Former NFL defensive end Josh Mauro died in April at age 35, and details surrounding his cause of death have only now been made public, highlighting the potentially deadly consequences of combining multiple substances.
According to a Phoenix Police Department case report obtained by The California Post on Monday, Mauro had reportedly been using cocaine and drinking alcohol before he was found unresponsive at his Arizona home.
A woman who was at the residence told investigators that Mauro had been on a four-day "bender" and had experienced frequent nosebleeds and sweating after using cocaine.
An autopsy later found fentanyl, cocaine and ethanol, or alcohol, as well as their metabolites, in Mauro's system. The Maricopa County Medical Examiner ruled his death an accidental overdose.
Mauro, who spent eight seasons in the NFL and played one season with the New York Giants before finishing his career with the Arizona Cardinals, was 35.
His death underscores the dangers of polysubstance use, particularly when a powerful opioid such as fentanyl is combined with stimulant drugs and alcohol.
Why Mixing Drugs Can Be So Dangerous
Polysubstance use refers to using more than one drug within a period of time. The combination can make the effects of each substance harder to predict and increase the risk of overdose.
According to the National Institute on Drug Abuse (NIDA), fentanyl is a synthetic opioid that is about 50 times more potent than heroin and 100 times more potent than morphine. Even a small amount can cause a fatal overdose, particularly in people who do not know they have been exposed to it.
Cocaine, meanwhile, is a powerful stimulant that can raise heart rate, blood pressure and body temperature. It can increase the risk of heart attack, stroke, seizures and dangerous heart rhythms.
The combination creates a particularly unpredictable situation. A person may feel alert or energized from cocaine, while fentanyl simultaneously depresses the central nervous system and slows breathing. The stimulant effects may mask some signs of opioid intoxication, potentially delaying recognition that someone is experiencing a life-threatening overdose.
Alcohol can add another layer of danger. Like opioids, it can suppress breathing and impair consciousness. Combining alcohol with opioids can significantly increase the risk of respiratory depression and death.
Why Fentanyl Makes Illicit Drug Use More Unpredictable
One of the biggest challenges in the current overdose crisis is that people may be exposed to fentanyl without realizing it.
Illicitly manufactured fentanyl can be mixed into other drugs or pressed into counterfeit pills. A person who believes they are taking cocaine or another substance may unknowingly consume fentanyl, according to the Centers for Disease Control and Prevention (CDC).
This unpredictability means even someone who does not consider themselves a regular opioid user can be at risk. A person's tolerance, the amount consumed, and whether other substances are involved can all influence the outcome.
Are Nosebleeds and Sweating Warning Signs?
The symptoms described in the police report are not, by themselves, proof that a person is experiencing an overdose.
Frequent nosebleeds, however, can occur with repeated cocaine use, particularly when the drug is snorted. Cocaine can damage the nasal tissues and blood vessels, potentially leading to irritation and bleeding.
Sweating can also occur after cocaine use because stimulants can increase heart rate and body temperature. More broadly, excessive sweating, agitation, confusion, chest pain, seizures, or severe changes in consciousness can signal a serious medical emergency.
A suspected overdose should always be treated as an emergency. Signs of an opioid overdose can include pinpoint pupils, inability to wake up, slow or stopped breathing, and bluish or grayish skin.
Naloxone, an opioid overdose reversal medication, can rapidly restore breathing in someone experiencing an opioid overdose and should be administered when an opioid overdose is suspected.
Prolonged substance use can place significant stress on the body, particularly when multiple drugs are involved. Sleep deprivation, dehydration, poor nutrition and repeated exposure to drugs can further compound the risks.
An overdose does not require someone to have a long history of addiction. Fentanyl exposure can be fatal regardless of a person's background or whether they consider themselves a recreational user.
Mauro's death serves as a stark reminder that recreational drug use can become dangerous quickly, especially when substances are combined or contaminated with fentanyl.
