Poly drug use

Poly drug use
Classification and external resources
Specialty	psychiatry
ICD-10	F19

Caffeinated alcoholic beverage is widespread and legal.

Ayahuasca being prepared in the Napo region of Ecuador

Poly drug use refers to the use of two or more psychoactive drugs in combination to achieve a particular effect. In many cases one drug is used as a base or primary drug, with additional drugs to leaven or compensate for the side effects of the primary drug and make the experience more enjoyable with drug synergy effects, or to supplement for primary drug when supply is low.

Combinations

Common combinations

Drug 1	Drug 2	Drug 3	Poly drug name	Intoxication name	Comment
Any drug	Nicotine		Cooler		A cigarette laced with a drug
Any depressant	Any stimulant		Over and under
Any pharmaceutical	Any pharmaceutical		Pharming
Alcohol	Caffeine		Caffeinated alcoholic drink
Alcohol	Cannabis		Herb and Al	Cross fading
Alcohol	Cocaine		Snow-coning		Metabolized into a cocaethylene
Amphetamine	Cocaine		Snow seals
Banisteriopsis caapi	β-Carbolines containing plants (eg Peagnum harmala)		Ayahuasca, changa
Caffeine	Cannabis		Hippie-speedballing
Caffeine	Methamphetamine		Biker's coffee
Cannabis	Any drug		Amp joint		Marihuana cigarette laced with some form of narcotic
Cannabis	Crack-cocaine		Crack weed (less known: champagne, chronic, cocktail, dirty joint, fry daddy, gimmie, gremmies, juice joint, lace, oolies, p dog, primo, splitting, thirty eight, turbo, wollie, yeola)	Cocoa puffs
Cannabis	Crack-cocaine	PCP	Jim Jones
Cannabis	DXM	Nicotine	Candy blunt
Cannabis	Heroin		Atom bomb, stuff
Cannabis	Heroin or opium		A-bomb
Cannabis	Opium		Buddha
Cannabis	PCP		Killer weed (less known: clickums, donk, dust blunt, illies, illing, leak, love leaf, lovelies, parsley, zoom)
Cannabis	Nicotine		Joint, blunt, spliff	Stoned	A rolled marijuana cigarette usually made with rolling paper. A blunt is a cigar hollowed out and filled with marijuana. It is rolled with the tobacco-leaf "wrapper" from an inexpensive cigar. Blunts take their name from Phillies Blunt brand cigars.
Cocaine	Heroin		Snowball, murder one, whiz bang	Snowballing
Cocaine	Heroin	LSD	Frisco special
Cocaine	Heroin	Nicotine	flamethrower, primos		Cigarette laced with cocaine and heroin
Cocaine	Heroin or morphine		Speedball, powerball	Speedballing, powerballing	Speedballing, powerballing is often used to describe intravenous use. The term can also be applied to use of pharmaceutical opioids, benzodiazepines or barbiturates along with stimulants.
Cocaine	Ketamine		CK1
Cocaine	LSD		Cracid (or outer limits)
Cocaine	Morphine		C & M
Codeine	Glutethimide		Pancakes and syrups		Combination of glutethimide and codeine cough syrup
Codeine	Promethazine		Purple drank
Crack-cocaine	Benzocaine		Fire		Crack cut with benzocaine
Crack-cocaine	Heroin		Chocolate rock, dragon rock, eightball, moonrock, smoking gun, tar
Crack-cocaine	LSD		Outerlimits
Crack-cocaine	Methamphetamine		Fire, twisters
Crack-cocaine	PCP	Nicotine	Ozone		PCP and crack cigarette
Crack-cocaine	PCP		Missile basing, P-funk, space basing, spaceball, space cadet, space dust, tragic magic
Crack-cocaine	Nicotine		Coolie, crimmie, woolas		A cigarette laced with crack
DMT	MAOIs		Pharmahuasca
DXM	LSD		LSDXM
DXM	Psilocybin or psilocybin mushroom		Cherry-bombing
GHB	Methamphetamine		Cherry meth
Hashish	Belladonna		Alamout Black Hash		Mixed
Hashish	LSD		Royal Temple Ball		The hashish is mixed with LSD and rolled into a ball intended for oral use, because LSD cannot be smoked.
Hashish	Opium		Black hash
Heroin	Morphine		New Jack swing
LSD	Nitrous oxide		Gasid
LSD	PCP		Black acid
LSD	Psilocybin or psilocybin mushroom		God's flesh
MDMA	2C-B		Nexus flip, honey flip	Nexus flipping, honey flipping
MDMA	2C-E		Sparkle flip	Sparkle flipping
MDMA	2C-I		Science flip	Science flipping
MDMA	2C-T-7		Lucky flip	Lucky flipping
MDMA	Alcohol		Tipsy flip	Tipsy flipping
MDMA	Cocaine		Sugar flip	Sugar flipping
MDMA	Cocaine	LSD	Candy-flip on a string	Candy-flipping on a string
MDMA	DMT		Shaman flip, time flip	Shaman flipping, time flipping
MDMA	DXM		Robo flip	Robo flipping
MDMA	GHB		Gamma flip	Gamma flipping
MDMA	Ketamine		Kitty flip	Kitty flipping
MDMA	Ketamine	GHB	EKG. The "E" is for Ecstasy.
MDMA	LSD		Candy flip	Candy flipping
MDMA	LSD	Psilocybin or psilocybin mushroom	Jedi flip, twilight flip	Jedi flipping, twilight flipping
MDMA	MDEA		Adam and Eve
MDMA	Mescaline or psychoactive cactus		Love flip	Love flipping
MDMA	Methadone		Chocolate flip	Chocolate flipping
MDMA	Methamphetamine		Trailer flip	Trailer flipping
MDMA	Nitrous oxide		Nox
MDMA	Opiates		Poppy flip	Poppy flipping
MDMA	PCP		Elephant flip	Elephant flipping
MDMA	Psilocybin or psilocybin mushroom		Hippy flip, flower flip)	Hippy flipping, flower flipping
MDMA	Psilocybin or psilocybin mushroom	Cocaine	Flower flip on a string, hippie flip on a string	Flower flipping on a string, hippie flipping on a string
MDMA	Sildenafil		Sextasy (or hammerheading)
PCP	Nicotine		Chipping

Dangerous interactions

A useful chart from TripSit.me which can be used to identify dangerous drug combinations quickly and easily.

Tranquillizers, sleeping pills, opiates and alcohol. Opioid-related deaths often involve alcohol.

Risks

A spoonful of promethazine/​codeine syrup showing the characteristic purple color that gave rise to the name purple drank.

Poly drug use often carries with it more risk than use of a single drug, due to an increase in side effects, and drug synergy. The potentiating effect of one drug on another is sometimes considerable and here the licit drugs and medicines – such as alcohol, nicotine and antidepressants – have to be considered in conjunction with the controlled psychoactive substances. The risk level will depend on the dosage level of both substances. If the drugs taken are illegal, they have a chance of being mixed (also known as "cutting") with other substances which dealers are reported to do to increase the perceived quantity when selling to others to increase their returns. This is particularly common with powdered drugs such as cocaine or MDMA which can be mixed with relative ease by adding another white powdery substance to the drug. This cumulative effect can lead to further unintended harm to health dependent on what is being covertly added. Concerns also exist about a number of pharmacological pairings: alcohol and cocaine increase cardiovascular toxicity; alcohol or depressant drugs, when taken with opioids, lead to an increased risk of overdose; and opioids or cocaine taken with ecstasy or amphetamines also result in additional acute toxicity. Benzodiazepines are notorious for causing death when mixed with other CNS depressants such as opioids, alcohol, or barbiturates.

Scheduling

Within the general concept of multiple drug use, several specific meanings of the term must be considered. At one extreme is planned use, where the effects of more than one drug are taken for a desired effect. Another type is when other drugs are used to counteract the negative side effects of a different drug (e.g. depressants are used to counteract anxiety and restlessness from taking stimulants). On the other hand, the use of several substances in an intensive and chaotic way, simultaneously or consecutively, in many cases each drug substituting for another according to availability.

Research

The phenomenon is the subject of established academic literature.

A study among treatment admissions found that it is more common for younger people to report polydrug drug use.

See also

• Combined drug intoxication
• Drug overdose
• Lacing
• Recreational drug use
• Responsible drug use
• Speedball (drug)