The practice and embodiment of “goofballs”: A qualitative study exploring the co-injection of methamphetamines and opioids

Ivsins, Andrew; Fleming, Taylor; Barker, Allison; Mansoor, Manal; Thakarar, Kinna; Sue, Kimberly; McNeil, Ryan

doi:10.1016/j.drugpo.2022.103791

Cited by 22 publications

(11 citation statements)

References 51 publications

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“…The rise of deaths involving cocaine and methamphetamine must be understood in the context of a shifting illicit opioid drug market increasingly dominated by illicit fentanyls 10 . Recent ethnographic and qualitative research suggests that fentanyls have created conditions that make polysubstance use more desirable and commonplace 13,14 . For instance, many individuals report that mixing a small amount of methamphetamine into injected doses of fentanyl subjectively prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk, and improves energy levels required to continue to collect funds for the next set of drug purchases [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…Recent ethnographic and qualitative research suggests that fentanyls have created conditions that make polysubstance use more desirable and commonplace 13,14 . For instance, many individuals report that mixing a small amount of methamphetamine into injected doses of fentanyl subjectively prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk, and improves energy levels required to continue to collect funds for the next set of drug purchases [13][14][15] . These perceived advantages may be particularly important given the short duration of fentanyls, requiring individuals to inject far more frequently than heroin, and the heightened overdose risk from each injection 10 .…”

Section: Discussionmentioning

confidence: 99%

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Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

Preprint

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Aims: To characterize polysubstance death in the United States during the transition to the fourth wave of the overdose crisis. To characterize co-involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogs) by year, state, and intersectional sociodemographic groups. Design: Population-based cohort study of national death records. Setting: United States. Participants/Cases: People who died from drug overdose in the United States between 2010-2021. Measurements: Percentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co-involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by state and year. Percentage of fatal fentanyl overdose co-involving stimulants by intersectional region, race/ethnicity, age, and sex. Findings: The percent of US overdose deaths involving both fentanyl and stimulants concurrently rose nearly 60-fold, from 0.6% (n=235) in 2010 to 32.3% (n=34,424) in 2021. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin-fentanyl co-involvement in the mid-2010s, and nearly universally to cocaine-fentanyl co-involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine-fentanyl co-involvement predominated by 2021. The proportion of stimulant involvement in fentanyl-involved overdose deaths rose in virtually every state 2015-2021. Cluster analysis reveals particularly high rates for older Black and African American individuals living in the West. Conclusions: By 2021 stimulants were the most common drug class found in fentanyl-involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more desirable and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges. Ongoing nuanced surveillance is needed to track this rapidly shifting phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Friedman

Shover

2022

Preprint

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“…‘stops the pain’ or ‘to maintain balance staying awake and relaxed’), better availability, reducing the frequency of their opioid use (e.g., ‘speed makes fentanyl's kick last longer and bigger’), preference (liking) and better value for money [66 ▪ ]. These motives were largely confirmed by other users and in other studies (e.g., [63 ▪ ,67,68,69 ▪ ]. Other co-users of methamphetamine and opioids expressed similar motive but in a somewhat different way, for example, they believe that stimulants offset the negative effects of opioids, such as withdrawal symptoms by alleviating some acute physical withdrawal symptoms, and that methamphetamine provides a cheaper alternative for heroin, because methamphetamine has an opioid sparing effect (value for money) or that it gives a more desirable effect, enhances or prolongs the “high” of opioids and alleviates the pain and discomfort of opioid withdrawal [69 ▪ ].…”

Section: Personal Motives Of Polydrug Use In Opioid Usersmentioning

confidence: 70%

Predictors and motives of polydrug use in opioid users. A narrative review

Amsterdam

Pierce

Brink

2023

Current Opinion in Psychiatry

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Purpose of reviewTo review the recent literature on predictors and personal motives of polydrug use in opioid users with a focus on combined use of opioids with stimulants, benzodiazepines and gabapentinoids.Recent findingsIn North America, methamphetamine is now the most prevalent co-drug in opioid users and is responsible for high mortality rates. In Europe, opioids are rather combined with either cocaine, benzodiazepines or gabapentionoids, but recent data are lacking.Main personal motives of opioid users to combine opioids with methamphetamine or cocaine is to boost the opioid high, inhibit the withdrawal effects of heroin and have a cheaper alternative to maintain the opioid high. Risk factors of polydrug use by opioid users included being male, younger age, homelessness, high-risk sexual behavior, needle sharing, incarceration, poor mental health and recent use of cocaine or prescription opioids. The motives for co-use of opioids and gabapentinoids also include seeking a better high, lower price and to self-medicate pain/physical symptoms, including those resulting from withdrawal.SummaryWhen treating opioid users with polydrug drug use, special attention should be paid to dosing when in opioid agonist methadone/buprenorphine treatment and to the presence of physical pain. The validity of part of the personal motives seems questionable which deserves attention when counselling opioid users with polydrug use.

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“…The rise of deaths involving cocaine and methamphetamine must be understood in the context of a shifting illicit opioid drug market increasingly dominated by illicit fentanyls [13]. Recent ethnographic and qualitative research suggests that fentanyls have created conditions that make polysubstance use more sought-after and commonplace [17,18]. For instance, many individuals report that mixing a small amount of methamphetamine into injected doses of fentanyl subjectively prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk and improves energy levels required to continue to collect funds for the next set of drug T A B L E 1 Percent of fentanyl overdose deaths containing stimulants by key socio-demographic characteristics, 2021. purchases [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Charting the fourth wave: Geographic, temporal, race/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010–2021

Friedman,

Shover

2023

Addiction

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AimsTo characterize polysubstance death in the United States during the transition to the fourth wave of the drug overdose crisis. To characterize co‐involved substances in fatal overdose involving synthetic opioids (mainly illicitly manufactured fentanyl analogues) by year, state, and intersectional sociodemographic groups.DesignPopulation‐based study of national death records.SettingUnited States.Participants/casesAll people who died from drug overdose in the United States between 2010 and 2021.MeasurementsPercentage of all fatal overdose involving fentanyls, stimulants, and other drugs. Most commonly co‐involved substances in fentanyl overdose by state and year. Percentage of fatal fentanyl overdose co‐involving stimulants by state and year. Percentage of fatal fentanyl overdose co‐involving stimulants by intersectional region, race/ethnicity, age, and sex.FindingsThe percent of US overdose deaths involving both fentanyl and stimulants increased from 0.6% (n = 235) in 2010 to 32.3% (34 429) in 2021, with the sharpest rise starting in 2015. In 2010, fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol. In the Northeast this shifted to heroin‐fentanyl co‐involvement in the mid‐2010s, and nearly universally to cocaine‐fentanyl co‐involvement by 2021. Universally in the West, and in the majority of states in the South and Midwest, methamphetamine‐fentanyl co‐involvement predominated by 2021. The proportion of stimulant involvement in fentanyl‐involved overdose deaths rose in virtually every state 2015–2021. Intersectional group analysis reveals particularly high rates for older Black and African American individuals living in the West.ConclusionsBy 2021 stimulants were the most common drug class found in fentanyl‐involved overdoses in every state in the US. The rise of deaths involving cocaine and methamphetamine must be understood in the context of a drug market dominated by illicit fentanyls, which have made polysubstance use more sought‐after and commonplace. The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges.

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The practice and embodiment of “goofballs”: A qualitative study exploring the co-injection of methamphetamines and opioids

Cited by 22 publications

References 51 publications

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Charting the Fourth Wave: Geographic, Temporal, Race/Ethnicity, and Demographic Trends in Polysubstance Fentanyl Overdose Deaths in the United States, 2010-2021

Predictors and motives of polydrug use in opioid users. A narrative review

Charting the fourth wave: Geographic, temporal, race/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010–2021

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