Stimulants in Combination With Opiates Cause for Overdose Concern

By on December 3, 2020

Discussion about use of illegal drugs usually focuses on one drug or another. However, “the reality is that many people use drugs in combination and also die from them in combination. Although deaths from opioids continue to command the public’s attention, an alarming increase in deaths involving the stimulant drugs methamphetamine and cocaine are a stark illustration that we no longer face just an opioid crisis.”

Availability of different drugs, such as methamphetamine and cocaine, pose an increased possibility of overdose either by using one drug or by combining them, according to Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) who summarizes concerns about increased abuse of stimulant drugs, often in combination with opiates.

Overdose deaths involving methamphetamine started rising steeply in 2009, and provisional numbers from the CDC show they had increased 10-fold by 2019, to over 16,500. A similar number of people die every year from overdoses involving cocaine (16,196), which has increased nearly as much over the same period.

National surveys indicate that use of cocaine and of meth has not increased during the time that the overdoses have increased. It seems that the “increases in mortality are likely due to people using these drugs in combination with opioids like heroin or fentanyl or using products that have been laced with fentanyl without their knowledge.” (Fentanyl is 80 times more potent than morphine.)

Staff at some programs involving syringe services report that more people are injecting opioids and methamphetamine together.  They also report that some are switching to methamphetamine from opioids because they are afraid of the possibility that opioids may contain fentanyl (note that meth may also be laced with fentanyl).

A 2018 study from Washington University in St. Louis found that meth use has increased significantly among people with an existing opioid use disorder (OUD). The people with OUD in the study said they used methamphetamine instead of opioids when they had a difficult time getting the opioids or when they thought they were unsafe. They also sought an increased effect when they were combined.

Some of the people who combined heroin and cocaine or meth said that the stimulant helps to balance the impact of the opioid which made them sleepy, so they could function “normally”. The problem is that “the combination can enhance the drugs’ toxicity and lethality, by exacerbating their individual cardiovascular and pulmonary effects.”

“Overdose is not the only danger. Persistent stimulant use can lead to cognitive problems as well as many other health issues (such as cardiac and pulmonary diseases). Injecting cocaine or methamphetamine using shared equipment can transmit infectious diseases like HIV or hepatitis B and C. Cocaine has been shown to suppress immune-cell function and promote replication of the HIV virus and its use may make individuals with HIV more susceptible to contracting hepatitis C. Similarly methamphetamine may worsen HIV progression and exacerbate cognitive problems from HIV.”

The COVID-19 pandemic and its stresses have made this situation more urgent. The NIDA report indicates that “since the beginning of the national emergency in March there has been a 23 percent increase in urine samples taken from various healthcare and clinical settings testing positive for methamphetamine nationwide, a 19 percent increase in samples testing positive for cocaine, and a 67 percent increase in samples testing positive for fentanyl. Another recent study of urine samples . . .  found significant increases in fentanyl in combination with methamphetamine and with cocaine during the pandemic.”

Hopefully anyone using any of these drugs will make efforts to obtain treatment or at the least not use any of them in combination with another drug.

Source:   NIDA. 2020, November 12. Rising Stimulant Deaths Show that We Face More than Just an Opioid Crisis. Retrieved from on 2020, November 18

Jo Ann Hummers, EdD, is a Licensed Clinical Addictions Specialist. She has a private practice at the Nags Head Professional Center. Her work includes assessments and treatment for DWIs and other drug offenses, smoking cessation sessions, and treatment for gambling and other addictions.


Barnhill Building Group has been selected as the Construction Manager @ Risk by the College of the Albemarle and is seeking to pre-qualify construction trade contractors to submit bids for the furnishing labor, materials, equipment, and tools for the new College of The Albemarle – Allied Health Sciences Simulation Lab (COA Health Sciences) located in Elizabeth City, NC. Please note: Only subcontractors who have been prequalified by Barnhill will be able to submit a Bid.

The project consists of the new construction of a 38,000-sf, 2-story expansion to the existing Owens Health Sciences Center and will house classrooms, labs, and a simulation lab. The site is just over just over 4.5 acres and is located on an active campus. This new construction will be a steel structure with a brick and metal panel veneer, curtainwall, and storefront glazing with a PVC roof membrane.

Principal trade and specialty contractors are solicited for the following Bid Packages:

BP0100: General Trades

BP0105: Final Cleaning

BP0390: Turnkey Concrete

BP0400: Turnkey Masonry

BP0500: Structural Steel & Misc. Steel

BP0740: Roofing

BP0750: Metal Panels

BP0790: Caulking / Caulking

BP0800: Turnkey Doors/Frames/Hardware

BP0840: Glass & Glazing

BP0925: Drywall

BP0960: Resilient Flooring

BP0980: Acoustical Ceilings

BP0990: Painting & Wallcovering

BP1005: Toilet Specialties / Accessories / Division 10

BP1010: Signage

BP1098: Demountable Partitions

BP1230: Finish Carpentry and Casework

BP1250: Window Treatment

BP1400: Elevators

BP2100: Fire Protection

BP2200: Plumbing

BP2300: HVAC

BP2600: Turnkey Electrical

BP3100: Turnkey Sitework

BP3290: Landscaping

Packages may be added and/or deleted at the discretion of the Construction Manager. Historically underutilized business firms are encouraged to complete participation submittals.

HUB/MWBE OUTREACH MEETING: Barnhill Building Group will be conducting a HUB/MWBE Informational Session. You are encouraged to attend the following session to learn more about project participation opportunities available to you. These seminars will help to: Learn about project and scope; Inform and train Minority/HUB contractors in preparation for bidding this project; Assist in registration on the State of North Carolina Vendor link; Stimulate opportunities for Networking with other firms. Location and time TBD. Please visit our planroom at for more information.

Interested contractors should submit their completed prequalification submittals, by July 22, 2024, to Meredith Terrell at or hardcopies can be mailed to Barnhill Contracting Company PO Box 31765 Raleigh, NC 27622 (4325 Pleasant Valley Road, NC 27612).


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