Speedballing: Mixing Opioids and Stimulants

Misuse of both opioids and stimulants on their own is associated with many serious health risks. However, mixing the two can exacerbate the immediate dangers and potential long-term consequences, especially when used intravenously.^{1, 2}

This page will define the practice of “speedballing” and explain its subjective effects and health risks.

What is a Speedball?

A “speedball” is a slang term that most commonly refers to a combination of heroin and cocaine. Both substances are dissolved and injected directly into the bloodstream together for an intensely euphoric rush.¹

Sometimes people may use one syringe to mix the cocaine and heroin and then share the mixture by filling other syringes. This is known as “backloading”³ and is a practice that could potentially increase some of the health risks associated with injection drug use.

Mixing Other Substances with Speedballs

A speedball generally refers to a combination of heroin and cocaine, though people may use other combinations of opioids and stimulants for similar subjective effects. Such mixtures might include stimulants such as:

• Methamphetamine (meth and heroin combined is sometimes referred to as a “goofball”).⁴
• Prescription stimulant medications (such as Adderall or Ritalin).

Other opioids that may be used in a stimulant/opioid combination include:

• Morphine.
• Fentanyl.
• Hydrocodone.
• Oxycodone.

How does a Speedball Work?

A speedball works by eliciting a pleasurable “push-pull” effect due to the opposing stimulant and depressant effects of the combination.¹

The desirable effects of heroin or other opioids may include:^{1, 5}

• Euphoria.
• Sleepiness.
• Relaxation.
• Pain relief.

Desirable effects of cocaine or other stimulants can include:

• Alertness and heightened energy.
• Subjective boost to cognition.
• Improved confidence.
• Increased libido.

Both classes of drugs produce a pleasurable euphoric feeling which can synergistically reinforce problematic patterns of misuse. ^{5, 6, 7, 8}

People that use speedballs may also do so to counteract the unwanted side effects of each drug when it is taken on its own.¹ For example, heroin might make someone overly drowsy, so they may use a stimulant simultaneously to keep them awake.

Unfortunately, while speedballing may mitigate some of the negative subjective effects of using one drug at a time, it may still introduce the same health risks associated with each individual substance and may additionally give rise to some unique risks.¹

How Dangerous are Speedballs?

Speedballing carries the same risks that are found with misuse of opioids and stimulants individually, as well as added dangers caused by combining the two.¹

Misuse of either opioids or stimulants also puts people at risk of overdose. Respiratory arrest is a considerable risk with speedballs since some of the physiologically stimulating effects may wear off before certain opioid effects do. Once this happens, the full brunt of the respiratory depressing opioid effects is felt, potentially resulting in fatal slowing of breathing.¹

Speedballing can also:¹

• Result in uncontrolled movements.
• Increase the risk of heart attack and stroke.
• Increase the risk of a brain aneurysm.

Some studies suggest that co-use of both cocaine and heroin is especially reinforcing of problematic patterns of use, and people that combine stimulants and opioids may have poorer treatment outcomes.¹¹

Injection drug use (the preferred route of administration for speedballs) carries several other serious risks, including:²

• Scars (e.g., “track marks”).
• Abscess or other skin infections.
• Collapsed veins.
• Endocarditis (inflammation of the heart).
• Contraction of infectious diseases (like HIV or Hepatitis C).

Polysubstance Use and Its Risks

Polysubstance use (i.e., using more than one substance simultaneously or consecutively), whether stimulant/opioid or any other type of substance, can exacerbate the already serious risks and consequences of substance use.¹²

It may be more difficult for people to get sober and remain in recovery when they have been misusing multiple substances. When compared to use of a single substance, misuse of multiple drugs may be more prevalently associated with:^{12, 13}

• Poorer retention in treatment programs.
• Higher relapse rates.
• Increased fatality rates (especially when the misuse involves opioids).

While recovery from addiction to multiple substances is especially difficult, there is hope. Often, it just takes getting the right support. If you or a loved one struggles with substance use disorders, please reach out to an admissions navigator at to start treatment at a River Oaks facility, which operates both an inpatient rehab near Tampa and an outpatient rehab in Riverview, FL.

You can also verify online whether your health insurance covers rehab at River Oaks by completing the confidential , or you can get information on other ways to pay for rehab by completing the financing questionnaire below.