If you ever pay attention to a prescription drug commercial, you may notice that they often spend some time warning you not to take certain other substances. Labels may also warn you to avoid mixing drugs with other substances like alcohol. For instance, the Food and Drug Administration warns you not to mix benzodiazepines with opioids. That’s because drugs can have potentially dangerous effects on your body. But that danger doesn’t stop a phenomenon known as polydrug use.
Polydrug use is the use of two or more drugs at the same time, whether by accident or intentionally. Mixing drugs is often associated with serious issues like substance use disorders and overdose. For instance, according to the National Institute on Drug Abuse (NIDA), there were 15,883 overdose deaths in 2019. The vast majority of these deaths involved other drugs, especially synthetic opioids like fentanyl.
But what happens if you combine cocaine with a common prescription medication like Xanax? Why is it dangerous to mix depressants and stimulants? Learn more about the effects cocaine and Xanax can have on your system.
Cocaine is a central nervous system stimulant that works to increase activity in your brain and nervous system. Like other stimulants, it interacts with naturally occurring chemicals in your brain like dopamine, serotonin, and norepinephrine. These chemicals are closely tied to reward, energy levels, and heightened moods.
Cocaine doesn’t make these chemicals and, unlike other stimulants, it doesn’t cause your brain to make more either. Instead, it interferes with a process called reuptake. Reuptake is when the nerve cell that sends a chemical messenger like dopamine, reabsorbs it.
This prevents an excessive buildup of dopamine in your system and removes chemicals that are no longer needed. As cocaine blocks reuptake, it allows for more dopamine to remain in your system to bind to more receptors. Once bound, dopamine makes you feel happy, excited, euphoric, and energized. Cocaine causes these feel-good chemicals to cause increased wakefulness, alertness, and energy levels. It can also make you feel extremely confident and powerful, suppress your appetite, and makes you sensitive to light and sound.
Some people feel like cocaine helps them perform physical and cognitive tasks. Cocaine also comes with some side effects like anxiety, panic, heart palpitations, restlessness, and discomfort. As cocaine wears off, it can cause you to feel fatigued, anxious, depressed, or apathetic.
Xanax is the brand name for a drug called alprazolam. It’s a benzodiazepine that’s used to treat anxiety and panic disorders. Unlike cocaine, Xanax is a prescription drug that’s still widely used today. As a benzodiazepine, Xanax is a central nervous system depressant that works by interacting with a natural chemical messenger in the brain called gamma-aminobutyric acid (GABA). GABA is a chemical that’s closely tied to the rest and digest response and it’s instrumental in facilitating sleep. People with anxiety, panic, and sleep disorders often have issues that prevent them from relaxing and sleeping when they want to. This can mean anxiety, racing thoughts, and insomnia.
Benzodiazepines can help correct this by helping GABA become more effective. Xanax binds to GABA receptors on a different site than GABA. When GABA binds to the same receptor, Xanax increases its effectiveness, increasing the intensity of its nervous system slowing abilities. Xanax can also cause some side effects, including hypnosis, sedation, dizziness, memory impairment, and other symptoms that are similar to alcohol-intoxication. Because of these effects, the drug has significant abuse potential and may be misused to achieve a relaxing high.
Both cocaine and Xanax can be dangerous if the drugs are taken in very high doses. Cocaine can cause serious symptoms that are associated with an overexcited nervous system. This can include heart arrhythmias, tremors, seizures, panic attacks, sweating, and a condition known as stimulant psychosis. Stimulant psychosis is characterized by a temporary break from reality, causing symptoms like hallucinations and delusions.
These symptoms are similar to the issues people with schizophrenia face, although stimulant psychosis usually goes away when the drug wears off. What isn’t temporary, is the damage a high dose of cocaine can do to your body, including your heart. A cocaine overdose can cause a heart attack or stroke that may prove fatal.
A Xanax overdose may be less toxic than cocaine, but it can cause uncomfortable symptoms. It may also cause a deadly overdose if it’s taken in extremely high doses. Though this is usually seen in suicide attempts, not accidental overdose. A Xanax overdose can cause you to feel uncomfortable symptoms like sedation, depression, and intense sleepiness. You may also feel like your arms are heavy as your muscles are weakened. You may also experience a slower heart rate, lower body temperature, and slowed breathing. In extreme cases, slowed breathing can cause your breathing to slow to dangerous degrees. You may lose consciousness and experience oxygen deprivation, leading to coma, brain damage, or death.
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Mixing these two drugs is essentially subjecting your nervous system to opposing forces. Cocaine increases activity in your nervous system and Xanax slows down activity in your nervous system. This is often called mixing uppers and downers, and it’s well-known to be dangerous. It’s not as dangerous as mixing two different depressants or two different stimulants. That can cause the drugs to potentiate, having a much more potent effect. Instead, mixing Xanax and cocaine is dangerous because of its deception.
Mixing depressants and stimulants can mask some of the effects of each drug. For instance, taking too much Xanax may make you feel sleepy, slowing down your use of the drug. Too much cocaine may make you feel anxious and irritable, causing you to stop using. As you notice the increasing effects, you may realize when you’ve reached your limit. However, when the drugs are combined, they may counteract each other.
Instead of feeling sedated on Xanax, the cocaine keeps you awake. Instead of feeling restless on cocaine, Xanax keeps you calm. However, avoiding these extreme symptoms gives you the false belief that you can handle more. This can cause you to take a dose of one or both of the drugs that’s too high for you to handle safely. Plus, cocaine’s effects are relatively short-lived, while Xanax lasts for hours. If you take a high dose of Xanax, as cocaine wears off, it leaves the Xanax to its intense effects.
These effects can be even more dangerous if other drugs are mixed in as well. In some cases, people mix cocaine and benzos with alcohol or heroin.
Though both of these drugs have counteracting effects, your body has to process them both. Many drugs are processed in the liver, which works to break down the drug and eliminate it. Combining drugs can put a lot of strain on the organs that are involved in chemical processing. This can lead to damage, especially if you engage in polydrug use for a long period of time. This damage can lead to long-term health problems.
Mixing depressants and stimulants isn’t a new idea, and Xanax and cocaine isn’t the only combination that people use. In fact, many of the high-profile deaths of the 20th and 21st centuries were caused by a drug mix referred to as a speedball. A speedball is the street name for a mix of heroin and cocaine, and the mix was linked to the deaths of many notable celebrities including John Belushi, River Phoenix, and Chris Farley.
In some cases, drug mixing can happen by accident. One of the most common accidental mixes happens when a person is taking a prescription and then drinks alcohol. Or you may encounter drugs like cocaine and alcohol in the same party setting, not knowing mixing them can be dangerous.
However, some people mix the drugs like cocaine and Xanax intentionally. Stimulants and depressants may be mixed in an attempt to counteract some of the negative side effects of each drug. However, this can limit your awareness of the drug’s effect on your brain and body, leading to an overdose.
If you take Xanax and cocaine and start to experience serious overdose symptoms, you may need medical attention. Cocaine can cause chest pains, heart palpitations, trouble breathing, confusion, or seizures. Xanax can cause you to lose consciousness and it can slow down your breathing to a dangerous degree. Treatment may depend on your symptoms. If you take an ambulance to the hospital, you may be given a solution of activated charcoal, which can prevent any drugs in your stomach from being absorbed. If breathing is slow or labored, you may be given oxygen.
You may be given tests to find out what you have in your system. If you took illicit drugs, even you may not know what you took. Cocaine overdoses are often treated with sedatives to calm down your nervous system. However, if you already have a benzodiazepine in your system, doctors may use different options. A Xanax overdose may be treated with a drug called Flumazenil, which counteracts benzodiazepines.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
National Institute on Drug Abuse. (2021, January 29). Overdose Death Rates. Retrieved February 12, 2021 from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
National Institute on Drug Abuse. (2018, July). Cocaine. Retrieved from https://www.drugabuse.gov/publications/drugfacts/cocaine
RxList. (2018, February 6). Benzodiazepines Drug Class: Side Effects, Types & Uses. Retrieved from from https://www.rxlist.com/benzodiazepines/drug-class.htm
U.S. Food and Drug Administration. (2016, September). XANAX® alprazolam tablets, USP. Retrieved February 12, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf