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What Happens When Heroin and Cocaine Are Combined?

The combination of heroin and cocaine is referred to as a speedball. Since both drugs have different effects on the body, people take them together hoping they will balance each other out. However, this can pose the risk of far more serious health consequences.
When heroin and cocaine are combined, the potential for fatal overdose is heightened. 

Signs of Abuse

When someone is abusing speedballs, there are usually clear signs of abuse. Physical signs of drug abuse may range in severity depending on the extent of abuse.

  • Change in normal pupil size
  • Physical appearance deterioration, such as not grooming as usual
  • Sudden weight loss
  • Slurred speech
  • Impaired coordination
  • Bloodshot eyes
  • Sleep pattern changes
  • Appetite changes
  • Tremors
  • Unusual body, breath, or clothing odors

There are also behavioral signs that may indicate drug abuse.

  • Issues with personal relationships
  • Getting into trouble due to drugs
  • Sudden friend changes
  • Getting into dangerous situations to buy or use drugs
  • Engaging in suspicious or secretive behaviors
  • Neglecting normal responsibilities
  • Unexplained need for money

The Effects of Combined Abuse

Cocaine is a stimulant, and heroin is a depressant. Heroin binds to opioid receptors after being converted into morphine.
People primarily abuse heroin for the euphoria it causes. When combined with cocaine, that euphoric rush can be more intense.

Other effects of heroin can be negative.

  • Warm skin flushing
  • Vomiting or nausea
  • Drowsiness
  • Slowed heart function
  • Reduced breathing
  • Dry mouth
  • Clouded mental function
  • Severe itching

As a stimulant, cocaine provides the “speed” element of a speedball. The initial effects of cocaine can be felt quickly

  • Irritability
  • Mental alertness
  • Intense energy
  • Overall happiness
  • Paranoia
  • Sensitivity to sound, light, and touch
  • Pupil dilation
  • Muscle twitching or tremors
  • Blood vessel constriction
  • Feelings of restlessness
  • Increased heartbeat, blood pressure, or temperature
  • Irregular heartbeat
  • Nausea

The effects of cocaine do not last as long as heroin. When someone initially takes a speedball, their respiratory rate may be mostly normal since both drugs are working together.

Once the cocaine wears off, it is possible for breathing to get to a potentially life-threatening level since only the heroin will be acting on the body. Most fatal opioid overdoses are the result of depressed breathing.

Potential for Overdose

Mixing two different substances always increase the risk of overdose. When someone experiences a fatal overdose, it is common for them to have used more than one drug.
A speedball can increase the risk of overdose for several reasons.

  • The breathing rate is reduced by heroin, while cocaine causes the body to use more oxygen. This push-pull effect takes a significant toll on the body.
  • The body is forced to process both drugs instead of only one. The body can’t metabolize the drugs quickly enough, resulting in an overdose.
  • In order to maintain the euphoric effect, people who use speedballs tend to inject the combination more frequently than those who use only one drug.
  • Because the effects of one drug may mask the effects of the other, people may take increasingly higher doses of both.

Long-Term Effects of Combined Use

Using heroin and cocaine together increases the risk of respiratory failure. A speedball also increases the risk of stroke, aneurysm, and heart attack.

Since most people who use speedballs inject the drug combination intravenously, there are certain consequences that are specific to this injection drug use. The risk of these consequences increases with long-term use. Intravenous drug use problems may include:

  • Skin infections and abscesses.
  • Endocarditis, which is an interior heart lining infection.
  • Needle tracks and scarring.
  • Increased risk of overdose.
  • Blood vessel damage.
  • HIV/AIDS due to sharing needles with people who are infected with the virus.

When It Is Time for Treatment

Anyone who experiences the negative effects of speedballs or an overdose as a result of using this drug combination should seek professional treatment. The following symptoms may indicate a speedball overdose:

  • Vomiting and nausea
  • Loss of consciousness
  • Difficulty walking
  • Violence or aggression
  • Tremors
  • Delusions or hallucinations
  • Drowsiness
  • Difficulty breathing
  • Agitation
  • Enlarged pupils
  • Convulsions

A speedball overdose is a medical emergency. If you witness an overdose, call 911 and stay with the person until help arrives.

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Treatment Options

Treating speedball addiction can be challenging since the medications commonly used for heroin addiction only help moderately with speedball addiction, according to the National Institute on Drug Abuse. There are no medications approved by the FDA to treat cocaine addiction.

Some research published in the American Journal on Addictions states that certain medications may help with cocaine addiction, including dopamine-blocking agents or agonists, anti-craving agents, and antidepressants. These drugs may be given along with those prescribed to treat heroin addiction.

Medication is only one prong of addiction treatment, however. Therapy is the backbone of a program, and various therapies may be applied to those who struggle with speedball abuse.

Powder on a scale

Both heroin and cocaine are dangerous on their own. When they are combined, the potential for serious effects, including overdose, is greater.


(April-June 1991) Heroin Addiction: Neurobiology, Pharmacology, and Policy. Journal of Psychoactive Drugs. Retrieved February 2019 from

(July 2018) What is Cocaine? National Institute on Drug Abuse. Retrieved February 2019 from

Mixing Drugs. Harm Reduction Coalition. Retrieved February 2019 from

(June 2013) Real Teens Ask About Speedballs. National Institute on Drug Abuse for Teens. Retrieved February 2019 from

Potential Complications of IV Drug Use. Semel Institute for Neuroscience and Human Behavior. Retrieved February 2019 from

(December 2016) Drug Overdose. Healthline. Retrieved February 2019 from

Research on Heroin. National Institute on Drug Abuse. Retrieved February 2019 from

(2003). Pharmacologic Treatments for Heroin and Cocaine Dependence. American Journal on Addictions. Retrieved February 2019 from

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