“Speed-balling”: Mixing Stimulants and Opioids Micro-module

“SPEED-

BALLING”:

MIXING

STIMULANTS

AND OPIOIDS

MICROMODULE

SPONSORED BY

THE FLORIDA ALCOHOL AND DRUG ABUSE ASSOCIATION (FADAA)

AND THE STATE OF FLORIDA, DEPARTMENT OF CHILDREN AND FAMILIES.

LEARNING OBJECTIVES

 List the various substances that can be combined to create a

“speedball”.

 Describe the effects of “speedballing” on the user.

 Describe the health consequences of “speedballing”.

WHAT IS SPEEDBALLING?

 Substances involved

SPEEDBALL DEFINED

 Typically a “speedball”

involves a combination of an

opioid (a depressant) and a

stimulant (e.g., cocaine,

methamphetamine).

The

concurrent use of depressant

and stimulant combinations

are typically injected but can

be consumed intranasally and

other ways.

SPEEDBALL DEFINED

 In a speedball, the cocaine (or other

stimulant) may be:

 Injected in a mixture with heroin

 ‘Piggy-backed’: injected immediately before

or after the heroin (sometimes without

removal of the syringe),

the drug being

‘back-loaded’ directly in the same syringe.

SPEEDBALL DEFINED

 Today the “speedball” term

encompasses various

combinations of stimulant and

opioid substances.

 This polydrug combination is

not the only form or method of

polydrug consumption among

speedball users.

SPEEDBALL

COMBINATIONS

Common examples of stimulants that can

be mixed with an opioid to create a

speedball include:

 Cocaine

 Methamphetamine

 Prescription stimulant medications like

those used to treat attention-deficit

hyperactivity disorder (ADHD) such as:

 Dexedrine

, Adderall

, Ritalin

Concerta

 Counterfeit versions of stimulant

substances

SPEEDBALL

COMBINATIONS

Common opioids that can be mixed with a

stimulant to create a speedball include:

 Heroin

 Opioid medications (prescribed or from

the street including counterfeit versions)

such as:

 Hydrocodone (Vicodin

) oxycodone

(OxyContin

, Percocet

)

 Oxymorphone (Opana

)

 Morphine (Kadian

, Avinza

)

 Codeine

 Fentanyl

HEROIN/METH

COMBINATION

 Heroin and methamphetamine

are commonly misused

together.

 Both of these drugs are

incredibly addictive and

dangerous when taken

separately. Mixing heroin and

meth together creates far

greater danger.

FENTANYL/COCAINE COMBINATION

 Fentanyl is sometimes

deliberately mixed with cocaine

to create a speedball.

 More often, fentanyl/cocaine

mixtures target users who are

unaware they are consuming

fentanyl; they are more likely to

have an adverse reaction than

those who intentionally sought

out the opioid.

FENTANYL/COCAINE COMBINATION

 Fentanyl powder cannot be detected in powdered cocaine just by

looking at it. 2016 saw a nearly 297 percent increase in fentanyl

reports also containing cocaine (496 out of 34,204 total reports).

 The cocaine and fentanyl mix is considered by some experts to be

“speedballing on steroids.”

 Fentanyl is also sometimes deliberately mixed with cocaine and

heroin for a “super speedball”.

Cities with

Heroin

Exhibits that

Contained

Fentanyl or

Fentanyl-

Substances

GENERAL EFFECTS OF

SPEEDBALLING ON THE USER

GENERAL EFFECTS

 Cocaine (and similar stimulants) and heroin (and similar opioids)

exert different effects on the brain.

 For example, consuming cocaine and heroin together creates a

“push-pull” reaction in the body and brain.

 By combining a stimulant and an opioid, users experience an

intense rush, while hoping to reduce the negative effects of both

drugs.

GENERAL EFFECTS

Example:

 Heroin tends to make users very drowsy to the point that they may

have difficulty staying awake during the high. Taking cocaine fixes

this with a burst of energy.

 On the other hand, cocaine use can cause a person to be agitated,

anxious, and paranoid while adding heroin can instantly calm the

person down.

OPPOSITE

EFFECTS

 Stimulants like meth have long-

lasting effects. Opioids slow the

activity of the central nervous

system, including breathing.

 A heroin high for example doesn’t

last long, often only a few minutes.

It’s not uncommon for people to

find combining opioids and

stimulants appealing.

GENERAL

EFFECTS

 Abusing these

powerful drugs

through their

combination can

affect one’s health,

social life, increase

risky behaviors,

and damage or end

relationships.

HEALTH EFFECTS AND

CONSEQUENCES OF

SPEEDBALLING ON THE USER

 Both stimulants and opioids are

common, addictive, and

destructive.

 Once someone develops tolerance

to a drug, they may be more likely

to combine drugs in order to

achieve the desired effects.

 While abusing two drugs at once

will almost always guarantee some

type of high, it also increases the

risks of negative side effects.

HEALTH EFFECTS

 Taking stimulants with opioids can cause

negative side effects typically associated with

the abuse of either one individually, such as a

state of general confusion, incoherence, blurred

vision, stupor, drowsiness, paranoia, and mental

impairment because of lack of sleep.

 The combination can also result in uncontrolled

and uncoordinated motor skills, and also the risk

of death from stroke, heart attack, aneurysm, or

respiratory failure.

HEALTH EFFECTS

 Negative effects of stimulants

include anxiety, high blood

pressure, and strong or irregular

heartbeat, while the negative

effects of opioids include

drowsiness and suppression of

breathing.

 Meth and other stimulants mask the effects

of the opioid.

 Since the effects of meth outlast heroin, a

person’s heart rate may also rapidly

change pace. Their heart rate can go from

very slow and depressed and then speed

up very quickly.

 A rapid change in heart rate and

respiration rate can cause arrhythmias,

heart failure or stroke.

HEALTH EFFECTS

 Respiratory failure is particularly likely with speedballs because the

effects of stimulants wear off far more quickly than the effects of

opioids.

 For example, fatal slowing of the breathing can occur when the

stimulating cocaine wears off and the full effects of the heroin are

felt on their own.

HEALTH EFFECTS

 Despite the allure of an intense

high, the dangers of mixing

opioids and stimulants are

significant.

 When meth and heroin are

combined, it’s difficult to

determine when too much of

either has been taken. This lack

of awareness can increase the

chances of a fatal overdose.

HEALTH EFFECTS

 Both meth and heroin are not only dangerous in the short-term but

can cause severe cognitive, physical and psychological effects with

long-term use.

 There is a mistaken belief held by some that if you mix heroin and

meth you can avoid overdosing (that one counters the other). Not

true!

SPEEDBALL AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)

 Sharing needles, syringes, or other injection equipment (works) to

inject drugs puts people at risk for viral hepatitis, HIV and other

infections. HIV can survive in a used needle for up to 42 days,

depending on temperature and other factors. People who inject

drugs can get other serious health problems, like skin infections or

abscesses.

OTHER RISKS

Compared to users of cocaine, speedball users:

 Exhibit a more severe psychopathology

 Are more likely to fail in substance use treatment

 Are at increased risk of contracting HIV infection

The search for effective treatment medications for speedball users is

complicated by the associated combination of pharmacologically

dissimilar drugs.

SPEEDBALLING: PARENTAL EFFECTS &

IMPACT ON CHILDREN

PARENTAL EFFECTS/CHILD IMPACTS

 Parents using speedballs may become anxious. Anxious parents tend to

display increased levels of uncertainty; criticize their children and themselves

more often; and demonstrate more fear and show less warmth and affection

toward family members. Parental anxiety is also a risk factor for childhood

anxiety.

 Parents under the influence of speedballs may experience paranoia. The

associated fear and perceived threats a parent may perceive can contribute to

their confrontational, aggressive, or violent behavior towards children.

 In addition to dangers from fetal exposure to opioids and other drugs,

babies

of parents who use speedballs are at risk of experiencing a roll-over injury or

death if their parent’s drowsiness contributes to co-sleeping.

PARENTAL EFFECTS/CHILD IMPACTS

 A child’s caregiving environment may become altered by speedballing-

related parental distraction creating potential safety risks for children.

 Mental impairment and confusion from a parent’s speedballing may

contribute to less interactions with children and disruptions in healthy

parent-child attachment, and developmental and cognitive delays in

children.

 A parent high from speedballing may experience uncontrolled and

uncoordinated motor skills and may accidentally drop an infant or small

child or cause other unintentional injuries.

QUICK REFERENCE RESOURCE

Thank you for completing this

micromodule. Please consider reviewing

this module’s quick reference resource

(partial resource pictured right). It is

available for download in the same

location as this module.

FOR QUESTIONS, OR FOR ADDITIONAL INFORMATION

For additional opioid training modules:

 http://www.training.fadaa.org/

CITATIONS

1. NIDA Drugs and Health Blog; https://teens.drugabuse.gov/blog/post/real-

teens-ask-about-speedballs

2. Hunt, D. E., Lipton, D. S., Goldsmith, D. & Strug, D. (1984) Street

pharmacology: uses of cocaine and heroin in the treatment of addiction.

Drug and Alcohol Dependence, 13, 375–387.

https://www.ncbi.nlm.nih.gov/pubmed/6479016

3. Leri, F., Bruneau, J., & Stewart, J. (2002) Understanding polydrug use –

review of heroin and cocaine co-use. Addiction, 98, 7-22.

4. Ibid p. 8

5. Dangers of Mixing Heroin and Meth;

https://www.therecoveryvillage.com/meth-addiction/meth-and-heroin/#)

CITATIONS

6. 2018 National Drug Threat Assessment (NDTA);

https://www.dea.gov/sites/default/files/2018-11/DIR-032-

18%202018%20NDTA%20final%20low%20resolution.pdf, p. 48

7. Ibid p. 48

8. Quote from Dr. Tony Campbell of the Substance Abuse and Mental Health

Services Administration (https://pittsburgh.steri-clean.com/fentanyl-cocaine-

combo-taking-lives-in-western-pa/)

9. 2018 National Drug Threat Assessment (NDTA);

https://www.dea.gov/sites/default/files/2018-11/DIR-032-

18%202018%20NDTA%20final%20low%20resolution.pdf, p. 48

10. Ibid p.16

CITATIONS

11. NIDA Drugs and Health Blog; https://teens.drugabuse.gov/blog/post/real-teens-ask-

about-speedballs

12. Dangers of Mixing Heroin and Meth; https://www.therecoveryvillage.com/meth-

addiction/meth-and-heroin/#)

13. https://teens.drugabuse.gov/national-drug-alcohol-facts-week/chat-with-

scientists/search?page=111&year=all

14. Dangers of Mixing Heroin and Meth; https://www.therecoveryvillage.com/meth-

addiction/meth-and-heroin/#)

15. NIDA Drugs and Health Blog; https://teens.drugabuse.gov/blog/post/real-teens-ask-

about-speedballs

16. Dangers of Mixing Heroin and Meth; https://www.therecoveryvillage.com/meth-

addiction/meth-and-heroin/#)

CITATIONS

17. https://www.cdc.gov/hiv/risk/idu.html

18. Rowlett, J.K., Negus, S.S., Shippenberg, T.S., Mello, N.K., Walsh, S.L., & Spealman, R.D.

(2001). Combined cocaine and opioid abuse: from neurobiology to the clinic. NIDA Res Monogr,

178, 55-7.

19. Burstein, M., Ginsburg, G.S. & Tein , JY. (2010). Parental Anxiety and Child Symptomatology: An

Examination of Additive and Interactive Effects of Parent Psychopathology. Journal of Abnormal

Child Psychology, 38: 897. https://doi.org/10.1007/s10802-010-9415-0

20. Shirley J. Semple, Steffanie A. Strathdee, Jim Zians, and Thomas L. Patterson.

Methamphetamine-Using Parents: The Relationship Between Parental Role Strain and

Depressive Symptoms. Journal of Studies on Alcohol and Drugs 2011 72:6, 954-964.

https://www.jsad.com/doi/abs/10.15288/jsad.2011.72.954

21. Understanding Opioid Use, Pregnancy, and Neonatal Abstinence Syndrome (NAS).

https://www.training.fadaa.org/m4/

22. Willinger M, Ko C, Hoffman HJ, Kessler RC, Corwin MJ. (2003) Trends in Infant Bed Sharing in

the United States, 1993-2000: The National Infant Sleep Position Study. Arch Pediatr Adolesc

Med. 2003;157(1):43–49. doi:10.1001/archpedi.157.1.43.

https://jamanetwork.com/journals/jamapediatrics/fullarticle/481230

CITATIONS

23. Shirley J. Semple, Steffanie A. Strathdee, Jim Zians, and Thomas L.

Patterson. Methamphetamine-Using Parents: The Relationship Between

Parental Role Strain and Depressive Symptoms. Journal of Studies on

Alcohol and Drugs 2011 72:6, 954-964.

https://www.jsad.com/doi/abs/10.15288/jsad.2011.72.954

24. Spratt EG, Friedenberg SL, Swenson CC, et al. The Effects of Early Neglect

on Cognitive, Language, and Behavioral Functioning in Childhood.

Psychology (Irvine). 2012;3(2):175-182.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652241/

OTHER REFERENCES AND RESOURCES

 Beswick, T., Best, D., Rees, S., Coomber, R., Gossop, M., & Strang,

J. (2001). Multiple drug use: patterns and practices of heroin and crack use in a

population of opiate addicts in treatment.

Drug and Alcohol Review, 20 (2), 201-204.

 Leri, F., Bruneau, J., & Stewart, J. (2002) Understanding polydrug use – review of

heroin and cocaine co-use. Addiction, 98, 7-22.

 Leri, F., Stewart, J., Tremblay, A., & Bruneau, J. (2004). Heroin and cocaine co-use in

a group of injection drug users in Montréal.

Journal of Psychiatry & Neuroscience,

(1), 40-47.

 Magura, S., Kang, S.-Y., Nwakeze, P. C., & Demsky, S. (1998). Temporal patterns of

heroin and cocaine use among methadone patients. Substance Use & Misuse,

(12), 2441-2467.

OTHER REFERENCES AND RESOURCES

 https://drugfree.org/learn/drug-and-alcohol-news/featured-news-meth-use-

rising-among-people-use-opioids/

 Jarlenski, M., Barry, C. L., Gollust, S., Graves, A. J., Kennedy-Hendricks, A., &

Kozhimannil, K. (2017). Polysubstance use among us women of reproductive

age who use opioids for nonmedical reasons. American Journal of Public

Health, 107(8), 1308–1310. http://dx.doi.org/10.2105/ajph.2017.303825.