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What Is a Speedball? What Are the Dangers?

People who struggle with drug abuse and addiction often spend time seeking the next high, hoping that it will be bigger and better than the one before. Sometimes, in attempts to achieve this ultimate high, they’ll combine or more substances. In other instances, they might combine drugs to take the edge off of one or the other substances. However, while they may be successful at getting the kind of high they seek, they put themselves at risk of experiencing not only the individual effects of each drug, but the potentially dangerous side effect interaction of both. The result can be extreme mental and/or physical harm, overdose, or even death.

Speedballs are just one such combination—a potent mix that can lead to severe consequences for those who try it even once.1

Elements of a Speedball

The term speedball is commonly applied to any combination of two different drug types: an opioid and a stimulant.The classic “speedball” is specifically heroin and cocaine1—both potent, illicit drugs that are risky on their own, let alone together.

Some people will concoct their own “speedballs” by substituting other drugs, with combinations that might include incorporate:2,3

  • Methamphetamine or amphetamine as the stimulant (sometimes called “goof balls”).
  • Opioid painkillers in place of heroin.

In the case of a speedball, the heroin and cocaine are mixed together and injected in one shot, which results in a rapid onset of intense effects.4

The National Institute on Drug Abuse states that people may take speedballs as a way to get an intense high that amplifies the euphoria and minimizes the negative side effects of each drug. In theory, the energizing action of the stimulant can counteract some of depressant, sedating effects of heroin, while the heroin can allay the agitating effects of the cocaine.1 However, as with many drug risks, the reality doesn’t turn out to be quite that simple.

Effects of the Drug Combination

While the combined subjective effects of heroin and cocaine may vary from one individual to the next, at the neurochemical level, the reinforcing effects of the combination are likely to be stronger than each drug taken alone. The combination involves both mu opioid receptor activation-related dopamine release and cocaine-directed increases in dopamine activity in key brain regions,5 resulting in an extremely strong reinforcing effect that compels people to injecting this drug combination over and over. This can be extremely dangerous as, for a number of reasons, even one speedball injection can be deadly. The risks of the heroin/cocaine combination are many and very significant.

Risks of Use

A person injecting a speedball may experience the negative side effects of both drugs, including:1

  • Anxiety.
  • Panic.
  • Paranoia.
  • Confusion.
  • Hypertension.
  • Racing heartbeat.
  • Trouble thinking or speaking clearly.
  • Cognitive impairment.
  • Stupor.

The combination may be fatal. Speedball users have died from:1

  • Stroke.
  • Aneurysm.
  • Heart attack.
  • Fatal respiratory depression.*

*One of the biggest risks of using speedballs is related to the fact that the effects of cocaine wear off faster than heroin. As a result, if the person uses much more heroin than their system can handle, they may experience an opioid overdose and respiratory failure as the stimulant effects of cocaine subside.1

Long-Term Effects

A major concern for those who continuously inject speedballs is the cumulative risk of overdose. However, other long-term potential consequences of injecting heroin and cocaine include, but are not limited to:6,7

  • Abscesses, cellulitis, and/or tissue necrosis from injection use.
  • Contracting HIV or other bloodborne diseases through injection use.
  • Vascular inflammation and clogging 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 impairments.
  • Increased risk of developing Parkinson’s disease.
  • Problems with impulsivity.
  • Addiction.

Getting Help for Speedball Abuse or Addiction

According to a publication from the National Institute on Drug Abuse, a challenge in the treatment of speedball abuse is that treatments for heroin addiction are only moderately effective in helping those who use speedballs. There is no FDA-approved medicine to treat cocaine addiction, and the medications targeted specifically for opioid addiction won’t address the addiction to cocaine.8

However, addiction treatment involves more than medication and, in fact, behavioral therapy is at the core of treatment, even when medication is prescribed. Therapies may include cognitive-behavioral therapy, which helps you to uncover the reasons for using heroin and cocaine and help you to adjust harmful beliefs and learn new and better ways of coping.9 The Matrix Model is another therapeutic method that is geared toward the treatment of stimulant addiction and incorporates a number of different approaches, including relapse prevention, self-help program involvement, and drug abuse education.10

With the long list of dangers that injecting speedballs brings, those who are struggling with the abuse of this substance combination are in urgent need of addiction treatment. Reaching out for treatment could save your life or the life of someone you love.

References:

  1. National Institute on Drug Abuse. (2013). Real Teens Ask About Speedballs.
  2. Trujillo, K. A., Smith, M. L., & Guaderrama, M. M. (2011). Powerful behavioral interactions between methamphetamine and morphinePharmacology, biochemistry, and behavior99(3), 451–458. 
  3. Center for Addiction and Mental Health. (2010). Do You Know…Cocaine.
  4. Cornish JL1, Lontos JM, Clemens KJ, McGregor IS. (2005). Cocaine and heroin (‘speedball’) self-administration: the involvement of nucleus accumbens dopamine and mu-opiate, but not delta-opiate receptorsPsychopharmacology (Berl), 180(1), 21-32
  5. National Institute on Drug Abuse. (2016). Cocaine.
  6. Center for Substance Abuse Research. (2013). Heroin.
  7. National Institute on Drug Abuse. (2005). NIDA Notes: Research on Heroin.
  8. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disordersThe Psychiatric clinics of North America33(3), 511–525. 
  9. National Institute on Drug Abuse. (2018). The Matrix Model (Stimulants).