Updated on April 3, 2024
5 min read

What You Need to Know About Speedballing

Key Takeaways

What is Speedballing?

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. This generates an intense high.

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

However, speedballing is a very dangerous form of drug abuse. It can lead to fatal consequences.


Online Therapy Can Help

Over 3 million people use BetterHelp. Their services are:

  • Professional and effective
  • Affordable and convenient
  • Personalized and discreet
  • Easy to start
Find a Therapist

Answer a few questions to get started

Woman drinking coffee on couch

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 on their own.

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 can potentially lead to an addiction to one or both drugs. Without treatment, speedballing can easily ruin lives.

Cocaine and heroin may also include fentanyl, a potent synthetic opioid. Because of its potency, fentanyl can increase the risk of addiction to cocaine, heroin, or both.


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

Once the stimulating effects of cocaine wear off, your slow breathing can be fatal. Once these effects wear off, you will experience the full effects of heroin. 

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.

Heroin and cocaine overdose are two of the top ten most common causes of overdose deaths in the United States.

Centers for Disease Control and Prevention, 2018

Speedball Overdose Symptoms

Speedball overdose symptoms include:

  • Slowed, unstable, or shallow breathing
  • Erratic heart rate
  • Slurred speech or inability to speak
  • Pale, cold, or sweating skin
  • Dry heaving and vomiting
  • Blue-colored fingernails or lips
  • Passing out
  • Gurgling or choking sounds

If you or someone around you exhibits any of these symptoms, call 911 immediately. Describe the symptoms as detailed as possible so they can contact the appropriate response team. While you wait, lay the person overdosing slightly on their side and bend their top knee inward to keep their airways open.

Get Professional Help

BetterHelp can connect you to an addiction and mental health counselor.

Find a Therapist

Answer a few questions to get started

Rehab Together

Side Effects of Speedballing 

Heroin is a depressant, and cocaine is a stimulant. The opposing side effects of this combination lead to a push-pull effect. When taken together, the drugs will create a drug interaction that will give you an intense rush while also stopping each 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. This is so you don’t become drowsy or fall asleep.

The combination is also said to have an easier comedown. However, combining heroin and cocaine can have severe side effects, including:

Short-Term Side Effects of Speedballing

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 rate
  • Slowed heart rate
  • Mental impairment
  • Incoherence
  • Confusion
  • Blurred vision
  • Paranoia
  • Stupor 

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

Long-Term Side Effects of Speedballing

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

Phone, Video, or Live-Chat Support

BetterHelp provides therapy in a way that works for YOU. Fill out the questionnaire, get matched, begin therapy.

Get Started

Answer a few questions to get started

Woman drinking coffee on couch

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 but used consecutively).

However, those who use cocaine may experience more severe health problems and side effects. These side effects include:

Short-Term Side Effects of Cocaine

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

Long-Term Side Effects of Cocaine

Long-term and negative 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)

You can risk addiction or overdose if you frequently use cocaine. This can also lead to physical and mental dependence on the drug. 

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. Aside from the initial high, using heroin leads to short- or long-term side effects, including:

Short-Term Side Effects of Heroin

Short-term effects of heroin drug use include:

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

Long-Term Side Effects of Heroin

The more you use heroin, the more significant the toll on your body becomes. The long-term side effects of heroin use include:

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

Heroin is an addictive opioid with dangerous side effects. Compulsive heroin use often overtakes daily life. Many people continue heroin drug use, despite the damage it causes the body.

Addiction Treatment

Substance abuse, especially polydrug use, is a serious, dangerous issue. It can ruin lives and lead to a high risk of death. If you or a loved one suffers from substance use, seek medical advice immediately at a qualified treatment center.

Rehab centers will help you undergo detox safely and set you up for a successful recovery.

Get matched with an affordable mental health counselor

Find a Therapist

Answer a few questions to get started

Updated on April 3, 2024
8 sources cited
Updated on April 3, 2024
  1. Real Teens Ask About Speedballs, National Institute on Drug Abuse (NIDA), 2020, https://archives.drugabuse.gov/blog/post/real-teens-ask-about-speedballs

  2. 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

  3. 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

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

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

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

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

  8. 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 : 1123-36, https://pubmed.ncbi.nlm.nih.gov/9618415/

Related Pages