Speedball (Heroin & Cocaine)

Combining heroin and cocaine is known as a speedball. This drug mixture significantly increases the danger of a fatal overdose, among other risks
Evidence Based
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What is a Speedball?

A speedball combines heroin and cocaine. Heroin is a depressant, while cocaine is a stimulant. The combination creates a ‘push-pull’ reaction in the brain and body.

People speedball to achieve an intense rush. The aim is to experience the positive highs of both drugs while reducing each substance's adverse effects.

However, speedballing is dangerous and can lead to fatal consequences.

heroin cocaine

Effects of Cocaine Use

Cocaine sends high levels of dopamine into the areas of the brain that control pleasure. Dopamine is a natural chemical messenger in the body. 

The buildup of dopamine leads to intense feelings of alertness and energy. The effects of cocaine wear off after 15 to 30 minutes, depending on how it is used (IV or snorted - not mixed together but used consecutively).

Short-term stimulant effects of cocaine include:

  • An intense rush of energy and alertness
  • Extreme sensitivity to touch, sound, and light
  • Intense happiness
  • Anger or irritability
  • Paranoia
  • Decreased appetite 
  • Increased heart rate
  • Mental impairment
  • High blood pressure

Those who use cocaine often may experience more severe side symptoms, mental health problems, and long-term effects.

Long-term and adverse side effects of cocaine include:

  • Headaches 
  • Addiction
  • Convulsions and seizures 
  • Heart disease
  • Heart attack
  • Stroke 
  • Mood problems 
  • Sexual troubles 
  • Lung damage 
  • Stomach problems
  • HIV or hepatitis (if injected) 
  • Bowel decay (if swallowed)
  • Loss of smell, nosebleeds, runny nose, and difficulty swallowing (if snorted)

Users may develop strong cravings for cocaine and the intense rush it delivers. But the more a person uses cocaine, the more the brain will adapt to it. 

Stronger and more frequent cocaine doses can lead to long-term adjustments in the brain’s chemistry. The body and mind will begin to rely on cocaine. This can lead to mental impairment and a lack of sleep. Reaction times may become slower. 

Users will need a more potent dose to experience the same high. This can lead to addiction or overdose. 

Effects of Heroin Use

Heroin use leads to euphoric or pleasurable feelings in the body and mind. These effects are experienced almost immediately and last up to a few hours.

Following the initial high, a heroin user may feel drowsy for several hours.

Short-term effects of heroin drug use include:

  • A euphoric and intense rush
  • Dry mouth
  • Itchiness 
  • Legs and arms feel heavy 
  • Pain relief
  • Nausea
  • Vomiting
  • Warm and flushed skin 
  • Slowed heart rate 
  • Slowed breathing
  • Incoherence

The more an individual uses heroin, the more significant the toll on their body and mind. 

Long-term and adverse side effects of heroin use include:

  • Addiction
  • Constipation
  • Lack of sleep
  • A perforated septum (if snorted)
  • Stomach cramps
  • Withdrawal

Heroin is an addictive opioid drug. Once someone is addicted to heroin, the drug's effects on the body can become more dangerous. Compulsive heroin use often overtakes daily life, and many people continue heroin drug use despite the damage it causes the body.

Short- and Long-term Effects of Speedballing 

Heroin is a depressant, and cocaine is a stimulant, so the drug combination delivers a ‘push-pull’ effect. When taken together, the drugs give users an intense rush while wiping out the other's adverse effects. In theory, heroin is meant to reduce cocaine-induced agitation and jitters. Cocaine is supposed to cancel out some of the sedating effects of heroin, so users don’t become drowsy or fall asleep.

The combination of cocaine and heroin is said to induce a more pleasurable high and an easier comedown. When cocaine and heroin mix, the side effects of each may feel more intense.

Short-term side effects of speedballing include:

  • An intense rush 
  • High blood pressure
  • Fast or irregular heartbeat
  • Anxiety and agitation
  • Increased body temperature
  • Drowsiness
  • Slowed breathing
  • Slowed heart rate
  • Mental impairment
  • Incoherence
  • Confusion
  • Blurred vision
  • Paranoia
  • Stupor 

A significant concern for people who speedball is the increased risk of overdose. 

Other long-term side effects of speedballing include:

  • Abscesses, cellulitis, and tissue necrosis through injection
  • Contracting HIV or other diseases through injection
  • Vascular inflammation and blocking of the blood vessels from injected particles 
  • Anorexia and malnourishment
  • Ischemic or hemorrhagic stroke
  • Other ischemic organ damage
  • Ulcerations in the GI tract
  • Kidney and liver injury
  • Heart muscle inflammation
  • Aortic ruptures
  • Heart attack
  • Seizures
  • Long-lasting cognitive and mental impairments
  • Increased risk of developing Parkinson’s disease
  • Issues with impulsivity
  • Addiction

Why is Speedballing Dangerous?

Combining cocaine with heroin can cause dangerous side effects. These side effects are typically associated with the abuse of either drug individually.

Health Problems

Speedballing can lead to uncontrolled and uncoordinated motor skills. It also increases the risk of significant health issues like stroke, heart attack, aneurysm, and respiratory depression or failure.

Respiratory failure or depression is particularly likely with speedballs. This is because the effects of cocaine wear off more quickly than the effects of heroin. 


Speedballing is a combination of two highly addictive drugs. It is possible to develop an addiction to both drugs. Without treatment, speedballing can easily ruin lives.

Cocaine and heroin aren’t always pure and can include other substances, like fentanyl. Fentanyl is a potent, synthetic opioid. It is similar to morphine but is significantly more powerful.

As fentanyl is so potent, it takes a small amount of it to produce a high. Because of this, fentanyl is added to other substances like heroin and cocaine to reduce costs.

Fentanyl is often associated with contaminating opioids. However, it’s increasingly used for mixing substances. There have been several cases of unintentional fentanyl overdoses by people who thought they were taking cocaine.


Speedballing significantly increases the risk of overdose. Most fatal drug overdoses occur when someone uses more than one substance at a time.

Fatal slowing of the breathing can result when the stimulating effects of cocaine wear off. Once these effects wear off, the full effects of heroin are experienced. 

Additionally, the effects of each drug may be muted when someone speedballs. This false sense of sobriety may result in frequent re-dosing. This could eventually lead to overdosing.

Cocaine and heroin are two of the top ten drugs most frequently used in overdose deaths in the United States.

Centers for Disease Control and Prevention, 2018

Ready to Make a Change?


Real Teens Ask About Speedballs, National Institute on Drug Abuse (NIDA), 2020, https://teens.drugabuse.gov/blog/post/real-teens-ask-about-speedballs

Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016, National Vital Statistics Reports, Centers for Disease Control and Prevention, 2018, https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf

Armenian P, Whitman JD, Badea A, et al. Notes from the Field: Unintentional Fentanyl Overdoses Among Persons Who Thought They Were Snorting Cocaine — Fresno, California, January 7, 2019. MMWR Morb Mortal Wkly Rep 2019;68:687–688, https://www.cdc.gov/mmwr/volumes/68/wr/mm6831a2.htm

What are the short-term effects of cocaine use?, National Institute on Drug Abuse (NIDA), 11 Jun. 2020, https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-short-term-effects-cocaine-use

What are the long-term effects of cocaine use?, National Institute on Drug Abuse (NIDA), 6 Jun. 2020, https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use 

What are the immediate (short-term) effects of heroin use?, National Institute on Drug Abuse (NIDA), 28 May. 2020, https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use

What are the long-term effects of heroin use?,  National Institute on Drug Abuse (NIDA), 28 May. 2020, https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use 

Negus, S S et al. “Discriminative stimulus effects of a cocaine/heroin "speedball" combination in rhesus monkeys.” The Journal of pharmacology and experimental therapeutics vol. 285,3 (1998): 1123-36, https://pubmed.ncbi.nlm.nih.gov/9618415/

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Updated on: September 25, 2020
Ellie Swain
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Medically Reviewed
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Annamarie Coy,
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