Mixing Opioids and Stimulants: Effects and Dangers

The simultaneous use of more than one drug can have dangerous and unpredictable outcomes.1 Whether done intentionally or not, the practice of mixing drugs (also known as polysubstance use) was linked to nearly half of the overdose deaths reported in 2019.1

This page will focus on the effects and risks of combining two common types of drugs—opioids and stimulants—and explore treatment options for polysubstance addiction.

Is Mixing Opioids and Stimulants Dangerous?

Yes, mixing opioids and stimulants can lead to serious health risks. Some of the risks posed by using opioids or stimulants individually may be increased by polysubstance use. For instance, in the case of heroin and cocaine, the combination of drugs can lead to a higher risk of overdose than either drug used on its own.2,3

Both stimulants and opioids can lead to addiction and significant physiological dependence.  Over time, the simultaneous use of these drugs can result in a more complex, combined withdrawal syndrome, which may necessitate more careful withdrawal management efforts.4

Next, let’s discuss the differences between opioids and stimulants and their individual effects, before exploring the increased risks of using these substances concurrently.

The Differences Between Opioids and Stimulants

Opioids and stimulants have vastly different pharmacological effects and side effect profiles. When used in prescription form for therapeutic purposes, they are intended to treat very different conditions:5,6

  • Opioids can help decrease the perception of pain signaling but can also cause drowsiness and confusion, and may slow a person’s breathing.
  • Stimulants increase activity in the central nervous system, amplify certain physiological processes such as heart rate and respiration, and can be used to treat attention deficit disorder or narcolepsy.

Opioids include prescription medications used to manage pain (e.g., OxyContin, Vicodin, Codeine), as well as illegal drugs like illicitly manufactured fentanyl and heroin.7

Like opioids, there are both prescription and illicit stimulants. Prescription stimulants (e.g., dextroamphetamine formulations such as Adderall, methylphenidate drugs like Ritalin) are often used to help improve certain symptoms of attention-deficit/hyperactivity disorder (ADHD).8 Other methylphenidate containing prescription stimulants (e.g., Daytrana, Quillivant XR) may be used to treat extreme daytime sleepiness (EDS) among people with narcolepsy.9 Common illicit stimulants include illegally manufactured methamphetamine (i.e., crystal meth) and cocaine.10,11

Both opioids and stimulants—prescription or otherwise—are potentially very addictive and carry the risk of overdose.5,8,10,11,12,13

Adverse Effects of Opioids

Potentially negative side effects and dangers of opioids may include:5,12,13,15

  • Extreme drowsiness.
  • Intermittent loss of consciousness.
  • Confusion or clouded mental function.
  • Sweating.
  • Slurred speech.
  • Itchy skin.
  • Dry mouth.
  • Nausea and vomiting.

Fatal overdose from opioids is usually caused by slowed or stopped breathing leading to hypoxia (lack of oxygen reaching the brain).5,12,13

Long-term opioid misuse is associated with:12

  • Chronic insomnia.
  • Chronic constipation and other GI issues.
  • Increased risk of lung complications such as pneumonia.
  • Endocrine/hormonal disruptions.

Adverse Effects of Stimulants

Some of the negative side effects and dangers of stimulants include:8,10,11,15

  • Decreased appetite.
  • Anxiety.
  • Agitation.
  • Paranoia.
  • High blood pressure.
  • Rapid breathing.
  • Fast or irregular heartbeat.
  • Vasoconstriction and decreased blood flow.

A fatal overdose on stimulants may involve seizures or catastrophic cardiovascular events, such as heart attack and stroke.8,10,11 

Long-term stimulant misuse is associated with:6,8

  • Chronically elevated risk of stroke or heart attack.
  • Unhealthy weight loss.
  • Drug-induced psychosis.

What Are the Effects of Mixing Opioids and Stimulants?

When taken together, opioids and stimulants may elicit a desirable “push-pull” reaction. This effect is often sought after by people who engage in “speedballing,” a term used to describe the simultaneous use of meth or cocaine with heroin.2

By mixing opioids and stimulants, a person may also hope to reduce the negative effects of both drugs while still experiencing an intense high.2 For example, they may try to use opioids to mitigate the anxiety or insomnia caused by stimulants or use stimulants to reduce the drowsiness caused by opioids.

Since opioids and stimulants have somewhat opposite effects, someone may feel they need to take higher doses of either drug than they normally would.1 When someone uses both cocaine and opioids, the initial stimulating effects of cocaine can mask some of the signs of an impending opioid overdose.2

Does Using Opioids and Stimulants Together Increase Overdose Risk?

A 2022 study published in Bio-Med Central (BMC) Public Health found that people who use stimulants and opioids together had more than twice the likelihood of fatal overdose compared to people that only used opioids.3

Researchers believe that the increased polysubstance use of stimulants and opioids is likely contributing to a substantial increase in overdose deaths involving both drugs.14

Treatment for Stimulant and Opioid Addiction

Substance use disorders (i.e., drug addictions) are chronic but treatable conditions.15 There are several evidence-based treatment approaches that can help people struggling with polysubstance use find long-term recovery.16

Depending on someone’s unique situation, medically assisted detox may be necessary to stabilize the patient during acute withdrawal.4 With opioid addiction, this often involves certain medications for opioid use disorder (MOUD), the use of which may continue after detox as well.17

Stimulant and opioid addiction treatment typically involves behavioral therapy, peer support, psychoeducation, and the treatment of any co-occurring disorders that may be present. These approaches can be performed in a variety of settings.16

The levels of addiction treatment offered at Sunrise House, an inpatient addiction treatment center in New Jersey include:

Get admitted today and begin your journey to a better life. Admissions navigators at can verify your insurance coverage for rehab or help you explore other ways to pay for rehab.

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