On this page you can learn about:

  • How are opioids and stimulants different?
  • Trends in co-use of opioids and stimulants
  • Why people use opioids and stimulants together,
  • Risks of using opioids and stimulants together
  • What treatment options might be.

How are opioids and stimulants different?

Opioids and stimulants operate in the body in very different ways. People may have different reasons for using them. This table compares opioids and stimulants.

Drug effectsRelief from pain, feeling relaxed, drowsy, confused, happy/euphoric, slow breathingIncreased energy, attention, respiration, heart rate, appetite suppression, enhanced mood
Withdrawal effectsFlu-like symptoms (vomiting, diarrhea, discomfort, pain), anxiety, agitationSedation, depressed mood, lack of pleasure, slow movements, dulled responses
Why do people use?People with opioid use disorder use opioids to avoid withdrawal and to feel “normal”People use in order to feel pleasure, get energy, tend to use in binge pattern

Learn more about opioid basics here | Learn more about stimulant basics here.


Nationally and in Washington State more people are using both stimulants, like methamphetamine, with opioids like heroin or fentanyl. This can include using both drugs at the same time, or using one and then the other.

Methamphetamine is widely available in Washington State and the Western US. This has led to a wave of people with opioid use disorder who started to use methamphetamine, and an increase in co-use of methamphetamine and opioids.

What are the risks?

Using opioids and stimulants can increase the risk for poor mental or physical health.

What does this look like in terms of data?

  • Overdose deaths from opioids and methamphetamine have increased in the last decade, nationally and in WA State.
  • Healthcare providers report that many patients with opioid use disorder also use stimulants.
  • The large majority of people surveyed at WA State syringe services programs in 2019 used both methamphetamine and heroin.

Why do people use stimulants and opioids together?

People report many reasons to co-use opioids and stimulants, including practical reasons like to function better or avoid withdrawal, or for pleasurable effects. People who use opioids and stimulants together are more likely to have health issues, like hepatitis C, and social problems like trouble keeping a job or housing.

Reasons for using stimulants and opioids together can include:

Enjoyment. Using opioids and stimulants together can feel good.

Cope with emotional pain. People may use opioids and stimulants alone or together as a way to numb emotional pain or deal with past events.

Balance the effects of each drug. People may use methamphetamine for energy or to reduce opioid withdrawal symptoms. Opioids can help people with pain or relaxation.

Availability. Opioids and methamphetamine are both widely available in the illicit drug market. People talk about them “going hand in hand” and being sold by the same people, or available in the same social settings.


There are not specific treatments for people with stimulant and opioid use disorder together. Treatment that focuses on only one substance may not be enough, though it can eventually lead to reduced use in the other drug For example, buprenorphine for opioid use disorder is associated with eventual reduction in methamphetamine among some people. Treatment may address both substances, and the overall reasons why people use them. This can include housing, mental health, physical health, social support, counseling, and patient navigation in addition to substance use disorder treatment. People who use opioids and stimulants can do well in treatment.

For information about treating opioid use disorder go here. For information about treating stimulant use disorder go here.

Learn more

For more in-depth information, check out the ADAI info briefs “Opioids and Stimulants: What Are They and How Are People Using Them?” and “Helping People Who Use Opioids and Stimulants.”