People mixing stimulants and opioids is not a new phenomenon. Mixing heroin and cocaine, a “speedball,” was fairly common practice in the 1990s, for instance. More recently, mixing fentanyl and methamphetamine, in what’s known as a “goofball,” is a growing trend. But according to a new paper, put out by the University of British Columbia and other partnering universities, people mix these uppers and downers in intricate, measured ways, rather than just throwing them together—and do so for a number of specific reasons.
“We know poly-drug use is common. It sort of came on our radar [from] talking to people in the community,” said Andrew Ivsins, PhD, a research scientist at the British Columbia Centre for Substance Use, a postdoctoral fellow at the University of British Columbia in the department of medicine, and one of the authors of the paper.
The paper’s findings are based on interviews collected in two previous studies, both of which Ivsins was involved in. The two studies began before the pandemic hit and took place in Vancouver. One was an evaluation of a hydromorphone tablet distribution program that began in January 2020. The second, conducted around the same time, concerned stimulant use. Both were interrupted by COVID-19. For the new paper, the researchers examined over 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 told Filter that there were three broad motivations, depending on what the individual was trying to achieve.
At certain points, these interview subjects discussed using combinations of opioids and methamphetamine. Besides the term “goofballs,” they often referred to stimulants, or meth in particular, as “side;” “down” referred to opioids, which often contained fentanyl. When respondents and interviewees in the studies talked about using goofballs, the researchers of the earlier papers followed up with additional questions on the practice, asking them about their experience with mixing the drugs, and their reasons for doing so.
Ivsins’s paper cites various other articles on mixing meth and opioids, and notes that it’s not an uncommon practice. Its prevalence among people who inject drugs has been estimated at 32 percent in Washington State, 14 percent in Los Angeles and San Francisco, 50 percent in Denver, and 54 percent in Melbourne, Australia.
Through the interviews, the paper identifies several reasons behind mixing meth and opioids. Largely, people used goofballs because they offered an experience that they wouldn’t get from using either drug individually. Ivsins told Filter that there were three broad motivations, depending on what the individual was trying to achieve.
Some people mixed a little meth with their opioids to prolong the effect of the opioids, particularly shorter-acting fentanyl, to “give it more legs.”
“People complain a lot about the fentanyl not having very good legs; it doesn’t last very long,” Ivsins said.
People who use opioids also added meth in order to foster some energy, to enhance the euphoria that comes with opioids by giving it “a bit of a kick,” he said. Meth was seen to counteract the sedative effects of opioids, allowing people to enjoy the high without “nodding out.” Respondents said that this was particularly important when using in public, because it can be risky or somewhat dangerous to fall asleep in public areas. It could increase the risk of theft or violence, Ivsins said.
“It’s not just throwing in this mix of meth and fentanyl, but it’s mixing them in certain ways to achieve certain effects. It’s a very intricate process.”
Other people, meanwhile, were principally using stimulants, but adding some opioids in order to “smooth out” what Ivins noted can “sometimes be an intense experience.”
“It’s not just throwing in this mix of meth and fentanyl, but it’s mixing them in certain ways to achieve certain effects,” he said. “It’s a very intricate process where people get it in different ways to get different experiences out of it.”
Ivsins said that many other papers that dig into poly-substance use tend to focus on adverse health impacts. Most “overdose” deaths involve combinations of different drugs, and while fentanyl and its analogs have been involved in the largest number of deaths in North America in recent years, meth-involved deaths have also been rising.
But understanding why people use drugs is critical—to inform work to reduce harms, but also to present a more rounded picture of drug use by portraying the benefits people experience. That’s why the paper, as Ivsins noted, focuses more on the “purposeful, rational, meaningful” reasons behind use.
“We wanted to present that because it’s something of a missing piece in research. It’s something that’s not discussed among certain populations,” he said.
Photograph of methamphetamine by Psychonaught via Wikimedia Commons/Public Domain