Speedball (or powerball) is a

polydrug Polysubstance use or poly drug use or refers to the use of combined psychoactive substances. Polysubstance use may be used for entheogenic, recreational, or off-label indications, with both legal and illegal substances. In many cases one d ...

mixture of a

stimulant Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...

(most often

cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...

amphetamine Amphetamine (contracted from alpha- methylphenethylamine) is a strong central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. It is also commonly used ...

) with an opioid (

heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brow ...

morphine Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...

, and/or

fentanyl Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocaine ...

) that may be taken

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

ly or by nasal

insufflation In religious and magical practice, insufflation and exsufflation are ritual acts of blowing, breathing, hissing, or puffing that signify variously expulsion or renunciation of evil or of the devil (the Evil One), or infilling or blessing with goo ...

. Original speedball combinations used cocaine hydrochloride mixed with morphine sulfate, while modern speedballs may also use pharmaceutical opioids,

benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, i ...

, or

barbiturates Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as ...

along with stimulants. Speedballs often give stronger effects than either drug when taken alone due to

drug synergy Synergy is an interaction or cooperation giving rise to a whole that is greater than the simple sum of its parts. The term ''synergy'' comes from the Attic Greek word συνεργία ' from ', , meaning "working together". History In Christian ...

, and are considered a particularly hazardous mixture that can easily cause

heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...

respiratory arrest Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long p ...

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 In internal medicine, relapse or recidivism is a recurrence of a past (typically medical) condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or r ...

and also to overdose.

Physiological response

Cocaine acts as a

, whereas heroin/morphine acts as a

depressant A depressant, or central depressant, is a drug that lowers neurotransmission levels, which is to depress or reduce arousal or stimulation, in various areas of the brain. Depressants are also colloquially referred to as downers as they lower the ...

. Co-administration is meant to provide an intense

rush Rush(es) may refer to: Places United States * Rush, Colorado * Rush, Kentucky * Rush, New York * Rush City, Minnesota * Rush Creek (Kishwaukee River tributary), Illinois * Rush Creek (Marin County, California), a stream * Rush Creek (Mono Cou ...

euphoria Euphoria ( ) is the experience (or affect) of pleasure or excitement and intense feelings of well-being and happiness. Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music and da ...

with a high that is supposed to combine the effects of both drugs, while hoping to reduce the negative effects, such as the

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

, hypertension and palpitations associated with stimulants, and

sedation Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...

/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 Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (''hypo'' meaning "below") to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapnia ...

respiratory failure Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...

, which may become fatal.

Super speedballs

The United States

Drug Enforcement Administration The Drug Enforcement Administration (DEA; ) is a Federal law enforcement in the United States, United States federal law enforcement agency under the U.S. Department of Justice tasked with combating drug trafficking and distribution within th ...

warned in 2019 that the rapid rise of

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 Jean-Michel Basquiat (; December 22, 1960 – August 12, 1988) was an American artist who rose to success during the 1980s as part of the Neo-expressionism movement. Basquiat first achieved fame as part of the graffiti duo SAMO, alongside Al ...

, though other sources list his death as heroin overdose only. *

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* Chris Kelly *

Brent Mydland Brent Mydland (October 21, 1952 – July 26, 1990) was an American keyboardist and singer. He was a member of the rock band The Grateful Dead from 1979 to 1990, a longer tenure than any other keyboardist in the band. Growing up in Concord, ...

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, died from mixing cocaine, morphine, heroin and

ketamine Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppresses ne ...

. *

Michael K. Williams Michael Kenneth Williams (November 22, 1966 – September 6, 2021) was an American actor. He rose to fame in 2002 through his critically acclaimed role as Omar Little on the HBO drama series ''The Wire''. He has been described as a "singular pr ...

, died of overdose of a mixture of fentanyl-laced heroin and cocaine.

Notable incidents of use

In 1996,

Steven Adler Steven Adler (born Michael Coletti; January 22, 1965) is an American musician. He was the drummer and co-songwriter of the hard rock band Guns N' Roses, with whom he achieved worldwide success in the late 1980s. Adler was fired from Guns N' Roses ...

had a

stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...

after taking a speedball, leaving him with a permanent speech impediment. That same year,

Dave Gahan Dave may refer to: Film, television, and theater * ''Dave'' (film), a 1993 film starring Kevin Kline and Sigourney Weaver * ''Dave'' (musical), a 2018 stage musical adaptation of the film * Dave (TV channel), a digital television channel in the ...

suffered a heart attack following a speedball overdose, but survived. According to his autobiography,

Slash Slash may refer to: * Slash (punctuation), the "/" character Arts and entertainment Fictional characters * Slash (Marvel Comics) * Slash (''Teenage Mutant Ninja Turtles'') Music * Harry Slash & The Slashtones, an American rock band * Nash ...

experienced cardiac arrest for eight minutes after taking a speedball, but was revived.

References

External links