The National Pharmacy Association in the UK has published guidance on risk mitigation in relation to alcohol consumption during therapy with methadone. The hazards are manifold and include increased likelihood and severity of respiratory depression and hypotension, particularly with binge drinking. The risk if greater with during the initial titration phase of treatment and can lower the threshold for methadone overdose. People being treated for opiate misuse who also have a chronic alcohol misuse problem may need to receive detoxification treatment as an inpatient or through other specialist services. Supply of methadone to a patient who is clearly intoxicated has the potential to cause significant, and
possibly fatal, harm. The guidance also notes that reliance on alcohol may be a sign that the methadone dose is too low and may warrant review. Missing doses of methadone while intoxicated may affect tolerance or cause signs of withdrawal. Read the original guidance here