Speedball (or powerball) is a polydrug mixture of a stimulant (most often cocaine or amphetamine) with an opioid (heroin, morphine, and/or fentanyl) that may be taken intravenously or by nasal insufflation. Original speedball combinations used cocaine hydrochloride mixed with morphine sulfate, while modern speedballs may also use pharmaceutical opioids, benzodiazepines, or barbiturates along with stimulants.
Speedballs often give stronger effects than either drug when taken alone due to drug synergy, and are considered a particularly hazardous mixture that can easily cause heart attack, respiratory arrest and death. Evidence suggests that when compared to single drugs, speedballs are more likely to lead to addiction, and users are more likely to relapse and also to overdose.
Cocaine acts as a stimulant, whereas heroin/morphine acts as a depressant. Co-administration is meant to provide an intense rush of euphoria with a high that is supposed to combine the effects of both drugs, while hoping to reduce the negative effects, such as the anxiety, hypertension and palpitations associated with stimulants, and sedation/drowsiness from the depressant. While this can be somewhat effective, there is an imperfect overlap in the effects of stimulants and depressants. Some users report a higher rush and better comedown, and others report displeasure at the drugs effectively cancelling each other out.
By suppressing the typical negative side-effects of the two drugs, the user may falsely believe they have a higher tolerance, or that they are less intoxicated than they actually are. This can cause users to misjudge the intake of one or both of the drugs, resulting in a fatal overdose. Cocaine's stimulating effects also cause the body to use more oxygen, while the depressant effects of heroin slow breathing rates. This combination significantly increases the chance of experiencing respiratory depression or respiratory failure, which may become fatal.
The United States Drug Enforcement Administration warned in 2019 that the rapid rise of fentanyl supply in the country has led to combinations of both fentanyl and heroin with cocaine ("super speedballs"). In addition, the cross contamination of powdered fentanyl into cocaine supplies has led to reports of cocaine users unknowingly consuming a speedball-like combination.
Notable deaths attributed to speedball use
- Jean-Michel Basquiat, though other sources list his death as heroin overdose only.
- John Belushi
- Ken Caminiti
- Chris Farley
- Pete Farndon
- Zac Foley
- Trevor Goddard
- Mitch Hedberg
- Philip Seymour Hoffman
- Sebastian Horsley
- DJ Rashad
- Chris Kelly
- Brent Mydland
- River Phoenix
- Judee Sill
- Layne Staley
- Joey Stefano, died from mixing cocaine, morphine, heroin and ketamine.
- Michael K. Williams, died of overdose of a mixture of fentanyl-laced heroin and cocaine.
Notable incidents of use
In 1996, Steven Adler had a stroke after taking a speedball, leaving him with a permanent speech impediment. That same year, Dave Gahan suffered a heart attack following a speedball overdose, but survived. According to his autobiography, Slash experienced cardiac arrest for eight minutes after taking a speedball, but was revived.[when?]
- Brompton cocktail
- Combined drug intoxication
- Drug abuse
- List of deaths from drug overdose and intoxication
- Poly drug use
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