Speedball (or powerball) is a mixture of cocaine (a stimulant) with heroin or morphine (an opioid) or sometimes benzodiazepine, taken intravenously or by insufflation. Speedball is a dangerous mixture, often more so than the sum of the parts due to drug synergy. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin. Speedball may also use pharmaceutical opioids, benzodiazepines, or barbiturates along with stimulants. However, since opioids and sedative-hypnotics have different objective and subjective effects, stimulant–nonopioid mixtures are known by the slang term "set up". A cocktail of drugs containing an opioid can cause a strong physical dependence and withdrawal symptoms.
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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 anxiety, hypertension, palpitations and other common side effects of stimulants and sedation/drowsiness from the depressant. While this is somewhat effective, as one drug (the CNS stimulant) triggers the sympathetic nervous system and the other (the CNS depressant) triggers the parasympathetic nervous system, the two systems that regulate the fight-or-flight and rest-and-digest responses, respectively, and simultaneous activity of the two pathways is what normally keeps one's body in natural homeostasis, there is an imperfect overlap in the effects of stimulants and depressants. Additionally, 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, sometimes fatally.
Because the stimulant effects of cocaine wear off far more quickly than the depressant effects of heroin or morphine, fatal respiratory depression often occurs when the full effects of a heroin or morphine overdosage are felt in isolation. Due to the countering effect of the cocaine, a fatally high opioid dose can be unwittingly administered without immediate incapacitation, thus providing a false sense of tolerance until it is too late. This form of delayed opioid overdose is believed to be the most common mechanism of death in speedball overdoses.
Notable deaths attributed to speedball use
- Jean-Michel Basquiat, though some sources list his death as heroin overdose only.
- John Belushi
- Ken Caminiti
- Chris Farley, died of cocaine and morphine sulfate overdose, similar to Belushi.
- Pete Farndon
- Zac Foley
- Trevor Goddard
- Mitch Hedberg
- Philip Seymour Hoffman, died of cocaine, heroin, benzodiazepines, and amphetamines overdose.
- Sebastian Horsley
- Chris Kelly
- Brent Mydland
- River Phoenix
- DJ Rashad
- Eric Show
- Judee Sill
- Layne Staley
- Joey Stefano, died of cocaine, morphine, heroin and ketamine overdose.
Other notable users
Other notable users of the speedball drug combination have included:
- circa 1900, Harry Kendall Thaw, a mentally ill and profligate wealthy heir who was adjudicated not guilty of murder by reason of insanity
- Cream bassist Jack Bruce (as stated in an interview with the Daily Record in 2009)
- Nikki Sixx (in The Heroin Diaries: A Year in the Life of a Shattered Rock Star and The Dirt)
- Anthony Kiedis (in his autobiography Scar Tissue)
- John Frusciante
- Kurt Cobain (in his biography Heavier Than Heaven)
- David Crosby (in his autobiography Long Time Gone)
- Jerry Garcia (who died of a heart attack for which his prior use of the drug may have been a contributing factor)
- Miles Davis
- Ryan Adams
- Slash (discussed in his autobiography Slash, he experienced cardiac arrest for eight minutes, but was revived)
- Comedian Craig Ferguson (admitted in Season 9, episode 207 of The Late Late Show)
- Dave Gahan of the band Depeche Mode (who suffered a heart attack following a speedball overdose, but survived)
- Steven Adler (who had a stroke after taking a speedball, leaving him with a permanent speech impediment)
- Brompton's mixture
- Combined drug intoxication
- Drug abuse
- List of deaths from drug overdose and intoxication
- Poly drug use
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