Mixing heroin (an opioid depressant) and cocaine (a stimulant) is commonly known as a speedball. The combination greatly increases the risk of fatal overdose.

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What Is a Speedball?

Speedball Is An Especially Dangerous Combination That Is Very Likely To Result In Overdose And DeathA speedball is a mixture of the illicit drugs heroin and cocaine. Typically, speedballing involves both substances being injected into the bloodstream via needs, but they are sometimes snorted nasally together as well. Individual’s who speedball claim to experience a more intense, longer-lasting high than that experienced when taking either drug alone.

Heroin is a common illicit opioid (derived from morphine) that slows breathing and can lead to respiratory failure, especially when combined with another depressant, such as alcohol. Cocaine, a stimulant, has nearly the opposite effect (such as increased heart rate and energy, rapid breathing, et cetera). It is a common misconception that mixing heroin with cocaine will either balance or cancel out the negative side effects of heroin. In reality, combining these substances is more dangerous than using either alone because their negative effects can be amplified when combined.

Mixing heroin and cocaine increases the risk of overdose or permanent damage to the body.

Speedballing is especially risky because it forces the body to process more, different types of drugs simultaneously. Taking a depressant and a stimulant together causes a “push-pull” reaction in the body that can be very dangerous. Cocaine use requires the body to take in and use more oxygen while heroin slows breathing — putting a strain on overactive lungs, heart, and brain and causing confusion and turmoil in the body. In particular, speedballing makes it more difficult for the body to receive the amount of oxygen needed to keep itself safe and balance out the effects of cocaine. Even worse, because cocaine wears off much faster than heroin, people who speedball tend to inject more often than those who use either heroin or cocaine separately.

Side Effects of Speedballing

The side effects commonly associated with cocaine are anxiety; hypersensitivity to sight, sound, and touch; high blood pressure; and irregular or rapid heartbeat. Opioids like heroin are often linked to drowsiness and a slowed breathing rate. When combined, the side effects of speedballing primarily negatively impact the brain.

Combining cocaine and heroin is a potent cocktail with a very high risk of unpredictable side effects.

Common side effects of speedballing include:

  • Confusion or incoherence
  • Blurred vision
  • Drowsiness
  • Paranoia
  • Mental impairment due to lack of sleep
  • Uncontrollable movements
  • Incoherence
  • Stupor

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There are also long-term side effects of speedballing on the major organs of the body, including the lungs, heart, and liver. There are reports of individuals who experience manic episodes, paranoia, or depression after speedballing as well.

Even worse, speedballing creates a high risk of death. Potentially fatal side effects of speedballing include:

  • Stroke
  • Heart attack
  • Aneurysm
  • Respiratory failure
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Factors That Influence How Speedballing Impacts the User

There are many factors that influence how combining heroin and cocaine impacts the body. The same individual can use the same amount of the same drugs on difference occasions and experience different effects each time. Some of these factors include:

  • The drug itself: it’s purity, amount used, frequency of prior use, whether it has been cut or mixed with other drugs, and how it is administered
  • The setting: who the user is with and where they are physically
  • The individual taking the drugs: their mood, personality, mental health, medical history, and individual biology

Speedball Statistics



In 2015, 63% of cocaine-related overdose deaths involved an opioid, especially heroin.



By the first half of 2015, fentanyl-related deaths in Florida that involved cocaine increased to 42% (up from 17%).



Colombian cartels increased cocaine production by 100% between 2013 and 2015.

The Dangers of Mixing Drugs

Speedball Is A Combination Of Heroin And CocaineThe risk of respiratory failure is even more likely when speedballing due to differences in how long cocaine and heroin affect the body. The euphoric effects of cocaine wear off faster than heroin. When this happens, the full respiratory-impairing effects of heroin hit the body. Additionally, the combination of cocaine and heroin can strengthen the effects of each, often leading to overdose.

In 2014, cocaine was involved in the second-most number of overdose deaths, and use has increased each year. This increase comes directly after a steady decline in cocaine-involved overdoses between 2005 and 2009. Data from county coroners’ reports show that poly-drug use is driving that increase.

When there are no opioids involved in cocaine-overdose deaths you see an overall decline in recent years. But when you look at cocaine and opioids together, we see a more than doubling in the number of overdoses since 2010, with heroin and synthetic opioids increasingly involved in these deaths.

- Christopher M. Jones, Department of Health and Human Services acting associate deputy assistant secretary, U.S. News & World Report, 2017

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Speedball-Related Overdoses

Starting in the Second Wave of the Opioid Epidemic, the spread of illicitly manufactured fentanyl (a synthetic opioid up to 100 times stronger than morphine and 50 times stronger than heroin), caused a sharp increase in overdose deaths. Some purposely took fentanyl because they knew of its deadly, potent properties. However, many people were not aware of the presence of fentanyl in counterfeit pills (like oxycodone) and heroin. Overdose deaths increased as a result.

The combination of cocaine (currently at an all-time purity high) and fentanyl (potentially lethal at only 2 milligrams or the weight of 6 grains of salt) was present in 1,542 deaths in 2015. Many researchers believe the real number of deaths is actually higher due to the way counties report drug deaths.

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The process of recovery is difficult for anyone. Without help, it can feel impossible. Following periods of speedball abuse, detoxing can be uncomfortable and even fatal if done without medical care. Talk to a dedicated treatment provider today to learn about your options for living a fulfilling, healthier life of sobriety.

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