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What Is a Speedball? Heroin & Cocaine Drug Combo

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Nov 22, 2023 • 20 cited sources

A classic speedball is a combination of heroin and cocaine. Dealers can get creative and mix all sorts of substances into the products they call a speedball. But typically, they limit the ingredients to depressants and stimulants.[1]

Stimulant/depressant combinations have been around since the late 19th century. At that time, doctors considered heroin a miracle solution for pain and coughing, and they prescribed it liberally. 

During that same period, cocaine rose in popularity. Many people who became addicted to one or the other drug were first introduced by their doctors.[2]

The term speedball to describe a stimulant/depressant combination has been used since the 1950s. Just because the practice is established and somewhat common doesn’t make it safe. Of all drug overdose deaths in 2018, close to 19% can be attributed to speedballs.[3]

What Is a Speedball?

A stimulant/opioid combination is a speedball. Typically, users inject these drugs simultaneously.[1] 

They may buy premixed doses from dealers. Users may also purchase the elements they want and combine them into a customized dose. 

The stimulant inside a modern speedball can be cocaine, methamphetamine or prescription ADHD medications like Adderall or Ritalin.[1]

The opioid inside a modern speedball can be heroin, fentanyl or prescription painkillers like hydrocodone, morphine or codeine.[1] 

Two new and dangerous additions to speedballs include the following:[1,4]

  • Xylazine: This veterinary tranquilizer is profoundly sedating. It is most often found in drug doses containing two or more different substances.
  • Fentanyl: This powerful opioid is sometimes found in speedballs as a substitute for other opioids like heroin or codeine. Some experts consider this a speedball “on steroids.”[1] Since it’s so powerful, it can cause an overdose very quickly.

People rarely know exactly what’s included inside the speedballs they’re about to use. Dealers may say that the opioids they’re using are heroin, but they may include fentanyl instead. 

And they may say the dose is perfectly mixed, but it might include more of one element than another. Due to this element of the unknown, any dose could be very dangerous or even deadly. 

Side Effects of Combining Cocaine & Heroin 

People using speedballs experience a rush (likely from the stimulant) followed by sedation (from the depressant). Users hope they can experience intense pleasure while reducing the side effects these drugs can use when they’re taken alone.[1] Unfortunately, this method isn’t effective. 

Common side effects associated with a speedball include the following:[1]

  • Agitation
  • Blurred vision 
  • Confusion 
  • Drowsiness
  • Incoherence 
  • Paranoia 
  • Sedation
  • Slow breathing 

The results of mixing drugs can be unpredictable. Combining very different drugs is even riskier. 

The stimulant action inside a speedball can mask the sedation inherent in the depressant. Since symptoms of one drug are masked, it may prompt the user to take more. An overdose can quickly result. In 2019, about half of overdose deaths involved multiple drugs.[5]

Factors That Influence a Speedball’s Power 

Every speedball — and every user — is different. But some factors can influence how powerful a dose can be and the serious reactions it can cause. 

These three factors can include a speedball’s potential impact:[4,6]

  • Ingredients: A speedball with xylazine and another opioid increases the risk of a fatal overdose. Xylazine injections can also cause tissue death and resulting amputations.
  • Underlying health: Cocaine is a powerful cardiovascular drug. Researchers say people with a high risk of heart disease are more likely to experience problems like strokes and heart attacks when they use speedballs.
  • Drug use history: Opioids and depressants can cause tolerance. Recurring users can tolerate high doses that novices cannot. If you’re accustomed to both drugs, your overdose risk shifts accordingly. 

Know that every speedball is different. Dealers rarely test their doses for purity and strength. But understanding the factors that can make a speedball more deadly is critical. 

Long-Term Effects of Speedballing

Ingredients inside each speedball are addictive. Sometimes, people use them repeatedly. Doing so can lead to significant physical and mental health issues. 

Common long-term problems associated with speedballing include the following:[1]

  • Anxiety: The push/pull of a speedball can lead to mental health issues between doses. Intense anxiety is common.
  • Cardiac damage: Cocaine’s stress can lead to heart failure or stroke. 
  • Injected infections: Sharing needles can lead to infectious diseases like HIV and hepatitis. 
  • Needle-based infections: Poor hygiene, which is common when injecting drugs, can lead to skin infections or abscesses. 

Researchers also say that some people experience body temperature increases while they’re high on speedballs. These episodes can lead to dehydration. In severe cases, they can lead to kidney failure.[7] 

The longer you use these drugs, the more likely these problems can be. 

Speedballs can also lead to complex substance use disorders (SUD). Studies suggest that depressants and stimulants lead to very different types of addictive behavior that respond to different triggers and stresses.[8] 

Recovery is possible, but it can be harder to overcome than an addiction to one individual substance. Treatment for poly-substance addictions is generally more complex.

Can You Overdose on a Speedball? 

It’s very possible to overdose on a speedball. Unfortunately, it’s very common. 

In the first part of 2018, about 63% of opioid overdose deaths also involved stimulants like cocaine, methamphetamine or an unusual ingredient (like benzodiazepines).[9] 

Researchers say that the number of deaths caused by opioid/cocaine combinations has increased more than fivefold since 2010.[9] Researchers say powerful opioids like fentanyl are partially to blame. Even experienced drug users may be overwhelmed by the ingredients inside their doses.

Weak speedballs can be dangerous too. Cocaine and other stimulants can mask the sedating power of opioids.[10] This power means people may think they can take more or avoid getting help for the drugs they’ve taken, and they can slide into an overdose very quickly.

What Does a Speedball Overdose Look Like?

A speedball-released overdose is typically related to opioids. Symptoms may include the following:[11]

  • Pale or clammy skin 
  • Sedation 
  • Blue- or purple-tinged fingernails or lips 
  • Vomiting 
  • Gurgling sounds 
  • Slow breathing or heartbeat 
  • Inability to wake up

People reacting to the cocaine inside a speedball may have a high body temperature, fast heartbeat or chest pain.[6]

If you notice any of these symptoms in people taking speedballs, call 911. If you have an opioid antagonist like naloxone (Narcan), administer it per the package directions. Follow the operator’s instructions, and stay with the person until help arrives. 

If given in time, naloxone can reverse an opioid overdose.[12-14] There is no serious harm in giving naloxone if it isn’t needed. [15] If you suspect a possible opioid overdose, even if you aren’t certain, administer naloxone and call 911.  

Getting Help With Opioid Addiction 

While a speedball habit is incredibly dangerous, quitting isn’t easy. Opioids can alter brain chemistry in persistent ways.[16] People can feel sick when they try to quit. And they can experience deep cravings that increase their risk of relapse. 

Medications like buprenorphine attach to receptors used by opioids.[17] They ease withdrawal symptoms, helping people to get sober safely and effectively. 

Medications like Suboxone combine buprenorphine with misuse-prevention ingredients like naloxone for long-term use.[18] People use these therapies in Medication for Addiction Treatment (MAT) programs to get control of their opioid misuse and build a better life. 

MAT treats cravings, and therapy can last indefinitely. As long as relapse risks exist, medications can keep cravings under control. 

MAT With Bicycle Health

While MAT is effective, it’s not always easy to get. Some parts of the country don’t have MAT program availability. Telemedicine can help. 

An MAT program like this allows you to visit with a professional via your phone or computer, and you can pick up a prescription at a local pharmacy. Continued appointments via telemedicine ensure you stay connected with treatment. Telehealth services make MAT more accessible and convenient for patients in need.[19,20]

Bicycle Health is a leading telemedicine MAT provider. Our patients have used MAT via our telehealth services to ensure they don’t relapse to drugs like heroin or speedballs. It’s remarkably effective. 

Contact us to find out if this method of treatment is right for you. 

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Speedballing: Mixing stimulants and opioids. Florida Department of Children and Families. Accessed October 26, 2023.
  2. Kandall S, Chavkin W. Illicit drugs in America: History, impact on women and infants, and treatment strategies for women. Hastings Law Journal. 1992;43(3):615-643. 
  3. Peppin JF, Raffa RB, Schatman ME. The Polysubstance Overdose-Death Crisis. J Journal of Pain Research. 2020;13:3405-3408. 
  4. The growing threat of xylazine and its mixture with illicit drugs. U.S. Department of Justice, Drug Enforcement Administration. Published October 2022. Accessed October 26, 2023.
  5. Polysubstance use facts. Centers for Disease Control and Prevention. Published February 23, 2022. Accessed October 26, 2023. 
  6. Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. International Journal of Molecular Sciences. 2019;20(3):584. 
  7. Polydrug use. Alcohol and Drug Foundation. Accessed October 26, 2023. 
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  9. Opioid overdose crisis compounded by polysubstance use. Pew. Published October 8, 2020. Accessed October 26. 2023. 
  10. Polydrug use: Health and social responses. European Monitoring Centre for Drugs and Drug Addiction. Published October 22, 2021. Accessed October 26, 2023. 
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  12. Hanson BL, Porter RR, Zöld AL, Terhorst-Miller H. Preventing opioid overdose with peer-administered naloxone: Findings from a rural state. Harm Reduction Journal. 2020;17(1).   
  13. Naloxone drug facts. National Institute on Drug Abuse. Published January 11, 2022. Accessed October 28, 2023. 
  14. Shaw LV, Moe J, Purssell R, et al. Naloxone interventions in opioid overdoses: a systematic review protocol. Systematic Reviews. 2019;8(1). 
  15. Naloxone: Frequently asked questions. Anne Arundel County Health Department. Accessed October 28, 2023. 
  16. Kosten T, George T. The neurobiology of opioid dependence: Implications for treatment. Science & Practice Perspectives. 2002;1(1):13-20. 
  17. Shulman M, Wai JM, Nunes EV. Buprenorphine treatment for opioid use disorder: An overview. CNS drugs. 2019;33(6):567-580. 
  18. Velander JR. Suboxone: Rationale, science, misconceptions. The Ochsner Journal. 2018;18(1):23-29. 
  19. Molfenter T, Brown R, O’Neill A, Kopetsky E, Toy A. Use of telemedicine in addiction treatment: Current practices and organizational implementation characteristics. International Journal of Telemedicine and Applications. 2018;2018:1-7. 
  20. Hailu R, Mehrotra A, Huskamp HA, Busch AB, Barnett ML. Telemedicine use and quality of opioid use disorder treatment in the US during the COVID-19 pandemic. JAMA Network Open. 2023;6(1):e2252381. 

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