Trusted Content

What Is A Pharmaceutical Speedball?

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 19, 2019

A speedball is a combination of two drugs, specifically a central nervous system stimulant and a drug with major depressant properties, that are taken at the same time.

Traditionally, a speedball was a combination of cocaine and morphine or cocaine and heroin, administered intravenously, either in a mixture together within one needle, or separately and simultaneously through two needles. Also called powerballing, people may snort these or other combinations of drugs to create the speedball effect. This method of drug abuse has morphed into something even more dangerous, as people today now combine a wider variety of drugs in this potentially lethal pairing.

What Is A Speedball?

A speedball is a combination of two drugs, specifically a central nervous system stimulant and a drug with major depressant properties, that are taken at the same time. The former includes cocaine, methamphetamine, amphetamines, including ADHD drugs, while the latter may include opiates, benzodiazepines, or barbiturates. A pharmaceutical speedball is when one or both are pharmaceutically sourced drugs.

Why Are People Abusing These Drugs?

The prevalence of prescription drug abuse largely stems from the rise of these drugs being prescribed in greater amounts, thus increasing their availability on the street for use illicitly. For instance, the National Institute on Drug Abuse (NIDA) reports that “the number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013.”

Research published in the journal Pharmacology Biochemistry and Behavior proposed that the following are the three most typical reasons why a person takes these combinations of drugs.

  1. “administration of the combination produces effects greater than either drug alone (such as a greater high or greater rush);
  2.  administration of one decreases the side-effects of another (such as the opiate decreasing cocaine-induced agitation or anxiety, or conversely, cocaine tempering opiate-induced sedation);
  3.  the combination produces unique subjective effects desired by the user”

When a person is speedballing, they experience a rapid high and elevated mood, which is then followed by a longer-lasting euphoric state, and countered by the relaxing effects of the depressant. The stimulant properties contradict the drowsiness that may occur from the other drug, while the depressant tempers the anxiety, restlessness, heart palpitations, and other symptoms that might result from the stimulant.

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The Dangers Of Mixing Drugs

Just because you have tried each of the drugs individually without any serious complications does not mean that you will continue to be immune from these risks when you utilize them together. Drugs are chemicals, thusly they hold the potential to cause chemical reactions amongst themselves and within your body’s delicate chemistry. Keep in mind, if you are combining a pharmaceutical with a street drug, such as cocaine or heroin, drugs that are commonly cut with other substances, your risk of an adverse reaction is even greater.

Scientists admit that not enough is known about cocaine-opiate, and other stimulant-depressant combinations. They currently engage in ongoing research to better understand these interactions and seek the best venue for their treatment. What they and addiction specialists do know is this: anytime a person engages in polydrug use, their risk of serious consequence, including death, greatly increases.

This entails any hazard that is associated with the drug as it stands alone, paired with the increased risk that results from the two drugs used together. These risks include (as listed by NIDA for Teens):

  • A state of general confusion
  • Incoherence
  • Blurred vision
  • Stupor
  • Drowsiness
  • Paranoia
  • Mental impairment because of lack of sleep

They continue to list these more severe threats which might result in death, such as:

  • Stroke
  • Heart attack
  • Aneurysm
  • Respiratory failure

NIDA cites the following risks that are associated with an injected cocaine/heroin speedball. The former two may apply to other combinations, while the latter may also apply to other injected speedball combinations:

  • Greater severity of psychiatric disorders
  • Higher incidence of failure in drug abuse treatment
  • Increased risk of contracting HIV

When you use these drugs together, your body is caught in a dangerous, and at times, deadly tug of war. Each drug exerts specific impact and damage on your body. The way the drug alters your body’s chemistry differs from drug to drug, thus when you are using two drugs simultaneously, your body is receiving mixed signals, signals that at times may even exert opposite impacts on your body and brain.

Your body is being stimulated and depressed at the same time, or within a very short period of time. This drastically impairs your body’s crucial life-support systems while each substance directly battles the other in unnatural ways that make health risks and side effects much worse.

Respiratory depression resulting in respiratory failure is one of the most serious risks, caused, as NIDA explains “because the effects of cocaine wear off far more quickly than the effects of heroin. Fatal slowing of the breathing can occur when the stimulating cocaine wears off and the full effects of the heroin are felt on their own.”

Your heart is an organ caught in the middle. The stimulant causes your heart rate to climb and become rapid or irregular, then as the depressant drug takes over, it is suddenly being told to slow down. This puts an inordinate measure of strain (and damage) on this vital organ, resulting in cardiac complications, including cardiac arrest. This is one of the greatest reasons why fatalities exist from these types of drug duos.

Another risk of fatality arises directly from one of the effects that an individual is likely seeking by this combination—that the two drugs may in part cancel out or mask some of the negative side effects of each other. Just because you can’t feel the totality of each drug’s high, or their side effects to the extent that you do when you take them alone, doesn’t mean that your body is free from the damage that the drug wields. The damage is still occurring.

A person might wrongly think that they have a tolerance greater than they actually have, due to this apparent absence of side effects, causing them to take even greater amounts of the drugs, which often leads to overdose and death. All the drugs that are used within this potentially fatal combination can drastically derail your life by their capacity for addiction and withdrawal. Together, they hold an even greater potential for addiction and more severe withdrawal.


A speedball is made up of some of the most addictive drugs known to man. It can harbor physically, mentally, and emotionally devastating results. Whenever you or a loved one suffers from drug abuse or addiction, the best chance of overcoming this destruction is by seeking help. Depending on the severity and frequency of use, your or your loved one might enter into either outpatient or inpatient rehabilitation for the best chance of recovery.

It is crucial that the medical or addiction support team in treatment is aware that you or your loved one is taking multiple drugs. They will also need to be informed of any other drug use engaged in independently of this, as well as any other health or medical concerns. This will influence treatment plans and safe procedures within the rehabilitation program.

Don’t Get Caught In The Middle

Don’t let your drug use leave you stranded beneath the weight of the drug’s heavy hand on your life. It is never too late to stop using and begin your journey toward sobriety. Please, reach out to someone who cares. Our staff at is sympathetic to your needs and standing by with a wealth of resources and recommendations to help you bridge the gap between drug abuse and recovery. Contact us today, we are here to help you!

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