Speedball (drug)

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Cocaine powder
Heroin powder

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.[1][2] Original speedball combinations used cocaine hydrochloride mixed with morphine sulfate,[3] 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.[4] Evidence suggests that when compared to single drugs, speedballs are more likely to lead to addiction,[5][6] and users are more likely to relapse[5][7] and also to overdose.[8][9][10]

Physiological response[edit]

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.[11]

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.[11]

Super speedballs[edit]

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.[2]

Notable deaths attributed to speedball use[edit]

Notable incidents of use[edit]

In 1996, Steven Adler had a stroke after taking a speedball, leaving him with a permanent speech impediment.[33] That same year, Dave Gahan suffered a heart attack following a speedball overdose, but survived.[34] According to his autobiography, Slash experienced cardiac arrest for eight minutes after taking a speedball, but was revived.[35][when?]

See also[edit]


  1. ^ Martin, Peter R.; Weinberg, Bennett Alan; Bealer, Bonnie K. (2007). Healing Addiction: An Integrated Pharmacopsychosocial Approach to Treatment. Hoboken, New Jersey: Wiley-Interscience. p. 122. ISBN 978-0-47165-630-2.
  2. ^ a b "2019 National Drug Threat Assessment". Drug Enforcement Administration. 2019. Retrieved 27 May 2022.
  3. ^ Rowlett, K.; Negus, S. S.; Shippenberg, T. S.; Mello, N. K.; Walsh, S. L. & Spealman, R. D. "Combined Cocaine and Opioid Abuse: From Neurobiology to the Clinic". Opioids.com. Archived from the original on 24 September 2020.
  4. ^ Martin, Peter; Weinberg, Bennett Alan; Bealer, Bonnie K. (2007). Healing Addiction: An Integrated Pharmacopsychosocial Approach to Treatment. Wiley. p. 122. ISBN 9780470082737.
  5. ^ a b Duvauchelle, Christine L.; Sapoznik, Tova; Kornetsky, Conan (1998). "The synergistic effects of combining cocaine and heroin ("speedball") using a progressive-ratio schedule of drug reinforcement. Pharmacology Biochemistry and Behavior". Pharmacology Biochemistry and Behavior. 61 (3): 297–302. doi:10.1016/S0091-3057(98)00098-7. PMID 9768564. S2CID 21108950.
  6. ^ Hunt, Dana E.; Lipton, Douglas S; Goldsmith, Douglas; Strug, David (1984). "Street pharmacology: Uses of cocaine and heroin in the treatment of addiction". Drug and Alcohol Dependence. 13 (4): 377. doi:10.1016/0376-8716(84)90005-X. PMID 6479016.
  7. ^ Wapler, M; Mendelson, J. H.; Teoj, S. K.; Mello, N. K.; Kuehnle, J. C.; Weiss, R. D.; Sholar, S. W.; Hanjra, B; Rhoades, E (1992). "Buprenorphine attenuates drug craving in men with concurrent heroin and cocaine dependence". Problems of Drug Dependence: 339.
  8. ^ Ochoa, Kristen C.; Hahn, Judith A.; Seal, Karen H.; Moss, Andrew R. (2001). "Overdosing among young injection drug users in San Francisco". Addictive Behaviors. 26 (3): 453–460. doi:10.1016/S0306-4603(00)00115-5. PMID 11436937.
  9. ^ O'Driscoll, Peter T.; McGough, Jim; Hagan, Holly; Thiede, Hanne; Critchlow, Cathy; Alexander, E. Russell (2001). "Predictors of Accidental Fatal Drug Overdose Among a Cohort of Injection Drug Users". American Journal of Public Health. 91 (6): 984–987. doi:10.2105/ajph.91.6.984. PMC 1446480. PMID 11392946.
  10. ^ Latkin, Carl A.; Edwards, Catie; Davey-Rothwell, Melissa A.; Yang, Cui; Tobin, Karin E. (2018). "The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland". Substance Abuse. 39 (3): 384–389. doi:10.1080/08897077.2018.1439801. PMC 6107432. PMID 29432084.
  11. ^ a b Santos-Longhurst, Andrew (12 February 2020). "Everything You Need to Know About Speedballs". Healthline. Archived from the original on 20 January 2021.
  12. ^ a b c "Death by Drugs: Fatal Celebrity Drug and Alcohol Addictions". Gatehouse Academy. Archived from the original on 14 March 2011. Retrieved 27 March 2010.
  13. ^ Largo, Michael (2010). Genius and Heroin: Creativity and Reckless Abandon Through. HarperCollins. p. 22. ISBN 9780062043696.
  14. ^ Boyce Davies, Carole (2008). "Basquiat, Jean-Michel (1960-1988)". Encyclopedia of the African Diaspora: Origins, Experiences, and Culture. ABC-CLIO. p. 150. ISBN 978-1-85109-700-5.
  15. ^ Dowd, Vincent (25 September 2017). "Jean-Michel Basquiat: The neglected genius". BBC News. Archived from the original on 14 January 2021.
  16. ^ Litsky, Frank (2 November 2004). "Report Says Overdose Killed Caminiti". The New York Times. Archived from the original on 9 March 2021.
  17. ^ "Chris Farley's Death Laid to Drug Overdose". The New York Times. 3 January 1998. Archived from the original on 1 December 2020.
  18. ^ Henke, James (26 April 1984). "Chrissie Hynde Without Tears". Rolling Stone. Archived from the original on 10 December 2020.
  19. ^ Peacock, Tim (1 October 2002). "Obituary: Zac Foley". Whisperin' and Hollerin'. Archived from the original on 19 November 2018.
  20. ^ "JAG star died from drug overdose, coroner rules". The Sydney Morning Herald. 6 August 2003. Archived from the original on 3 August 2019.
  21. ^ "Report: Mitch Hedberg died of drug overdose". Today. Associated Press. 27 December 2005. Archived from the original on 20 March 2021.
  22. ^ "Philip Seymour Hoffman Killed By Massive OD Heroin, Coke, Rx Meds". TMZ. 28 February 2014. Archived from the original on 26 January 2021.
  23. ^ Soltis, Andy (28 February 2014). "Hoffman Died from Toxic Drug Mixture". New York Post. Archived from the original on 9 March 2021.
  24. ^ "UK artist Sebastian Horsley dies of overdose". NineMSN. 18 June 2010. Archived from the original on 14 July 2012.
  25. ^ Michaels, Sean (8 August 2015). "House artist DJ Rashad died of a drug overdose, post-mortem confirms". The Guardian.
  26. ^ Markman, Rob (2 May 2013). "Report: Kris Kross' Chris Kelly Autopsy Complete". MTV. Archived from the original on 25 January 2021.
  27. ^ "Grateful Dead Member Died of Drug Overdose". Los Angeles Times. United Press International. 11 August 1990. Archived from the original on 5 May 2021.
  28. ^ Mydans, Seth (13 November 1993). "Death of River Phoenix Is Linked To Use of Cocaine and Morphine". The New York Times. Archived from the original on 1 March 2021.
  29. ^ Alfonso, Barry (2002). The Billboard Guide to Contemporary Christian Music. Billboard Books. p. 243. ISBN 978-0-8230-7718-2.
  30. ^ "Report: Staley Died of Heroin/Cocaine Overdose". Billboard. 8 May 2002. Archived from the original on 18 January 2021.
  31. ^ Aldrich, Robert; Wotherspoon, Garry (23 November 2000). Who's Who in Contemporary Gay and Lesbian History Vol.2: From World War II to the Present Day. Routledge. p. 387. ISBN 978-0-203-99408-5. Based on information from Charles Isherwood's Wonder Bread and Ecstasy.
  32. ^ "Medical Examiner Reveals Cause of Death for Michael K. Williams". The Daily Beast. 24 September 2021.
  33. ^ Himmelsbach, Eric (8 July 2004). "Little Drummer Boy Lost". LA CityBeat. Southland Publishing.
  34. ^ Davis, Johnny (28 October 2007). "This Much I Know: Dave Gahan, singer, 45, London". The Observer. Archived from the original on 26 March 2021.
  35. ^ Hudson, Saul (2007). Slash. United States: HarperEntertainment. p. 480. ISBN 978-0-06-135142-6.

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