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Speedball: Deadly Combination of Substances

A speedball is an injectable combination of an opioid (like heroin) and a stimulant (like cocaine).

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Some people believe combining these drugs leads to a stronger, more persistent, safer high. In reality, mixing drugs can lead to unpredictable results. Sometimes, this combination leads to sudden death. 

What Is a Speedball?

A speedball combines a stimulant and an opioid in a dose users shoot into the veins with a needle.[1] Some people call speedballs other terms like goofball or bombita.[1,2] 

In 2023, researchers said combination drugs like speedballs were common in multiple locations throughout the United States, including the following:[2]

  • Seattle, Washington
  • San Diego, California 
  • Denver, Colorado
  • Dayton, Ohio

It’s critical to know what this combination drug is and how it works since it seems to be more popular now than it was previously. 

What’s Inside a Speedball?

A classic speedball contains heroin and cocaine.[1] However, some dealers experiment with the elements inside their products. 

Common substitutions for heroin include the following:[3]

Common substitutions for cocaine include the following:[3]

Why Do People Use Speedballs?

Researchers say people who abuse speedballs do so for the following reasons:[1]

  • Bigger rush or high 
  • Side effect management (such as using opioids to ease amphetamine-related anxiety)
  • Unique experience

Other researchers say that people use speedballs due to drug myths. For example, some people believe meth protects them from an opioid overdose.[2] They may think a speedball is safer than using heroin independently. 

Why Is Speedballing Dangerous?

Mixing drugs is often riskier and less predictable than using single substances. Combining opioids and stimulants is particularly dangerous for these reasons:

Harder to Quit 

Substances that produce a big rush are harder to quit than those that don’t. Users say speedballs produce a more pleasurable trip than using either drug independently. 

The high is blamed for the difficulty speedball users have in quitting their drug of choice and their higher relapse risks.[4] The drug combination is just too powerful to quit without help. 

Enhanced Vein Damage 

Injecting any drug with a needle is risky, but a speedball is particularly dangerous. Cocaine acts as a local anesthetic, making it harder for users to find the right injection site. Multiple attempts increase the risk of deep infections.[5] 

Poor Mental Health 

Speedball users subject brain cells to conflicting signals. The damage can linger, and mental health challenges can appear. Researchers say speedball users have more problems with depression and anxiety than single-drug users.[6]

Higher Death Rates

The stimulant in a speedball constricts blood vessels, which increases the body’s oxygen needs. But the opioid inside the dose slows breathing rates, reducing oxygen levels.[7] These two conflicting actions can lead to brain cell death. Eventually, all systems shut down. 

Researchers say people who combine opioids and stimulants have more than twice the risk of fatal overdose than those who use one drug alone.[8] 

A speedball may seem safer to some users. But in reality, the opposite is true. 

Contaminated Speedballs 

For decades, experts have warned about an overdose epidemic within the United States. Contamination is worsening this issue. 

In 2013, experts noticed illegal fentanyl (and analogs) entering the drug market.[9] These substances are much stronger than traditional opioids like heroin, and they’re impossible to see, taste, or smell. People who took contaminated doses started overdosing, and they may have never known their drugs were tainted. 

In a study of drug users, 64% considered a speedball their intoxicant of choice. About half of all drug users perceived fentanyl in their drugs half, most of, or all of the time.[10] 

Any speedball you buy from a dealer could contain fentanyl or one of its analogs. You may never know the drug is there until you overdose. Contamination makes a speedball even more dangerous. 

Do You Have to Detox?

Regular speedball users can benefit from a detox program. Common ingredients in speedballs cause persistent brain changes that can make relapse more likely.

Opioid withdrawal is a life-threatening condition caused by the regular use of opioids, including those inside a speedball.[11] Vomiting and diarrhea can lead to dehydration, organ failure, and death. Medications can ease your symptoms and allow you to detox both safely and successfully.

Stimulant withdrawal doesn’t cause the flu-like symptoms opioids do.[12] But stimulants can lead to intense cravings that are hard to ignore. A detox program can help you recover in a protected environment, so you don’t relapse immediately.

If you’ve been using speedballs, a detox program is the safest way to get well. It can also set the foundation of heroin addiction treatment, easing you into therapy that will be the backbone of your recovery efforts. 

Updated March 19, 2024
  1. Trujillo KA, Smith ML, Guaderrama MM. Powerful behavioral interactions between methamphetamine and morphine. Pharmacol Biochem Behav. 2011;99(3):451-458. doi:10.1016/j.pbb.2011.04.014
  2. Ondocsin J, Holm N, Mars S.G., et al. The motives and methods of methamphetamine and ‘heroin’ co-use in West Virginia. Harm Reduct J 20, 88 (2023).
  3. Speedballing: Mixing stimulants and opioids. Florida Department of Children and Families. Accessed September 19, 2023.
  4. Duvauchelle C, Sapoznik T, Kornetsky C. The synergistic effects of combining cocaine and heroin (“speedball”) using a progressive-ratio schedule of drug reinforcement. Pharmacology Biochemistry and Behavior. 1998;61(3):297-302.
  5. Rhodes T, Briggs D, Kimber J, Jones S, Holloway G. Crack–heroin speedball injection and its implications for vein care: qualitative study. Addiction. 2007;102(11):1782-1790.
  6. Malow R, West J, Corrigan S, Pena J, Lott W. Cocaine and speedball users: Differences in psychopathology. Journal of Substance Abuse Treatment. 1992;9(4):287-291.
  7. Ahmed S, Sarfraz Z, Sarfraz A. Editorial: A changing epidemic and the rise of opioid-stimulant co-use. Front Psychiatry. 2022;13:918197. Published 2022 Jul 6.
  8. Palis H, Xavier C, Dobrer S., et al. Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study. BMC Public Health. 2022:2084.
  9. Jones CM, Bekheet F, Park JN, Alexander GC. The evolving overdose epidemic: Synthetic opioids and rising stimulant-related harms. Epidemiol Rev. 2020;42(1):154-166. doi:10.1093/epirev/mxaa011
  10. Park J, Weir B, Allen S, Chaulk P, Sherman S. Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD. Harm Reduct J. 2018;15:34.
  11. Shah M, Huecker M. Opioid withdrawal. StatPearls. Published July 21, 2023. Accessed September 19, 2023.
  12. Cocaine withdrawal. U.S. National Library of Medicine. Published January 2, 2023. Accessed September 19, 2023.
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