PPeople mixing stimulants and opioids is not a new phenomenon. Mix heroin and cocaine, a “speed ballwas a fairly common practice in the 1990s, for example. More recently, the mixing of fentanyl and methamphetamine, in what is called a “goofball”, is a growing trend. But according to a new paperpublished by the University of British Columbia and other partner universities, people mix those ups and downs in complex and measured ways, rather than just throwing them together, and do so for a number of specific reasons.
“We know polydrug use is common. It kinda came on our radar [from] talk to people in the community,” said Andrew Ivsins, PhD, researcher at the British Columbia Center for Substance Use, postdoctoral fellow at the University of British Columbia in the Department of Medicine and one of the authors of the article.
The conclusions of the article are based on interviews collected in two previous studies, in which Ivsins participated. Both studies began before the pandemic hit and took place in Vancouver. One was an evaluation of a hydromorphone pill distribution program that began in January 2020. The second, conducted around the same time, looked at the use of stimulants. Both were discontinued by COVID-19. For the new paper, the researchers looked at more than 100 transcripts of conversations with people who use drugs from these two qualitative studies. The paper ended up focusing on qualitative data from 29 of the respondents.
Ivsins said Filtered that there were three main motivations, depending on what the individual was trying to achieve.
At times, these interviewees discussed the use of combination opioids and methamphetamine. Besides the term “goofballs”, they often referred to stimulants, or methamphetamine in particular, as a “side”; “down” referred to opioids, which often contained fentanyl. When respondents and respondents in studies talked about using goofballs, researchers in previous articles asked additional questions about the practice, asking about their experience with mixing drugs and their reasons for doing so.
Ivsins’ article cites various other articles about mixing methamphetamine and opioids, and notes that it is not an uncommon practice. Its prevalence among injecting drug users has been estimated at 32% in Washington State, 14% in Los Angeles and San Francisco, 50% in Denver, and 54% in Melbourne, Australia.
Through the interviews, the paper identifies several reasons behind mixing methamphetamine and opioids. Largely, people used goofballs because they provided an experience they wouldn’t get from using either drug individually. Ivsins said Filtered that there were three main motivations, depending on what the individual was trying to achieve.
Some people mixed a little methamphetamine with their opioids to prolong the effect of the opioids, especially the shorter-acting fentanyl, to “give him more legs.”
“People complain a lot that fentanyl doesn’t have very good legs; it doesn’t last very long,” Ivsins said.
People who use opioids have also added methamphetamine in order to promote some energy, to enhance the euphoria that comes with opioids by giving it “a little bit of a kick”, he said. Methamphetamine has been shown to counteract the sedative effects of opioids, allowing people to enjoy the high without “dozing off”. Respondents said this was particularly important when using in public, as it can be risky or somewhat dangerous to fall asleep in public places. This could increase the risk of theft or violence, Ivsins said.
“It’s not just about adding this mix of meth and fentanyl, but mixing them in certain ways to get certain effects. It is a very complex process.
Other people, meanwhile, mostly used stimulants, but adding some opioids in order to “smooth out” what Ivins noted can “sometimes be an intense experience.”
“It’s not just throwing out this mix of meth and fentanyl, but mixing them in certain ways to get certain effects,” he said. “It’s a very complex process where people get it in different ways to get different experiences out of it.”
Ivsins said many other articles that delve into polydrug use tend to focus on adverse health effects. Most “overdose” deaths involve combinations of different drugs, and although fentanyl and its analogues have been implicated in the most deaths in North America, methamphetamine-related deaths have also increased.
But understand Why people use drugs is essential — to inform harm reduction work, but also to present a more complete picture of drug use by illustrating the benefits people’s experience. That’s why the article, as Ivsins noted, focuses more on the “intentional, rational, and meaningful” reasons behind the use.
“We wanted to feature this because it’s sort of a missing piece in research. This is something that is not discussed among certain populations,” he said.
Methamphetamine photograph by Psychonaught via Wikimedia Commons/Public Domain