"Findings from these recent surveys of SSP clients in Seattle showed that goofball use is common, with over half of respondents reporting using heroin and methamphetamine together. Moreover, PWID whose main drug was goofball reported considerable health risks and morbidity, including more frequent injection, femoral and jugular vein injection, public injection, abscesses and skin infections, infected blood clots and blood infections, and endocarditis. They also reported more overdose-related risk including injecting alone and witnessing both opioid and stimulant overdoses. At the same time, the majority of PWID who reported that goofball was their main drug also reported interest in reducing or stopping their drug use. In light of the opioid crisis in the U.S., it is critical for stakeholders to recognize the substantial and growing overlap between opioid and methamphetamine use, acknowledge the contextual factors that may be driving the combined use of these drugs, and develop health interventions accordingly.

"Polysubstance use is a global phenomenon, especially the use of opioids in combination with stimulants, and has been associated with high levels of HIV and other negative health outcomes. Prior opioid-stimulant co-use research has mostly focused on speedball. At present, there is limited epidemiologic data on the unique health effects of combined heroin and methamphetamine use. Due to the shorter half-life of heroin relative to methamphetamine, people using goofball may re-dose when the effects of heroin wane but before the effects of methamphetamine have worn off, potentially leading to the unsafe injection behaviors or overdose.

"A very high proportion (82.5%) of people whose main drug was goofball were homeless or unstably housed. This aligns with dramatic increases in homelessness in the Seattle area. Many other observed associations with goofball use are correlated with homelessness. People living outdoors may use stimulants to counter the depressant effects of opioids to remain more aware of their possessions and surroundings. However, further research is needed to better understand the motivations and causes of the increase in methamphetamine use, particularly among this largely homeless population with high levels of risk and vulnerability."


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