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The Dangers of Using Heroin with Cocaine (Speedball)

Jennifer Cousineau MSCP, LPCI, NCC

Medically reviewed by

Jennifer Cousineau MSCP, LPCI, NCC

March 1, 2019

Also known as polydrug abuse, individuals often take multiple drugs with different effects to create new highs. A common polydrug combination among abusers is the use of heroin and cocaine (powder or crack) simultaneously. Also known as a “speedball,” this combination of a stimulant and a depressant offers users a completely different and dangerous high.

What is Heroin?

Heroin is in a category of drugs labeled opioids. Opioids are a commonly abused drug in the US that come in various forms, including legally prescribed pain medication as well as illegally sold intravenous forms of heroin and many other variations in between.

Heroin is made from morphine which is derived from the seed pods of the opium poppy plant such as those that are grown in Asia, Europe, and the Middle East. Heroin can come in many forms and take on many different appearances, which can sometimes make it difficult to identify.

It is common to have heroin portrayed as a clear, injectable fluid, but it can also come in powder or tar form, often being brown or black in color. While injecting is commonly associated with heroin use, abusers can also snort and smoke the drug.

Street names of heroin include:

  • Smack
  • Thunder
  • Junk
  • Horse
  • China White
  • Skag

Signs of Heroin Use and Abuse

Heroin turns back into morphine once it hits the bloodstream and spreads rapidly through the brain searching for opioid receptors to bind to. These opioid receptors are often associated with feelings of pleasure and pain, giving the user a sense of invincibility and euphoria.

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The short-term effects of heroin use can occur immediately after use, and often include symptoms such as:

  • Dry mouth
  • Warm flushing of the skin
  • Decreased respirations (breaths)
  • Euphoric “rush”
  • Increased pain tolerance
  • Nausea
  • Vomiting

Long-term effects from repeated and prolonged use of heroin can include:

  • Loss of appetite
  • Tooth loss/rot
  • Constipation
  • Severe itching
  • Cold sweats
  • Pustules or abscesses on face, neck, and injection sites
  • Muscle and bone pain
  • Respiratory issues
  • Depression
  • Addiction

What is Cocaine?

Cocaine is a drug derived from the leaves of a South American coca plant. Cocaine is commonly seen in two forms: powdered or rock. The powdered form of cocaine, popularly referred to as “blow” on the streets, is snorted or dissolved in water to be injected. Its rock form, known on the street as “crack” or “rock,” is still derived from the coca plant, but is chemically processed into a solid form that can be smoked.

Cocaine is a popular drug among young adults, most commonly abused in the age group of 18- to 25-year-olds. It has been referred to as the “caviar of street drugs” due to its high price and popular portrayal in movies as being used by the wealthy and powerful. Do not let this image fool you, cocaine is a potent drug that can cause severe effects on heart and brain function, as well as powerful emotional swings.

Signs of Cocaine Use and Abuse

Cocaine affects the body by increasing levels of dopamine, a naturally occurring chemical in the brain, to an unnatural level. This increase of dopamine can lead to a build up between nerve cells, which leads to a disruption of the body’s natural chemistry, causing the user to feel a high.

This rush of dopamine can lead a user to feel excessive reward for a mundane task such as eating an apple, causing the apple to taste better to the user than it ever has before. This positive reward cycle is what keeps a cocaine abuser coming back for more.

Short-term effects of cocaine use can include:

  • Extreme happiness
  • High-level alertness
  • Paranoia
  • Irritability
  • Loss of appetite
  • Increased heart respiration
  • Increased heart rate

Long-term effects of cocaine use can include:

  • Weight loss from malnutrition
  • Destruction of nasal passageways (from snorting)
  • High blood pressure
  • Heart attack
  • Stroke
  • Damage to blood vessels
  • Psychosis or mental breakdowns
  • Addiction (even after just one use)

The Dangers of Mixing Heroin With Cocaine or Crack Cocaine

A popular choice among polydrug users comes in the form of a heroin and cocaine combination known on the street as a “speedball.” Mixing a stimulant such as cocaine with a depressant like heroin can create a euphoric high combined with a feeling of relaxation, while combating the drowsiness and sedation that can commonly be caused by using depressants alone.

This crossover of the symptoms of both drugs is what can sometimes lead to a fatal overdose, causing the abuser to believe they are less high or more tolerant than they really are, which can sometimes prompt them to take more of one or both drugs.

While there are many dangers that come with combining heroin and cocaine, the most common cause of death from a speedball comes from a delayed overdose response to the stimulant. Because the effects of stimulants such as cocaine wear off more quickly than the effects of depressants like heroin, a user may attempt another dose of cocaine to get back to their previous high.

This additional dose of cocaine can lead to a fatal opioid overdose by causing the user to feel a false sense of stability from using the two drug simultaneously. The effects of this delayed overdose cannot be felt by the user until it is too late.

Get Help Today

The importance of finding help for yourself or a loved one increases exponentially with polydrug abuse. Each drug comes with its own set of symptoms, withdrawals, and consequences that need to be treated. Whether a user has endured years of prolonged use or has only used a few times, quitting can be a long and hard road. We are here to help you or a loved one begin your journey.

Our rehab centers are able to treat a variety of drug addictions, including polydrug abuse. With treatment program options that are designed to treat addiction from a multidisciplinary approach, we are dedicated to assisting you to overcome all aspects of addiction including mental, physical, and social symptoms.

Contact us today at to learn more about our rehab centers and what type of treatment options we have to offer

U.S. National Library of Medicine - Cocaine: history, use, abuse

National Institute on Drug Abuse - Cocaine

Center For Disease Control And Prevention - Today’s Heroin Epidemic

Hindawi - The Destructive Capacity of Drug Abuse

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