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.

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