Effects & Dangers of Mixing Cocaine and Opioids

Polysubstance use is when a person uses more than one substance at a time. For example, this occurs when a person is under the influence of cocaine, and then uses opioids.¹ Polysubstance use can also happen accidentally, such as when illicit or recreational substances like cocaine are laced with other drugs, like fentanyl, creating an unknowingly lethal combination.¹ 

Unfortunately, this practice is common, dangerous, and oftentimes deadly.¹ For example, in 2022 alone, of the more than 100,000 people who people died from a drug overdose, nearly half involved more than one substance.² Furthermore, over three-quarters of those drug overdose deaths involved fentanyl, a highly addictive synthetic opioid.²

Mixing cocaine and opioids puts your health and wellbeing at risk. This article will specifically address polysubstance use involving cocaine and opioids, explain the potential impacts of this type of co-use, and help you find effective polysubstance use treatment for yourself or a loved one.

Combining Cocaine and Opioids

Cocaine, including crack cocaine, is a very addictive and illegal synthetic stimulant drug that increases the activity of the central nervous system (CNS).^3,4 Opioids are a class of highly addictive natural, semi-synthetic, and synthetic drugs that include illegal opioids and prescription painkiller medications that decrease the activity of the CNS.^3,4,5,6

According to a recent study conducted by the Department of Quantitative Health Sciences at Case Western Reserve University in Ohio, half of those who engage in regular or daily cocaine use knowingly also misuse opioids, such as heroin and illegally-manufactured fentanyl and prescription painkillers like hydrocodone, oxycodone, codeine, and hydromorphone.^7,8 Conversely, 1 in 4 of those who engage in regular or daily opioid use also knowingly also use cocaine.⁷ 

People may mix these two substances for various reasons, but doing so is a highly risky practice that poses numerous risks, including the serious and very real danger of fatal overdose.¹ 

Dangers of Mixing Cocaine and Opioids

There are a wide range of effects that a person may experience when using cocaine mixed with opioids. These effects can depend on several factors such as the amount consumed, purity of the drugs, the person’s level of tolerance, how the drugs were administered, and if any other substances were consumed.⁶

Effects of Cocaine

Since cocaine is a stimulant, it produces excitatory effects on the body.⁴ People can experience a variety of short-term effects of cocaine, which can be serious and sometimes even fatal.⁸ These effects can depend on the amount used, along with other factors, and can include:^4,8

• Narrowed blood vessels. 
• Abdominal pain and nausea. 
• Insomnia. 
• Restlessness. 
• Anxiety/panic attacks.
• Erratic and violent behavior. 
• Paranoia. 
• Psychosis. 
• Heart rhythm problems. 
• Heart attack. 
• Stroke. 
• Seizure. 
• Coma. 
• Sudden death.
• Increased body temperature, heart rate, and blood pressure. 

People who chronically use cocaine use may also experience detrimental long-term effects.⁸ These can depend on the way cocaine is taken and may include:^4,8

• Lung damage from smoking crack cocaine.
• Increased risk for contracting/transmitting bloodborne diseases, such as HIV and hepatitis, in those who inject cocaine.
• Loss of sense of smell, nosebleeds, nasal damage, and trouble swallowing due to snorting. 
• Gastrointestinal issues such as tears and ulcerations, as well as infection and bowel tissue death due to decreased blood flood.
• Cardiovascular problems including stroke, aortic rupture, and inflamed heart muscle.
• Neurological problems, including bleeding in the brain, increased risk of developing movement disorders, and cognitive issues.
• An increased risk of addiction.

Effects of Opioids

Since opioids are a CNS depressant, they can produce many sedating effects, as well as pain relief and euphoria.⁵ The misuse of opioids can cause various immediate short-term health effects.⁶ Some of these potential effects of opioid misuse can include:⁸

• Drowsiness.
• Nausea.
• Constipation.
• Dry mouth.
• Itching.
• Vomiting.
• Dangerously slowed breathing and heart rate.

Chronic, regular opioid misuse can lead to various long-term and sometimes serious effects, which may depend on the specific opioid and the method of administration. These effects can include:^8,9

• Constipation and stomach cramps.
• Liver or kidney disease.
• The onset of depression.
• Sleep-disordered breathing.
• Collapsed veins if opioids are injected.
• Abscesses, meaning swollen tissue with pus.
• Cardiovascular complications, such as an infection of the heart lining and valves, heart attack, or heart failure.
• An increased risk of addiction.
• An increased risk of overdose.

Interactions Between Opioids and Cocaine

The possible interactions that can occur when opioids and cocaine are mixed can be highly unpredictable.¹ The most concerning, however, is the risk for overdose, which can be fatal.¹

When cocaine and opioids are used together, their effects may mask one or both substances’ effects.¹ This often results in a person consuming more of one or both substances in order to achieve the desired effect.¹ However, this increases overdose risk, particularly because cocaine wears off faster than opioids, making an overdose more likely to occur.¹ 

Generally speaking, all types of polysubstance use (including cocaine and opioids) is also associated with greater addiction severity, more unmet physical and mental health needs, increased risk-taking behaviors, violent behaviors, and increased overdose and mortality risks compared to the use of just one substance.¹⁰

Cocaine and Opioid Addiction Treatment

People who are struggling with addiction, including polysubstance addiction related to cocaine and opioids, should know that effective, evidence-based treatments are available that can help them start the path to recovery. Treatment can take place in different settings depending on a person’s unique needs, and may include:¹¹

• Medical detox, which involves medically supervised attention, care, and support to people as they go through substance withdrawal, helping them achieve medical stability so they can, in many cases, proceed to formal treatment.
• Inpatient drug and alcohol rehab, which entails living at a treatment facility where a person will receive round-the-clock care and support, engage in therapy, and undergo various treatments.
• Partial hospitalization programs for addiction, which are highly supportive outpatient rehab options that provide 4-8 hours of treatment most days of the week.
• Intensive outpatient addiction treatment programs, which are comprehensive outpatient settings that provide 9-20 hours of treatment each week.
• Outpatient drug and alcohol rehab programs, which allows people to live at home, however they will need to travel to a treatment facility on a regular schedule. 
• Sober living, which are supportive, structured substance-free homes that help people in recovery.
• Rehab aftercare, which refers to ongoing recovery support, such as 12-Step groups, telehealth options, or individual counseling, that can help prevent relapse.

Get Help for Cocaine and Opioid Addiction

Recovery is possible, and we are here to help you every step of the way. If you’re struggling, or you know someone who is, please call our free, confidential helpline at to speak to a compassionate admissions navigator. We can help you get admitted to treatment, explain how to use health insurance coverage for rehab, and even verify your insurance right away. We can also provide you with information and options if you are not yet ready to enter into treatment, but would like to know more.

Do not wait – reach out to us right now. We are here to help.