The Effects of Mixing Heroin and Cocaine (Speedballing)

Heroin and cocaine are both commonly used illicit substances.1,2 Individually they effect the body differently, but when combined can produce dangerous effects. One way that people engage in mixing drugs is combining heroin with cocaine, also known as speedballing.1,3

This page will explore the individual effects of heroin and cocaine use, speedball effects, and treatment options for misuse and mixing heroin and cocaine or speed balling.

Heroin vs. Cocaine

Heroin and cocaine affect the body in different ways – the former is a central nervous system depressant, and the latter is a stimulant. .2,3  The differences between stimulants and depressants can be broadly described as the ability to speed up or slow down a person’s brain and body function.3

Heroin is a highly addictive illicit opioid.4 It is most often injected, but individuals may also snort the white powder form.4

Cocaine has some medical use – though it is rarely used as a legal anesthetic — but on the street, it is commonly available as a powder or crystalized rock.4 As a powder, it is often snorted – though some people may inject it. In its rock form it is most often smoked.4

The Effects of Heroin

As a member of the opioid class of substances and a CNS depressant, heroin use can have dangerous effects on the body.1 Short-term effects of heroin may include:1

  • Euphoria.
  • Dry mouth.
  • Flushed face or skin.
  • Heaviness of the arms or legs.
  • Feeling nauseous or vomiting.
  • Itchiness.
  • Difficulty thinking.
  • Falling in and out of consciousness (going “on the nod”).
  • Dangerously slowed breathing.
  • Coma.

Heroin use can have long-term effects on a person’s health as well.1 Some effects may occur after chronic use, but others may occur after relatively few uses.1 Some of these long-term effects include: 1

  • Infection of heart lining and valves.
  • Liver and kidney disease.
  • Increased risk of developing HIV or hepatitis C.
  • Insomnia.
  • Abscesses and skin infections.

The Effects of Cocaine

Cocaine works as a central nervous system stimulant by effectively increasing the levels of dopamine – the “reward chemical” in the brain.2 As a result, the effects of cocaine may include:2

  • Euphoria.
  • Increase in energy.
  • Mental alertness.
  • Heightened senses (oversensitive sight, hearing, or touch).
  • Dilated pupils.
  • Decreased need for sleep.
  • Increased body temperature.
  • Increased blood pressure.
  • Irregularities in heartbeat.

What Is Speedballing?

Speedballing is the practice of consuming an opioid and a stimulant at (or near) the same time. A common speedball is the combination of heroin and cocaine. 1,2 Some people combine these substances to create a different experience than they would achieve with one of these substances on their own.6 Others may use one drug shortly after the other to minimize opioid withdrawal symptoms or temper overexcitement from cocaine.7

Despite being involved in 50% of drug overdose deaths in 2019, polysubstance use is common among people who misuse drugs.3,7 In fact, cocaine use and the development of cocaine use disorder is specifically associated with parallel use of heroin and other substances.

Speedballing is dangerous because it puts you at risk of dangerous side-effects associated with each specific drug. These side effects can worsen when combining drugs, and using a stimulant and a depressant together can blunt the side effects of one drug (stimulant) and therefore one may use more of the other drug (depressant) to feel the full effect which puts the individuals at a higher risk of overdose.7

Is Speedballing Addictive?

Because heroin and cocaine each have a high potential for addiction on their own, speedballing carries a high risk for dependence and addiction.1,2 The simultaneous ingestion of both drugs has been shown to enhance their addictive capabilities.6

Dependence is defined by when the brain’s reward system is stimulated from drugs such as heroin or cocaine and this continued drug use causes the brain to adapt to its presence.2 Once the brain has adapted, if use is slowed down or stopped, withdrawal symptoms may emerge, and someone may compulsively use cocaine to avoid withdrawal symptoms.2

Addiction refers to the compulsive, uncontrollable use of a substance despite all of the harm that it causes. Addiction may entail not only physiological changes (such as tolerance and dependence) but several harmful behavioral changes adversely impacting every aspect of an individual’s life.

Addiction development is accompanied by functional changes within the brain that can impact an individual’s drive, motivation, thought processes and behaviors so much that drug use becomes prioritized over all else. The development of addiction is influenced not only by repeated substance use itself, but also by genetic, psychosocial, and environmental factors.

Risk of Speedball Overdose

It is easier to overdose when taking heroin and cocaine together, because each drug may mask some effects of the other.3 This can make it more difficult for a person to monitor how much they have taken, which can result in overdose and death.3

In fact, most overdoses involving cocaine in 2020 also involved a synthetic opioid.8 And, heroin-involved overdoses in 2020 were largely affected by combinations with other opioids (primarily fentanyl).8

Symptoms of a speedball overdose (from either cocaine or heroin) include:1,2

  • Dangerously slowed breathing or difficulty breathing.
  • Heart arrhythmias.
  • Heart attack.
  • Seizure.
  • Significant blood pressure changes.
  • Significant changes in body temperature.
  • Hallucinations.
  • Agitation or anxiety.
  • Changes in consciousness.
  • Coma.

Treatment for Cocaine and Heroin Addiction

f you are looking for help with cocaine or heroin use, treatment is available. Heroin and cocaine addiction treatment often begin with a medically supervised detox in order to manage withdrawal symptoms and ensure your comfort and safety as you begin your journey to recovery.

But detox is only the first step. To get the best chance at long-term recovery, a person may require various types of addiction treatment. If you are looking for inpatient rehab, New Jersey may have what you need. Sunrise House Treatment Center has staff members available 24/7 to answer any questions you may have about enrollment, paying for rehab, or using insurance to pay for rehab. Call 973-447-3677 today, start treatment, and begin your road to recovery.


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