Call it the “shampoo effect”—that internal sudsing after you stuff your bloodstream with chemicals, then shake it around on the dance floor. If you’re slurping protease cocktails while feeding your mind, your body may react in ways you didn’t sign up for. Why? Protease inhibitors wreak havoc with the liver-enzyme pathway that is used in the breakdown of party drugs. With these enzymes out of whack, MDMA, meth and other magic substances are metabolized either too slow or too fast. This presents two distinct dangers: A buildup of the drug will increase its nasty side effects, while less drug may tempt you to do more, risking overdose. Drug companies steer clear of research on street drugs, and precious little is known about these interactions, so you’re on your own in partyland. The bottom line is, mixing recreational chemicals with antiretrovirals is flirting with fate. But if you’re a dedicated user, there are precautions. The list and chart in this user’s guide are culled from Glen Monks; essential booklet, Positive About Drugs, and GMHC’s pamphlet Drugs in Partyland.

  1. Don’t use recreational drugs during your first six to eight weeks on a new protease inhibitor.
  2. To keep your kidneys clean and prevent dehydration, drink plenty of water and avoid alcohol.
  3. A street/scrip mix risks nonaherence. If you’re off your head, you may go off your pills. Don’t miss meds while tweaking.
  4. Most illicit drugs are cut with crap and come in varying degrees of purity. Predicting an interaction between a protease pill and a wild-card potion is impossible.

Take heed, club lovers— there’s no map for these trips.

Drug: Ecstasy 

Interaction and Effects: 3-to-10 fold buildup of MDMA in blood. More teeth grinding,palpitations, joint stiffness, dehydration. Greater chance of liver andkidney damage. May be deadly: Britain’s Philip Kay died under a discoball, the casualty of a ritonavir/ecstasy mix.  

Reduce the Harm: Divide the Dose. Take ¼ or ½ a tablet and wait to see how you feel.Since X is often cut with ketamine, speed, ephedrine or even caffeine,which mimic MDMA’s effects, factor in these risks. Crixivan users:Guzzle H2O the day after to reduce chance of kidney stones.

Drug: Speed/Meth 

Interaction and Effects: 2-to-3-fold buildup of meth in blood. Increased anxiety, manic behavior, shortness of breath, racing heart beat, dehydration.

Reduce the Harm: Don’t be greedy. Dab a little and see what effect it has. If injecting, use clean equipment; if sharing needles, first flush syringe with undiluted bleach for one minute, then with cold water. Repeat three times with new bleach.

Drug: Heroin 

Interaction and Effects: Heroin metabolized more quickly.Less hit, less buzz, withdrawal symptoms.   

Reduce the Harm: Take the normal dose initially and increase it only if you experience less hit and less buzz. As always, safe injecting is essential.  Heroin is an especially bad mixer with other drugs and will only make the chances of unconsciousness, vomiting and choking greater.

Drug: Special K

Interaction and Effects: Buildup of ketamine likely. Increased sedation, disorientation and hallucinations. Effects last longer.

Reduce the Harm: Less is more. Take 1/3 or ½ of usual dose. Wait for effect. Only re-K if you feel OK. The difference between a pleasantly-out-of-it sensation and landing in a semi-catatonic K-hole is a matter of dose. Once you’re baked, you may forget about the half-dose rule.

Drug: Cocaine   

Interaction and Effects: Little is known about coke’s interaction with protease inhibitors— no studies. But if you have HIV, smoking, shooting or even snorting cocaine is no party for your immune system: In one test-tube study, coke made HIV reproduce 20 times faster than normal.

Reduce the Harm: When it comes to binge drugs, coke is it. The higher you fly, the faster you fall— and to keep from crashing, you do bump after bump after bum. A lost weekend is a ticket to nonadherence. If you do miss a med or three, don’t double your dose the next time! Follow the scrip.

Drug: GHB

Interaction and Effects: Combining GHB, aka Grievous Bodily Harm, with the anti-protease drugs is another unknown. Like many party favors, GHB may suppress the immune system.

Reduce the Harm: Don’t assume a bottle of “liquid X” equals a dose. Start with a teaspoon, and give it half an hour to work before taking more. The right amount may make you feel electric; a little more, you may slip into a deep sleep; even more can cause coma or death. Avoid mixing with alcohol.