Buprenorphine, alcohol and black-outs

What is the relation between buprenorphine, alcohol and black-outs?

Regarding buprenorphine and alcohol being co-administered. Last week I drank 2-3 alcoholic beverages too quickly. Also, I am taking 4MG of buprenorphine daily. So, is it blacking out for an extended period of time?

Originally posted in SR 2.0 15/10/2013. Reviewed 20/2/22

Buprenorphine is a medication that is primarily used to treat opioid addiction.  Blackouts or amnesic episodes are not typical side effects. In fact, this possibility is not even mentioned as a rare side effect in the technical sheet of the product.

However, the consumption of alcohol can lead to blackouts or amnesic episodes, even without any other factors present. Drinking alcohol too quickly, especially high concentration beverages, can increase the likelihood of experiencing a blackout. During a blackout, a person may engage in activities as talking, walking… but they have no recollection of these events the next day.

This occurs because alcohol interferes with the formation of new memories in the hippocampus. The hippocampus is a part of the brain that is responsible for forming and storing memories. 

To prevent blackouts, it is recommended to drink alcohol in moderation, avoid binge drinking, and stay hydrated by drinking water between alcoholic beverages. It is important to pace yourself when drinking and to be aware of the concentration of the beverages you consume. 

In conclusion, while blackouts are not a known adverse effect of buprenorphine, consuming alcohol too quickly or in high concentrations can lead to blackouts or amnesic episodes. 


Isotretinoin and recreational drugs

If I take Isotretinoin, it’s safe to use LSD, Psylocibin, DMT, weed and alchool?
How often is to often to take LSD and DMT? What are harms of DMT?

Originally posted in SR 2.0 . Reviewed 20/2/22

Isotretinoin is a drug used in the treatment of some types of acne. Alcohol is the only drug strictly contraindicated with isotretinoin because of its toxic effect on the liver. All other substances listed are pharmacologically safe in combination with isotretinoin.

Some indirect data suggest that psilocybe mushrooms may also slightly increase the risk of liver problems in combination with isotretinoin. But in practice, no toxicity cases are reported, and this combination is probably safe.

Taking psychedelics is like going to Disneyworld (if you like Disney characters, of course). The first few times are extraordinary, but you will get tired and bored if you go too often. The frequency (in both cases) depends on personal preference. For some people, it’s twice a year. For others, once a month, but most people find it boring to do it every weekend. Generally, the less frequent the use, the greater the likelihood of enjoying the experience.

DMT, like other classic psychedelics, produces no effects. Harm is related to mental problems (anxiety, difficulty integrating the experience) or, very rarely, persistent mental health problems.


Oxycodone, benzos and alcohol risks

How much Xanax and Oxycontin would be fatal when consumed together with alcohol and how much alcohol would cause problems? I know that drinking increases it greatly but I want to know if I can at least have a few, or does it all depend on height and weight?

Originally posted in SR 2.0 . Reviewed 12/2/23

Benzodiazepines, alcohol or oxycodone are rarely fatal in overdose because they do not produce respiratory depression (or do so in extraordinarily high doses). But the risk increases when combining two substances, and even more mixing all three

It is very difficult to know exactly what is the dose above which the risk is elevated. They are drugs with different pharmacological properties. Weight, sex, age and tolerance are also factors to be considered.  Low-dose combinations probably does not  increase the risk of death, but uncomfortable adverse effects (such as amnesia) are very likely to occur.

In a series of 575 deaths attributed to oxycodone in Sweden between 2006-2018, the most commonly detected drugs were benzodiazepines (70%) and alcohol (50%). Another similar study found the same association between the three substances, with alprazolam (Xanax, Trankimazin). In this series, these appeared as   as the benzodiazepine most associated with oxycodone poisoning deaths.

There are anecdoticar reports of cases of death caused by  the combination of oxycodone and clonazepam at high doses 



Oral contraceptive and drugs interactions

Hi Doc,

My girlfriend has been in a panic lately about her contraceptive pill (mercilon). Previously she has always had a bar in her arm but switched 2 months ago to the pill. Do any of the following affect how well the pill works: Mephedrone, methylone, cocaine, mdma, alcohol or in any combination of the above?

Originally posted in SR 2.0 7/4/14 . Reviewed 8/2/23

There are no  significant pharmacological interactions between common  drugs and birth control pills. The use of substances you mention does not alter efficacy of birth control pills. Neither any other hormone-based method: patches, transdermal implants, vaginal rings …

Equally important, contraceptive efficacy of the «morning-after pill» is also not affected

There are some studies that suggest  pharmacological interactions between cannabinoids and some contraceptives . But these are experiments «in vitro» and do not seem to have any practical relevance in humans.

And the same goes for combinations. We will consider «combination» the use of moderate doses and reasonable frequencies of a few substances. «Drug salads» ( taking whatever anyone offers to you without  criteria) often have unpredictable effects, regardless of the use of contraceptives or any other medication.

In relation to drugs and hormonal contraceptives, one important exception is tobacco. Women who smoke tobacco are at increased risk of certain adverse effects.  Smoking increases hormone levels in the blood, which can lead to an increased risk of blood clots, myocardial infarction and stroke.

In addition, smoking is associated with a decrease in good (HDL) cholesterol levels and an increase in bad (LDL) cholesterol levels. This contributes also to cardiovascular problems.

It is therefore recommended that women using oral contraceptives do not smoke (especially women over 35 years of age). If a woman is unwilling or unable to quit smoking, it is reasonable to consider another method of contraception.

Like many other drugs, oral contraceptives are used on a daily basis.So, it is important not to forget doses in order to maintain their effectiveness. This can be significant in the context of a rave or party lasting several days. In any case, weekly or monthly contraceptives are available for people who have a tendency to forget to take a drug every day.