What is polysubstance abuse?

The ongoing use of two or more drugs simultaneously with serious consequences is often called “polysubstance use disorder.” While alcohol is the drug most commonly mixed with others, it is far from the only one. Sometimes polysubstance abuse disorder is simply the result of two overlapping addictions. Still, it can also arise as a means of making the drugs intensify one another, leading to enhanced and prolonged effects. When combined and used simultaneously, two drugs are usually far more dangerous, potentially causing long-term harm or leading to an overdose. Among opioid users, the two most common non-alcohol substance mixtures are called speedballing and goofballing. 

What is speedballing?

Speedballing is a form of polysubstance abuse that involves mixing an opioid–such as heroin, oxycodone, or fentanyl–with cocaine. Heroin and other opioids are depressants, meaning that they cause the body’s systems to reduce function or slow down. When taken, usually orally or intravenously, opioids bind with opioid receptors in the brain, causing the respiratory and cardiovascular systems to slow down, sometimes to dangerous or even fatal levels. 

Cocaine, on the other hand, is a stimulant and has a nearly-opposite effect on the body. When taking cocaine, a person’s bodily functions are stimulated and act at increased levels. Rather than counteracting one another, the drugs taken during speedballing amplify the others’ effects, creating a longer-lasting or more intense high for each drug. This leads to a push-pull effect as the body processes the drugs, which can cause significant damage to the body and danger for the person taking the drugs. For example, cocaine causes the body to use more oxygen, but opioids slow down a person’s breathing. This leads to heart and lung strain as the body struggles to meet competing needs simultaneously. 

What is goofballing?

Another form of common polysubstance use, goofballing, involves replacing cocaine with methamphetamine as a stimulant alongside opioid use. While both stimulants are similar in some ways, there are distinct dangers between goofballing and speedballing. Because meth takes longer for the body to process, goofballing can result in even more extended highs. Many people who simultaneously take methamphetamine and opioids report higher rates of hyperstimulation of the cardiovascular and respiratory systems. There are also higher reported rates of psychiatric problems such as paranoia. 

Why does polysubstance abuse happen?

Many factors drive polysubstance use disorder, depending on what drugs are used. In many cases, polysubstance use occurs to mitigate the adverse or uncomfortable effects of one drug. For example, people report that taking methamphetamine alongside an opioid prolongs the effects of the opioid and delays the onset of painful withdrawal symptoms. 

Some people will take both drugs at once to gain the euphoric and pain-relieving effects of the opioid while still benefiting from the physical stimulation of cocaine or meth. Others will stagger use, taking the second drug as the first one peaks to prolong the high and prevent the body from experiencing the effects typically associated with withdrawal.

In other cases, the drugs are taken hours apart. The stimulant may be taken in the morning to help the user feel wakeful and energetic. Sometimes a person will need continual use throughout the day, but by evening the stimulants will still be active in their body. To relax and sleep, a person may turn to an opioid to take advantage of its relaxing and lethargic effects since it’s a depressant. 

The risks of polysubstance use disorder

The use of multiple substances concurrently leads to far higher instances of health issues and overdose risks. It also seems that polysubstance use disorder is on the rise, as evidenced by a drastic increase in psychostimulant-related overdose deaths involving opioids and opioid-use-related deaths involving methamphetamine. Research has also shown that people with polysubstance use disorder are more likely to contract viral hepatitis, have poor mental and or physical health, and use more dangerous opioids–namely, fentanyl.

Additionally, the mixture of stimulants and depressants is not the only type of polysubstance use that is of concern. Opioids are increasingly mixed with other depressants, the most concerning of which are benzodiazepines. Also known colloquially as “benzos,” benzodiazepines are sedatives often prescribed to treat anxiety and sleep disorders. The combination of benzos and opioids is hazardous because they operate on the same bodily systems, meaning the respiratory system is even more depressed when under the effects of both drugs. As many as 14% of fatal opioid overdoses in 2021 also involved benzodiazepines. 

Patient-focused treatment for polysubstance abuse

Beginning treatment for polysubstance abuse often feels intimidating, and the possibility of precipitated withdrawal makes it even more so. Ophelia strives to make treatment as accessible as possible by offering MAT to patients across the country — online, from the comfort of their homes. 

Your personalized care team will work with you to reduce the risks of polysubstance abuse as much as possible and ensure you get the treatment that works. Contact our care team today to see if you’re a candidate.