Treatment training manual

7. 7 ART and recreational drug interactions: street drugs

Ecstasy
Potential interaction with PIs or efavirenz.

Other amphetamines
Potentially dangerous interactions with ritonavir. This combination should be avoided if possible.

GHB
Potential interaction with PIs (especially ritonavir) and possibly efavirenz.

Ketamine
There are no studies describing interactions between ketamine and ARVs. People on PIs may be at risk of ketamine toxicity because of drug accumulation. Ritonavir may increase levels of ketamine.

PCP (angel dust)
Potential interaction with PIs, and possibly efavirenz. May result in higher PCP concentrations and toxicity.

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.

Cocaine
Suggested that interactions with nevirapine or efavirenz may possibly increase risk of liver toxicity, but there is no research to support this.

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

Interactions between ARVs and street drugs – an excellent paper from 2003 describing scientific aspects of interactions (opens in new window).

Safer drug use

In most cases, problems arise because ART stops the liver processing recreational drugs in the normal way. This means they stay in the body for longer and/or at higher levels.

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.

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.

Further reading

  1. Interactions between ARVs and street drugs – Medical review from 2003 on the available data on interactions between differetn street and recreational drugs and antiretrovirals.
  2. Alcohol and HIV questions. Link to questions on alcohol and HIV shows a range of recent questions to i-Base.

Last updated: 1 December 2015.