7. 6 ART and recreational drug interactions: street drugs

The following summaries should be checked using information from the Liverpool University drug interaction service.
Liverpool University: ART interactions with street and recreational drugs (PDF)

Drug interactions can vary between different people. Some people have much higher or lower levels of the liver enzymes used by the body to process drugs than others. This is why some people are very sensitive to some drugs and they can get high with a much lower dose.

Each match of recreational drug might be stronger or weaker that you are used to, making overdose a higher risk. Using smaller more spaced-out doses can be safer, but still is not risk-free.

Ecstasy (E, Molly)
Potential interaction with PIs or efavirenz.

Crystal meth (Tina) and other amphetamines
Potentially dangerous interactions with boosted PIs due to interactions with ritonavir or cobicistat.

GHB
Potential interaction with boosted PIs increases levels of GHB. Serious and potentially fatal interactions between GHB and alcohol.

Ketamine
People on boosted PIs may be at risk of ketamine toxicity because of higher levels of ketamine. Ritonavir may increase levels of ketamine. Levels might be reduced with some NNRTIs.

PCP (angel dust)
Potential interaction with PIs, and possibly NNRTIs. May result in higher PCP concentrations and toxicity with boosted PIs and lower levels with some NNRTIs

LSD
It is not clear how this drug works, therefore anticipating drug interactions with LSD is extremely difficult. People on ARVs who use LSD should be warned about the possibility of an interaction, be aware of signs of LSD toxicity. May result in higher LSD concentrations and toxicity with boosted PIs and lower levels with some NNRTIs

Cocaine
Suggested that interactions with nevirapine or efavirenz may possibly increase risk of liver toxicity, but there is no research to support this. May result in higher cocaine levels with boosted PIs and lower levels with some NNRTIs

Heroin
May be processed faster when used with PIs and efavirenz, producing symptoms of withdrawal.

Safer drug use

In most cases, problems arise because ART stops the liver processing recreational/illicit drugs in the normal way.

People who are HIV/HCV coinfected may have liver damage, which can make it difficult for them to process recreational/illicit drugs.This means they stay in the body for longer and/or at higher levels.

Get your drugs tested

Because illicit drugs may be contaminated with dangerous substances, it may be possible to test your drugs for purity and strength.

Drug testing services use infrared spectroscopy, which works by by shining infrared light through drug samples. It detects impurities by matching the sample with a library of known substances in seconds.

See: https://wearetheloop.org/what-we-do

Take less…
Especially the first time after starting ART. Take less of the recreational drug and take them less often.

Know the danger signs…
Be aware of signs of overdose. ART side effects are similar to signs of recreational drug toxicity. The after-effects of recreational drugs can seem like ART side effects. ART side effects may re-appear or get worse.

Carry naloxone, a nasal spray that can reverse opioid overdose. It can be purchased at community pharmacies. Because some opioids have been contaminated with other substances such as xylazine, people may need CPR, and hospital care to revive them

If you are dancing…
Stay cool. Take breaks. Check whether there is medical help on site. Have a friend with you. Drink water regularly. Avoid alcohol.

7. 6 ART and recreational drug interactions: street drugs

Safer drug use

Further reading