Heroin + Cocaine (Speedball)
Heroin + Cocaine: the short answerSpeedballing is one of the most lethal street combinations: the cocaine can wear off first and unmask a full heroin overdose. If someone becomes unresponsive, give naloxone and call emergency services.
Why it’s dangerous
Cocaine is a short-acting stimulant and heroin a longer-acting depressant, so each partially masks the other's effects and people often take more of both than they would alone. Cocaine clears in under an hour while heroin keeps working for several — the stimulant 'brake' disappears and the full respiratory depression hits at once. The combination also strains the heart from two directions at once.
What happens
- An intense rush followed by heavy sedation as the cocaine fades
- Masked intoxication — feeling less high than you actually are
- Racing or irregular heartbeat, chest pain, raised body temperature
- Delayed opioid overdose as the stimulant wears off
Warning signs
- Sudden extreme drowsiness 30-60 minutes after use
- Slow or stopped breathing, blue lips, pinpoint pupils
- Chest pain, palpitations, or seizures beforehand
What to do
- Call emergency services; give naloxone and repeat if needed
- Rescue breathing/CPR if trained and breathing has stopped
- Recovery position; stay until help arrives
- Never speedball alone — and know that naloxone only covers the opioid half, so medical help matters even after the person wakes