol. This report showed clearly that a person abusing multiple drugs is much more likely to need emergency care than the single-drug abuser.

SAMHSA collected this information in 2009 from the nationwide monitoring system, the Drug Awareness Warning Network.

The report is titled Outcomes of Drug-Related Emergency Department Visits Associated with Polydrug Use. That year, there were about 4.5 million drug-related visits to the emergency room. This report selected out the top drugs involved in emergency room visits for further analysis.

The number of visits related to these top drugs broke down like this:

  • Cocaine - 422,901
  • Marijuana - 376,486
  • Heroin - 213,118
  • Opiate pain relievers - 342,983
  • Benzodiazepines (Xanax, Valium) - 312,931
  • Muscle relaxants (Soma, Flexeril) - 50,878
  • Stimulants (Ritalin, Adderall) - 21,799

In every category, more people needed emergency medical care for multiple drug abuse than for help with a single drug.

Heroin was the top drug that was used singly, with about half of those in the ER using only heroin. But only about 20% of those in the ER after abusing muscle relaxants had used just that drug alone. The other 80% mixed it with other drugs, most popularly, the combination of opiate painkiller hydrocodone and Valium. This combination is called the “Houston Cocktail”.

Only about one-third of cocaine users did not use another drug, and only about one-fourth of marijuana abusers just had weed in their systems.

When heroin, prescription painkillers, benzodiazepines, prescription stimulants or marijuana were involved, the use of multiple drugs was more likely to result in the individual staying in the hospital for additional treatment.

Overwhelming Proportion of Drug Deaths Also Due to Polydrug Abuse


DAWN also monitors drug-related deaths to find trends. In May 2012, they reported on the profiles of drug-related deaths that occurred in 2010 in cities across the country. Here is a sampling of their findings.

In Albuquerque, New Mexico and the surrounding area, the vast majority of drug deaths involved multiple drug abuse. For example:

Heroin and prescription opiate-type drugs:

  • 110 users of these drugs died in 2010
  • Only 20 were single drug deaths

Benzodiazepines (Valium, Xanax and others):

  • 54 users died
  • None were single drug deaths

This phenomenon is consistent with the simultaneous abuse of opiates and benzodiazepines that is very common. These two drugs can combine to result in a fatal suppression of a person’s breathing.


  • 46 people died
  • None were single drug deaths

Alcohol also suppresses breathing and can combine with opiates or benzodiazepines to result in an unintentional overdose.

In the Los Angeles-Long Beach area:

Heroin and prescription opiate-type drugs:

  • 430 users from opiates
  • Only 87 were single drug deaths.


  • 309 people died
  • Only 8 were single drug deaths

Stimulants (methamphetamine, Ritalin, etc.):

  • 117 people died
  • 82 were single drug deaths

In the Boston area:

Heroin and prescription opiate-type drugs:

  • 230 people died
  • 135 were single drug deaths


  • 143 people died
  • None were single drug deaths


  • 98 people died
  • 41 were single drug deaths

In the Philadelphia-Camden, NJ area:

Heroin and prescription opiate-type drugs

  • 419 people died
  • Only 67 were single drug deaths


  • 189 people died
  • Only 67 were single drug deaths


  • 252 people died
  • Only 1 was a single drug death.

Ref: http://www.samhsa.gov/data/2k12/DAWNMEAnnualReport2010/DAWN-ME-AnnualReport2010.htm

European Polydrug Abuse Patterns

In Europe, the European Monitoring Centre for Drugs and Drug Addiction compiles reports on the trends and statistics across the continent. In 2009, they published the report Polydrug Use: Patterns and Responses.

This report analyzed the trends of polydrug use among teens (15 to 16-year-olds), young adults and problem drug users. There were 22 European countries included in this analysis.


Teen Drug Use

Teens reporting polydrug abuse in the prior month:

6% used the combination cannabis, alcohol and cigarettes; 1% used cannabis, alcohol, cigarettes PLUS one of the following: Ecstasy, cocaine, amphetamine, LSD or heroin

When cocaine use was reported by a student, polydrug use was more frequently reported. This is a logical result, considering that a student who uses cocaine (instead of the most common illicit drug, cannabis) is already a higher-risk drug abuser.

Cannabis users were most likely to add Ecstasy and least likely to add heroin or LSD.

These proportions were higher in countries that generally had high substance abuse statistics.

Teens who were abusing multiple drugs also had higher levels of truancy.

Young Adults (15 to 34-year-olds)

While numbers vary widely from one country to another, on average, if a person is a heavy drinker, he (or she) is far more likely to report the abuse of one or more other drugs such as cannabis or cocaine. In Italy, nearly 80% of heavy drinkers also used cannabis. In many other countries, the figure was between 30% and 50%.

In Cyprus, 35% of cannabis users reported the addition of Ecstasy and in Denmark 17% added amphetamine to the mix. In Cyprus, Ireland, Spain and the UK, about 20% added cocaine.

Use of cocaine or Ecstasy was very frequently associated with the simultaneous abuse of another drug, particularly another stimulant or alcohol.

Problem Drug Users

Problem drug users are already living very risky lifestyles. Rates of polydrug use are much higher in this population, as would be expected.

Among this group, multiple drug abuse is a significant cause of medical emergency.

An analysis of European drug-related deaths from 2002 through 2006 showed that while an opiate-type drug was involved in three-quarters of all drug deaths, it was the sole drug involved in only 18% of them. The report summarizes: “These deaths are frequently related to combinations of substances, and only a minority of cases are related to one substance only.”

This report also commented that among heroin users, using alcohol at the same time was a contributing factor in overdoses that did not result in death.

Of course, most of these problem drug users are, in fact, addicted. When these people entered treatment programs, 57% reported multiple drugs giving them problems. The highest proportion of polydrug abusers entering treatment was found in Finland (86%). Cocaine, alcohol, cannabis and stimulants such as amphetamine were the secondary drugs reported, in that order. It was most common to find heroin/cocaine abusers (the most common combination) in large cities.

The report also noted that polydrug abuse is very common among people who are receiving substitution treatment - in other words, they are being given methadone or buprenorphine and continued to add other drugs to the mix. Many of these patients were also alcohol-dependent, or they abused benzodiazepines, known to make opiates more potent.

Amplifying the Effects of Drugs

When drugs are used in combination, some of the effects are amplified. In some cases, this is what the drug user is looking for - a specific kind of high. In other cases, the user is so careless that they will use anything available.

But the amplification applies to more than just the euphoric high. It also applies to the life-threatening aspects of drug abuse. When more than one drug that suppresses breathing is taken, a person can asphyxiate due to that combined effect. Multiple stimulant abuse can result in a terrible strain on the cardiovascular system and fatal damage.

Reports from both DAWN and the EMCDDA conclude that the polydrug abuser must have access to addiction treatment programs that can address polydrug use.

The Narconon drug and alcohol program has always been able to address polydrug abuse, because it focuses on helping a person recover from the disabilities that led him (or her) to want to use drugs in the first place. A person must find relief from the cravings that drove him relentlessly back into drug use, even while he could see that his life was being destroyed. He must gain the skills needed to establish new and honest relationships with family, friends, employers and his community.

The Narconon recovery program is structured so that the individual has tools that help him succeed in life and remain drug-free.


Losing Our Brightest to Polydrug Abuse

Perhaps it’s the feeling of invulnerability that the young so often possess. Maybe it’s simply the social acceptability of substance abuse in a college atmosphere. Whatever the underlying factors, America’s young adults on college campuses too often lose their lives to polydrug abuse.

Certainly, this indicates a lack of thorough education on the life-threatening effects of specific drugs in combination. It might not be possible any time soon to completely eliminate drug or alcohol abuse among the young but if they knew that certain combinations could kill them, they might restrain themselves from indulging.

Report from Chico State University

Between August 2006 and May 2012, Chico State University lost eight students to polydrug abuse. In an effort to save other lives, they published some of the toxicology reports from these deaths:

  • Kyle Barley, 22: cocaine, oxycodone and diphenhydramine (antihistamine)
  • Stephen Davis, 23: oxycodone, cocaine, morphine, codeine, alcohol
  • Angela March: oxycodone, methadone, fentanyl (painkiller), methamphetamine
  • Gina Maggio, 21: combination of prescription and illicit drugs
  • Carly Callaghan, 22: morphine, alcohol, Prozac.

Compelled to Act report

The website www.compelledtoact.com keeps a running tally of college students who passed away due to drugs or alcohol. Here are a few of the students who lost their lives due to a combination of substances:

  • Zachary Robinson, 21, University of South Carolina: alcohol, opiate painkiller.
  • Brett Malmquist, 21, Lincoln College: alcohol, heroin, codeine, marijuana, antihistamine (Benadryl), dimenhydrinate (Dramamine).
  • Julio Salgado, 21, Towson University: alcohol, oxycodone.
  • Michael Hoffman, 21, University of Colorado: alcohol, painkillers.
  • Wilson Forrester, University of Arizona: alcohol, prescription drugs.
  • Matthew Ainsworth, 21, Villanova University: alcohol, oxycodone.
  • Philip Christian, 23, Georgia Southern University (while on Spring Break): alcohol, oxycodone, cocaine.

Reference: http://compelledtoact.com/index.htm

Report from the National Center on Addiction and Substance Abuse (CASA)

CASA is located at Columbia University in New York, and provides in-depth reports on substance abuse by youth, young adults and the general population. In 2007, they published Wasting the Best and Brightest, an analysis of substance abuse on college campuses.

Their study of the situation showed that 2.3 million college students were abusing two or more substances at a time. They also noted that college students who binge drink (have five or more drinks in one sitting) are more likely to also abuse marijuana, cocaine, Ecstasy or other illegal drugs.

This study also states: “Students who abuse prescription opioids are more than four times likelier to report frequent binge drinking and driving after binge drinking, more than eight times likelier to report past-year marijuana use and more than 13 times likelier to report past-year cocaine use than students who do not abuse prescription opioids.”

Reference: http://www.casacolumbia.org/templates/Publications_Reports.aspx#r11

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