Poly drug use

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Poly drug use refers to the use two or more psychoactive drugs in combination to achieve a particular effect. It is usual among problem drug users to have a multi-drug dependence. In many cases one drug is used as a base-, primary- or preferd drug, with additional drugs to mild the side effects of the primary drug, to make the experience more enjoyable with drug synergy effects, or to supplement for primary drug when the supply is low.

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. Concerns 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.^[1] The risk for aggression and violent outbursts increase when some benzodiazepines, for ex Flunitrazepam, are combined with alcohol.

Within the general concept of multiple drug use, several specific meanings of the term must be considered. At one extreme is the use planned on the other there is 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.^[1]

There are many common drug combinations, including, but not limited to:

tobacco and marijuana (inside a joint called a "spliff")
marijuana and alcohol (referred to as a "green dragon")
alcohol and tobacco
tobacco and caffeine
marijuana and coffee (known as "hippie speedball")
LSD and ecstasy (known as "trolling" (a combination of tripping and rolling; tripping being the LSD effect and Rolling meaning the extacy high) and "candy flipping"^[2])
Psychedelic mushrooms and ecstasy (known as "hippie flipping" or "flower flipping"^[2])
marijuana and Psychedelic mushrooms (the marijuana as an anti-nausea)
cocaine and heroin or morphine (known as a "speedball")
cocaine and ketamine (known as "CK1"^[3])
ecstasy and viagra (known as "sextasy")
ecstasy and ketamine (known as "kitty flipping"^[2])
ecstasy and PCP (known as "elephant flipping"^[2])
ecstasy and mescaline (known as "love flipping"^[2])
heroin and diphenhydramine (known as "cheese")
marijuana and PCP (known as a "wet daddy")
crack and PCP (known as "space basing"^[4])
amphetamines and barbiturates

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 phenomenon is the subject of established academic literature (e.g., Scholey AB, Parrott AC, Buchanan T, Heffernan TM, Ling J, Rodgers J (2004). "Increased intensity of Ecstasy and polydrug use in the more experienced Ecstasy/MDMA users: a WWW study." Addictive Behaviors, 29, 743-752).