"Methamphetamine use is increasing in the wake of the opioid crisis in the United States (U.S.). Increases in the use of this highly addictive stimulant have been documented in the health literature, as well as in the national media. In Denver, Colorado, and Seattle, Washington, the increase in methamphetamine use has predominantly involved a growing proportion of people who inject drugs (PWID) using both methamphetamine and heroin, either separately or in a single injection commonly known as a goofball., (Goofball can also be smoked.) Data from San Diego, California, and Tijuana, Baja California, Mexico have also demonstrated high levels of co-injection of methamphetamine and heroin.

"Although existing literature provides some insight into the characteristics and circumstances of people who inject goofball, the available data remain very limited. We previously published an analysis of data from syringe services program (SSP) clients in the Seattle area between 2009 and 2017, and found that people who used goofball were significantly more likely than other PWID to be young, homeless, inject daily, and self-report an opioid overdose. Additional data on specific injection behaviors, other health outcomes, and interest in treatment among people who inject goofball are needed to understand how to most effectively implement harm reduction and substance use treatment efforts. In addition, it is important to focus on people whose primary drug is goofball to determine how the needs of this potentially high acuity group may differ from people predominantly using other drugs."


Glick SN, Klein KS, Tinsley J, Golden MR. Increasing Heroin-Methamphetamine (Goofball) Use and Related Morbidity Among Seattle Area People Who Inject Drugs. Am J Addict. 2021;30(2):183-191. doi:10.1111/ajad.13115