When Karina moved to Miami Beach from Eastern Europe in 2007, she used no nicotine, no alcohol, no drugs, nothing. Although she'd had a problem in her midteens with booze and MDMA, the 22-year-old was determined to begin her new life in America clean and sober.
Soon after she arrived, however, she fell in with a crowd of hard-partying Russians and began drinking again. Before long, she started snorting cocaine to wake herself up when she drank too much vodka. But it was only when she met a group of local gay men who hung out at clubs that her drug use really took off.
Now Karina (not her real name) was doing not only coke but also molly, GHB, and the animal tranquilizer ketamine. Strangely, when she tried crystal meth for the first time, she fell asleep on the toilet and missed work. She was often seen on the dance floor wearing a fanny pack -- which she dubbed "the crack pack" -- containing not just drugs but also sugar packets, Pedialyte strips, and a banana that helped her ease the inevitable crash. Her friends called her "Dyson," after the vacuum cleaner, because of her ability to suck up large amounts of cocaine. Still, she remained functional -- she held down a demanding day job as a computer programmer that often involved 12- to 14-hour shifts. And she never took drugs at work.
But then a couple of her comrades became addicted, and others lost their jobs. She found that the older she got, the longer it took to recover from drug binges. Today she restricts herself to alcohol and cocaine, but, she admits, even that's difficult, especially given the environment. "It's hard not to take drugs living in South Beach," she says in heavily accented English. "Different types of drugs are everywhere, and people share them all the time. This is not a town where it's easy to be straight-edged."
So-called polydrug use -- mixing various street drugs and/or prescription drugs either sequentially or simultaneously -- will probably be in evidence this week as Winter Music Conference and then Ultra Music Festival hit Miami. Some of the estimated 300,000 people expected to attend the events might consume potentially dangerous drug cocktails while ignorant of the potential pitfalls. Just how dangerous was recently underscored by the death of actor Philip Seymour Hoffman, who was discovered last month on the bathroom floor of his Greenwich Village townhouse with a needle stuck in his arm. What was initially reported as a suspected fatal heroin overdose turned out be a polydrug death involving not only heroin but also cocaine, amphetamine, and prescription tranquilizers. A combo of heroin and alcohol is bad enough. That's what killed Glee star Cory Monteith, who was found surrounded by empty champagne bottles and drug wrappers in a Vancouver hotel room last July. Combining heroin and cocaine -- a "speedball" -- is even worse. That's what killed comedian John Belushi. But two stimulants piled on top of two depressants? Reason columnist Jacob Sullum speculates the stimulants might have masked the effects of the depressants, causing Hoffman to take more heroin than usual.
Celebrities and electronic-music fans aren't the only ones consuming dangerous drug cocktails. Increasingly, ordinary consumers are turning to perilous polydrug use. In Florida, there were 117 heroin-related deaths in 2012 (the last year for which numbers are available), only one of which was heroin on its own, a single case in Sanford, according to the state medical examiner's office.
And it's not just heroin. In Miami, there wasn't a single cocaine-related death that didn't involve other substances. The most common ingredient found locally in fatal drug mixes is the prescription tranquilizer benzodiazepine (followed by alcohol, oxycodone, and cocaine), not surprising perhaps because in recent years Florida has stood at the epicenter of a massive wave of prescription drug abuse that only now is subsiding.
In 2009, James N. Hall, a drug epidemiologist at Nova Southeastern University, conducted an analysis of 1,185 Florida oxycodone deaths in which the drug was considered to be the main cause. Seventy-two percent also had one or more benzodiazepines in their systems at the time of death, and 42 percent had at least one other opioid in addition to oxycodone.
On the national level, drug deaths have doubled in the past decade to surpass automobile fatalities and gun homicides as the leading cause of accidental death in America. The reason is not that more people are using drugs but that people are using more dangerous combinations. "Substance abuse in America has become more dangerous, more addictive, and more deadly than any other period in our lifetimes," says Hall, who recently warned of an "emerging heroin epidemic" in Florida.
The list of famous actors and musicians killed over the years by polydrug use is long. Jimi Hendrix died from barbiturates and alcohol. Janis Joplin expired from heroin and alcohol. Whitney Houston was killed by a toxic combo of alcohol, cocaine, Xanax, the antihistamine DBH, and a muscle relaxant. Chris Farley, River Phoenix, Alice in Chains' Layne Staley, and Philip Seymour Hoffman all died from mixing cocaine with heroin or morphine.
Not just in America but also in the UK, the '90s rave scene played a particularly important role in popularizing polydrug use. "Modern patterns of polysubstance abuse go back to the mid-1990s rave scene when ecstasy was usually MDMA," Hall says. "Yet even back then, ecstasy did not always live up to its name. Users who expected more of a stimulant rush would begin their weekend with a snorted line of cocaine [or] try LSD... More experienced crashers would ultimately turn to heroin to bring them down after the weekend binge."
Flash forward to today, and the rave scene has been reborn as EDM, and ecstasy has been rebranded molly. Many EDM fans believe they are safe because they take only one substance, molly, which is supposed to be pure MDMA. The reality is that most molly contains little or no MDMA and often consists of some hideous polydrug combination of various cathinones (bath salts), methamphetamine, and whatever the drug dealer happens to have lying around when he or she fills the capsules.
The role of alcohol in these mixes is particularly problematic. Many polydrug users don't think vodka or tequila is a drug because it's legal and ubiquitous. But sometimes it can act as a hidden catalyst that turns a hazardous combo into a fatal one. How many people have woken up after a night of binging on cocaine, opened their fridge to find an empty bottle inside, and wondered, How the hell did I drink a liter of vodka last night?
Similarly with prescription drugs, there's a widely held belief that because a doctor prescribed the drug, it's pure, and pure means safe. With a few obvious exceptions -- such as fentanyl-laced heroin, the cause of more than 80 deaths in the Northeast within only the past few weeks -- oftentimes pure drugs are just as dangerous, if not more dangerous, than adulterated ones.
Another problem is that polydrug users think because a drug's high has worn off, the substance is no longer active in their bodies. That's simply not true. The toxic half-life of opiates, for example, can last for days after the initial high, so when the user redoses with more opiates or another type of drug, he or she can turn already-dangerous levels of toxicity into a deadly poison.
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As the old saying goes, choose your poison (or poisons) carefully -- because chemistry is not a DJ mix set.
But there is good news: The wave of prescription drug abuse so prevalent in recent years has begun to decline. The bad news: Lately, a new wave of drugs, so-called research chemicals from Chinese factories, has flooded the market. Adding another x-factor to an already-volatile mix, some of these substances are so obscure that not even DEA chemists can identify them.
"Polysubstance abuse is not new, but it has exploded in the 21st Century, fueled by wide-scale prescription drug diversion and now the emergence of hundreds of synthetic chemicals from labs in China which are sold online and delivered by worldwide overnight delivery services," Hall says. "In just the last two years, small cohorts of heavy club drug users have been identified in London as well as other European cities, the United States, and, of course, South Beach. Most have consumed numerous different drugs over the past three months and continue to mix three or four substances daily."