Opioid Interactions with Alcohol

Concomitant alcohol and narcotic abuse, and also combined addictive disease or narcotic addiction and alcoholism are very common. Interactions of both a pharmacodynamic and also dispositional type may occur between ethanol and either the short-acting exogenous opioids, such as heroin and morphine, or the long-acting exogenous opioid, methadone. Over half of the so-called "overdose" cases in which exogenous opioids (heroin or methadone) are implicated, are in fact cases in which concomitant abuse of alcohol has played a prominent role. Extensive studies have been carried out to determine factors which may alter the disposition of the long-acting exogenous opioid, methadone, which can be used successfully in the maintenance treatment of addiction. Chronic use of methadone, administered orally, can result in a steady state with respect to both drug levels and overall functioning. Many different physiological systems may be altered by acute or chronic use of short-acting narcotics such as heroin or morphine. Normalization of these functions occurs in the chronic steady state of long-term methadone treatment. However, many factors including chronic liver disease and use abuse of other drugs, including alcohol may alter this steady state. Studies have been carried out to determine the dispositional interactions between ethanol and methadone both in humans and in animal models. Also studies have been carried out to determine the effects of liver disease, which may result from alcohol abuse and/or sequelae of viral hepatitis infection on methadone disposition. Any factor which alters exogenous opioid disposition, specifically the steady state which may be achieved during chronic methadone maintenance treatment, may cause drug hunger and therefore drug-seeking behavior. Interactions between ethanol and methadone and also probably between ethanol and heroin may be major factors in contributing to the concomitant addictive diseases of narcotic addiction and alcoholism and also may contribute to persistent illicit drug use of a narcotic or non-narcotic type in patients receiving methadone treatment for heroin addiction. Treatment goals for the future are discussed in this report.