The number of people combining opioids and stimulants has grown. “I did crack and heroin both,” said Tom Wolf. “The amount of people using meth and fentanyl at the same time is growing.”40 The combination is known as a “goofball.”41 Indeed, the number of opioid-using Americans who also used methamphetamine rose 83 percent between 2011 and 2017, from 18.8 percent to 34.2 percent.42