The practice of mixing heroin and cocaine is often referred to by users as “speedballing” or “taking a speedball.” A speedball can be any combination of a prescription central nervous system depressant drug (e.g., other opiate drugs, benzodiazepines, or barbiturates) and any type of stimulant. Stimulant/depressant mixes can also be referred to by users as a “setup.”
The Dangers of Overdose as a Result of Mixing Heroin and Cocaine
There are some general dangers associated with mixing drugs that have opposite mechanisms of action, such as stimulants and depressants. Cocaine is a central nervous system stimulant, whereas heroin is an extremely powerful central nervous system depressant. The logic of mixing these drugs is to combine their effects to produce an intense feeling of euphoria that combines the euphoric effect of both drugs and at the same time to reduce the negative effects of these drugs, such as hyperactivity, sedation, irregular heartbeat, drowsiness, etc.
In addition to their central nervous system effects, the stimulant (cocaine) activates the sympathetic nervous system (the part of the peripheral nervous system that speeds up functioning), and the depressant (heroin) activates the parasympathetic nervous system (the part of the peripheral nervous system that slows down functioning). However, there is an imperfect overlapping of these contrasting effects that disrupts the body’s natural tendency to maintain balance. The major issue associated with combining these two drugs is the tendency to experience overdose effects.
- By attempting to suppress the unwanted effects of the drugs, the person taking them may incorrectly believe that they are less inebriated than they really are.
- Combining these two drugs leads to the mistaken perception that the user can take more of one or both of them.
- Cocaine has a much shorter half-life than heroin and is eliminated from the system much more quickly than heroin.
- Combining cocaine and heroin results in an individual taking more of each drug and having levels of heroin build up in the system that can be potentially fatal.
- A person under the influence of cocaine may have ingested a dangerous amount of heroin, and this could lead to an increased potential to overdose on heroin. One can also overdose on the cocaine, but the more likely effect is to overdose on heroin.
- Fatalities associated with the use of a speedball are typically due to heroin overdose, which can be fatal.
- Overdose associated with the use of a speedball typically involve significant issues with respiratory depression that can lead to brain damage, other organ damage, and death.
There are numerous celebrities who have overdosed on this combination, including:
- Actor Philip Seymour Hoffman (cocaine, heroin, and numerous other drugs)
- Actor John Belushi (cocaine and heroin)
- Actor and comedian Chris Farley (cocaine and morphine)
- Actor River Phoenix (cocaine and heroin)
- Musician DJ Rashad (cocaine, heroin, and benzodiazepines)
- Chris Kelly of the rap duo Kris Kross (heroin, cocaine, and numerous drugs)
The Centers for Disease Control and Prevention reports that a significant percentage of deaths that are related to overdose of heroin include individuals who use heroin and some other drug, such as a stimulant drug.
Other Potential Dangers and Risks
In general, mixing these drugs may also result in:
- An increase in the risk of unusual or unpredictable interactions, including the development of an allergic reaction, unusual side effects, etc.
- An increased risk of cardiac failure due to sudden changes in blood pressure, heartbeat irregularities, etc.
- Increased risk of stroke due to sudden alterations in blood pressure and the burden on the cardiovascular system
- Increased risk of liver damage
- Increased risk of developing respiratory issues due to respiratory suppression
- Increased risk of developing immune system dysfunction that can make one more vulnerable to other diseases
- An increased potential to neglect important aspects of self-care that can lead to health issues in the present and the future
- Cognitive issues and neurological damage that can include an increased risk to develop damage to the brain in several different systems, seizures, alterations in cognition that can lead to risky behaviors or accidents (e.g., needle sharing, unprotected sex, etc.), and alterations in the levels and availability of neurotransmitters that can result in negative changes to brain pathways
- Increased risk to develop psychological issues that can include psychosis (potential hallucinations and/or delusions), depression with or without suicidality, anxiety, and a polysubstance use disorder.
- Increased risk to develop physical dependence on one or both of the substances
- Increased risk to become involved in criminal activity or to be the victim of a crime or abuse
- Increased risk to be diagnosed with some other form of mental illness
- Problems occurring in other areas, such as in one’s relationships, occupation, finances, and educational goals
Treatment and Recovery
Individuals who regularly abuse either heroin and cocaine will experience very complicated roads to recovery when they decide to address their issues. Someone who has habitually combined these drugs will experience a more complicated course of recovery due to the interaction of these drugs. Typically, the combined effects of using these drugs is more significant than the effects of using either drug alone, and the combined effects of trying to recover from chronically using most combinations of more than one drug of abuse also follow the same principle.
Chronic combination of these drugs can lead to a very complicated development of physical dependence on both of them. Individuals will develop tolerance rapidly to both drugs, and this will result in an increase in the amount of the substance that is used to achieve their effects. As tolerance builds, the potential to develop very complicated withdrawal issues also increases.
Withdrawal from cocaine is typically more emotional or psychological in nature. Individuals experience issues with extreme depression, apathy, lethargy, problems with motivation, sleepiness, appetite increases, and some physical effects, such as sweating, irregular heartbeat, jitteriness, etc. Withdrawal from heroin can produce significant mood swings, nausea, vomiting, fever, chills, headache, and insomnia. Emotional effects may occur, such as depression, anxiety, and hallucinations, in rare cases.
The initial step in treating someone who has consistently combined these drugs would be to get them involved in a medically assisted withdrawal management program that would involve opioid replacement medications, such as Suboxone, as well as other medications to control withdrawal symptoms. Withdrawal from alcohol is commonly treated with benzodiazepines. The specific treatment used for any case would depend on the types of symptoms being displayed. The medications would be administered on a tapering schedule with the dose decreased over time to wean the person off the medicine as their withdrawal symptoms decrease. An inpatient program would be preferable over an outpatient program.
Relapse is a concern in any stage of the recovery process, and it is particularly concerning in the early stages. However, simply addressing the withdrawal syndrome associated with recovery and not becoming involved in a treatment and aftercare program will almost ensure that an individual will relapse rather quickly. A person in early recovery should begin to receive therapy, support group participation, support from friends and family, etc., while they are undergoing medical management for withdrawal symptoms. Once the withdrawal process has been completed, the person should continue these interventions in the form of a long-term aftercare program.
Participation in treatment and continued diligence to abstinence are necessary for many years following the initial decision to get into recovery. The spiral of relapse, returning to treatment, relapse, etc., is one that can be lessened or avoided if the person maintains commitment to an aftercare program that consists of substance use disorder therapy, support from family and friends, long-term participation in peer support groups (e.g., 12-Step groups), and lifestyle changes.