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Dangerous Drug Cocktails

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When people use illicit or prescription drugs recreationally, few of them expect it will end in serious injury or even death. Yet for hundreds of substance users every year, that’s exactly what happens – with drugs, alcohol, or a combination of intoxicants ultimately proving fatal. The American Association of Poison Control Centers (AAPCC) provides some of the most detailed data on these toxic exposures.

While most people think of poison control centers as a source of advice on accidental exposures to household products or medications, these hotlines also compile comprehensive information on every case to which they’re alerted; this includes in-depth analysis of reported fatalities related to drug and alcohol use. The 2013 Annual Report of the National Poison Data System (NPDS) from the AAPCC collected cases from 57 regional poison control centers around the United States. It provides key facts on every known fatality. These include the substance or substances a person was exposed to and the role each likely played in their death; each case is individually reviewed by a team of toxicologists.

We analyzed the NPDS data on both fatal and nonfatal exposures to illicit drugs, prescription drugs, and alcohol and charted which substances are involved in the most cases reported to poison control centers, including combinations of multiple substances. Read on to find out which drug cocktails most frequently result in death.

Reported cases of fatal and nonfatal exposures were classified by whether a single substance or multiple substances were involved. And among drugs and alcohol, it’s clear which category stands out above the rest: Alcohol was involved in more than 50,000 reports to poison control centers in 2013. However, of these reports, less than 20% involved alcohol as the only substance; in the remainder, alcohol was present along with additional substances, such as medications or illicit drugs.

This was not the case for every substance: For stimulants such as amphetamines, methamphetamine, caffeine, and methylphenidate (the key ingredient in the widely used ADHD medication Ritalin), most reported exposures involved only that substance. Amphetamines (which include Adderall, a widely prescribed ADHD medication) played a role in more than 15,000 reports, while methylphenidate was involved in nearly another 10,000. Other stimulants –such as cocaine with nearly 5,000 cases – were primarily reported in cases involving multiple substances.

You might be surprised to learn that marijuana, frequently thought of as a relatively innocuous drug, placed fourth among all substances, with about 5,000 reported cases. While the majority of these cases involved other substances as well, marijuana plays a role in an increasing number of emergency room visits, and severe marijuana intoxication can be associated with symptoms such as anxiety and psychosis.

Poly-substance abuse – or, using multiple substances at the same time – can present health risks to the users that no one can safely plan for. Frequently synergizing the individual drug highs experienced, while negating some of the side effects of each other, simultaneous use of several substances can lower the threshold for experiencing overdose and severe, life-threatening consequences. One should always be honest with medical professionals about the combination of drugs and/or alcohol that have been ingested as it can affect the treatment approaches for detox and withdrawal. Successful detox can lay the groundwork for those embarking on a path of recovery. Don't hesitate to seek help.

The NPDS also tracks the medical outcome of each reported exposure. This can range from no effect or a minor effect to moderate or major health effects. In the most severe cases, death results. We examined the data on drugs and alcohol to see which substances are associated with the most severe medical consequences.

Notably, most of these substances are associated with some medical effect as a result of exposure; only two substance categories –the stimulants ephedrine and methylphenidate – showed no medical consequences in a majority of cases. Meanwhile, heroin and GHB (gamma-hydroxybutyric acid, a nervous system depressant) show the greatest proportions of major medical consequences, followed by cocaine and methamphetamine. And while deaths made up the smallest portion of outcomes for each substance, they were most frequent for cocaine, heroin, methamphetamine, and alcohol.

We looked at the cases of fatal exposure where illicit drugs or alcohol were the primary substance found to be the cause of death, identifying which were tied to the most fatalities. Heroin was by far the most common, responsible for more than 220 deaths – greater than four times as many as the runner-up, alcohol. An overdose of heroin can cause respiratory depression, resulting in slowed or stopped breathing and a weak pulse, which can lead to coma or death. And excessive drinking can lead to alcohol poisoning, a potentially life-threatening condition that can involve vomiting, seizures, irregular breathing, unconsciousness, and potential brain damage or death.

Cocaine and methamphetamine take third and fourth place as the primary causes of dozens of deaths yearly. As a stimulant, cocaine toxicity can produce symptoms such as rapid heartbeat, irregular breathing, and a dangerously high body temperature, leading to total respiratory failure and cardiac arrest. And severe methamphetamine intoxication can present chest pain, seizures, labored breathing, stroke, and even a stopped heartbeat.

The NPDS also provided information on which secondary substances were most commonly found alongside the primary substances responsible for fatal exposures. We analyzed these deadly drug cocktails for the four most common primary substances leading to death: heroin, alcohol, cocaine, and methamphetamine.

Among heroin-related deaths, the most common secondary substance was cocaine; this combination is commonly known as a “speedball.” This dangerous use of a stimulant and depressant at the same time has been linked to numerous celebrity deaths, including John Belushi and Philip Seymour Hoffman.

Heroin-related fatalities also frequently involved alcohol, and the combined depressant effects of these substances can easily prove deadly. Because each drug can mask the effects of the other, users are at a very high risk of unintended overdose when combining substances.

Similarly, most cocaine-related deaths included alcohol as a secondary cause – another potentially fatal combination of a stimulant and depressant. Methamphetamine deaths also commonly involved the opioid painkillers Vicodin and morphine, opioid substances which are much like heroin in their effects on the body. Vicodin, oxycodone (OxyContin), and heroin ranked highly in cases of deaths where alcohol was the primary cause as well. Given the dangerous interactions of these substances, combining multiple illicit drugs or alcohol is far from recreational – it can be a matter of life or death.

Finally, we looked at the age and sex associated with each fatal exposure recorded by NPDS in 2013. Overall, fatalities among men were several times more common than fatalities among women. Young adults aged 20–29 were the range with the most deaths overall, followed closely by adults aged 40–49. Deaths among the elderly (age 60-plus) were more common than deaths among youth aged 14–19. Senior citizens are at an elevated risk of not only accidental drug overdoses but abuse of dangerous drugs such as prescription painkillers and anti-anxiety medications.

Seeking Help for Substance Abuse and Dependence

Every drug carries its own risks when abused – and when more than one drug is used at once, the dangers can quickly add up. Multiple-drug users may not realize it, but they’re placing themselves at risk for a variety of damaging health effects, as well as increasing their chances of overdose death. Hundreds face this tragic outcome every year, and the NPDS only accounts for that fraction that contacted a poison control center. The true numbers are almost certainly higher.

If you or someone you know is struggling with substance abuse or addiction, contact Detox.net today. Professional, personalized treatment is available even for complex cases of drug dependence. Don’t wait for an encounter with Poison Control or the Emergency Room before seeking help – you can search through our directory to find the right detox program today.




We used the 2013 Annual Report of the American Association of Poison Control Centers ’ National Poison Data System (NPDS) to determine which substances (alcohol, miscellaneous street drugs and stimulants) were involved in the most calls to regional poison control centers around the United States. In addition to calls, we looked at which substances caused the most fatal reactions as well as the secondary substances found within a report to determine what the most commonly reported fatal drug cocktails were in 2013 as reported by the NPDS.

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