THE PERILS OF MIXING DRUGS

Candy Flipping: Popping Ecstasy and LSD.

Hugging and Kissing: Using Ecstasy and methamphetamine.

Hippie Flipping: Taking Ecstasy and hallucinogenic mushrooms.

It's called poly-drug use. And while mixing drugs or taking multiple drugs
at once has been going on for some time, the new combination of Ecstasy and
Viagra - dubbed "Sextasy," "Trail Mix" or "Hammerheading" - has drawn
attention globally and has health officials renewing their warnings about
the dangers of drugs and the heightened risks when they're combined.

Just last week, local health officials announced they've gotten a federal
grant to expand a public campaign to curb the use of Ecstasy and other
so-called "club drugs."

"You don't know what you're going to get when you're combining substances,"
said Ellen Silverman, planning and policy specialist for the division of
alcohol and substance abuse of the state Department of Social and Health
Services.

As for Sextasy, there are reports of dealers marketing the
erectile-dysfunction prescription drug Viagra along with a hallucinogenic
Ecstasy pill in plastic bags called "party packages" in Australia and a
hybrid pill made from the two drugs being sold on the streets of New
Zealand. But there have only been anecdotal reports of the drugs being used
together locally.

Large-scale investigations involving Ecstasy haven't turned up Viagra, but
police haven't been looking for it, either, said Sgt. Eric Barden,
supervisor of the Seattle Police Department's narcotics section. "We only
concentrate on the stuff that's illegal," said Barden, who first heard about
Sextasy two years ago at a conference about clandestine drug labs.

Silverman said she's heard the combination is being used at private parties
and among the gay community in Seattle's bathhouses. And Dr. Rob Killian,
who has a family practice on Capitol Hill, said he's heard of its use from
his patients, 99 percent of whom are gay or lesbian.

Meanwhile, though Sextasy is the latest twist, Silverman said other drug
combinations like the stimulant methamphetamine and the prescription
painkiller Oxycontin are more prevalent. Mixing the depressant GHB and meth,
Ecstasy and meth, and the anesthetic ketamine and GHB are among combos that
also pose hazards (see accompanying story).

Why Combos Are Dangerous

Drugs in combination can potentially be hazardous depending on how they are
metabolized or broken down by the body, said drug-addiction expert Dr. Akira
Horita, a professor emeritus of pharmacology and psychiatry at the
University of Washington.

"Sometimes the breakdown of one drug will interfere with the breakdown of
another drug," he said. "There might be toxic side effects from a drug that
normally wouldn't produce them."

Called "synergism," the two substances acting together can have a greater
effect than the sum of their individual effects.

The reason behind the Sextasy combination: While Ecstasy can enhance
feelings of empathy and closeness, it can prevent or hinder erections in
men.

Although the dangers of combining Viagra and Ecstasy have yet to be studied,
Silverman warns of the risks of using the drugs individually.

Men who use Viagra and don't need it are susceptible to "a very painful,
unpleasant erection that won't go away for up to four hours," she said. And
people don't know what they're getting when they buy the illegal drug
Ecstasy. Ecstasy may also increase the risk of Parkinson's disease,
according to research published in the journal Science in September.

Plus, overlapping side effects, such as seizures, anxiety and high blood
pressure, create more hazards.

About 20 of the 600 patients who come into Killian's office each month
request a prescription for Viagra, he said. After taking a blood test,
Killian asks those patients - ranging from their 20s to 60s - about other
drugs and medicines they're using.

"You try to use it as an educational experience about mixing drugs," he
said. "You try to warn them things are risky and that mixing drugs are
risky."

Killian prescribes Viagra to about 15 of his patients each month and hopes
they will heed his caveat about combining the drug with others.

"I know if I tell them no, they can go somewhere else and get it," he said.
"So I try to educate them."

Viagra can be obtained over the Internet or stolen from medicine cabinets of
relatives, friends and neighbors, said Silverman.

Targeting The Warnings

While the city/county health campaign just started this year, Seattle's Gay
City Health Project, a nonprofit group that promotes health and HIV
prevention for gay, bisexual and transgender men, launched a campaign two
years ago with posters placed in bars and nightclubs warning people about
the dangers of mixing drugs, said media and events producer Avram Katzman.

The posters caution that mixing GHB and alcohol can lead to death, and that
Viagra and inhalants called "Poppers" can result in a heart attack.

"People are combining different drugs and experimenting, and that's
definitely a reality," said Katzman. "We want to give people information so
they can make decisions to reduce the harm."