Speedball (drug)

Speedball, powerball, or over and under is the polydrug mixture of a stimulant with a depressant, usually an opioid. The most well-known mixture used for recreational drug use is that of cocaine and heroin; however, amphetamines can also be mixed with morphine and/or fentanyl. A speedball may be taken intravenously or by nasal insufflation.

Speedballs often give stronger effects than either drug when taken alone due to drug synergy, and are a particularly hazardous mixture that can easily cause heart attack, respiratory arrest and death. When compared to single drugs, speedballs are more likely to lead to addiction, and users are more likely to relapse and also to overdose.

History
Original speedball combinations used methamphetamine mixed with heroin, or cocaine hydrochloride mixed with morphine sulfate.

Physiological response
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.

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.

Super speedballs
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.

Notable deaths attributed to speedball use

 * Jean-Michel Basquiat, though other sources list his death as heroin overdose only.
 * John Belushi
 * Ken Caminiti
 * Chris Farley
 * Pete Farndon
 * Zac Foley
 * Trevor Goddard
 * Mitch Hedberg
 * Philip Seymour Hoffman
 * Sebastian Horsley
 * DJ Rashad
 * Chris Kelly
 * Brent Mydland
 * River Phoenix
 * Judee Sill
 * Layne Staley
 * Joey Stefano, died from mixing cocaine, morphine, heroin and ketamine.
 * Michael K. Williams, died of overdose of a mixture of fentanyl-laced heroin and cocaine.

Notable incidents of use
In 1996, Steven Adler had a stroke after taking a speedball, leaving him with a permanent speech impediment. That same year, Dave Gahan suffered a heart attack following a speedball overdose, but survived. According to his autobiography, Slash experienced cardiac arrest for eight minutes after taking a speedball, but was revived.