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Is Heroin and Cocaine a Safe Mixing Combination (& How?)

There is no safe way to mix heroin and cocaine. The combination commonly results in overdose, which can be deadly.

drug effects


People have been mixing heroin and cocaine for the past several decades, as a party drug combination. This practice is known as “speedballing.”

The Centers for Disease Control reports that in 2016, the heroin-related overdose death rate increased 19.5 percent and the cocaine-related overdose death rate increased 52 percent.

Heroin and cocaine come from two different classes of drugs, so they can have very different effects on the body. Heroin has a sedative effect, while cocaine provides a stimulant effect. The combination of these drugs creates an intense high that infuses the user with a sense of euphoria and pleasure.

Heroin is an opiate drug that is derived from the opium poppy plant. Morphine is a natural substance that is extracted from the seedpod of the plant, which is then used to produce heroin.

Cocaine is a stimulant drug derived from the leaves of the coca plant found in South America. It is used in some medical settings as a local anesthesia, but it is an illegal recreational drug in the United States. Cocaine is sold in illicit drug markets in powdered or rock form; the rock form is known as crack.

Can Heroin and Cocaine Be Safely Combined?

This mixture is sometimes combined in their respective powder forms and snorted, or it may be mixed as an injectable and used intravenously.

There is no safe amount of this combination that can be reliably consumed. The highly potent nature of both these drugs creates an elevated risk of overdose and other serious outcomes, including death.

The mixture of these substances together has a volatile effect in the body. The sedative effect of heroin suppresses the respiratory and circulatory systems, and the stimulating effect of the cocaine simultaneously excites the same systems. This can have unpredictable effects in the body and increase the risk for adverse outcomes.

Even if someone combines these two drugs without issue, it doesn’t mean they can do it again. Each batch of cocaine and heroin is different. Each batch may have different purities levels or be laced with different drugs.

In addition, various individual factors affect the outcome of each drug situation. The person simply being in a different physical or mental state could mean overdose is more likely.

drug addiction

Potential Dangers of Combining Heroin and Cocaine

According to a study from the journal Synapse, the combination of heroin and cocaine as drugs of polysubstance abuse has been shown to result in more risky sexual behaviors, more economic crimes, and worse treatment outcomes than seen in those who use heroin alone.

The combination of these two drugs increases the risk of fatal overdose because of the effects each drug has on the respiratory system. Cocaine requires the body to use more oxygen as it speeds the body up, but heroin then suppresses the body’s ability to obtain oxygen. The result is respiratory failure.

What Are the Short-Term and Long-Term Effects?

According to the National Institute on Drug Abuse, there are many serious short-term and long term effects from both heroin and cocaine use. The combination of these drugs together increases the risks associated with both drugs. Polysubstance abuse tends to exacerbate the negative effects of all combinations of drugs.

The following are short-term effects of heroin use:

  • Euphoria
  • Nausea
  • Vomiting
  • Dry mouth
  • Analgesia
  • Respiratory depression
  • Depressed heart rate

The following are the short-term effects of cocaine:

  • Euphoria
  • Enlarged pupils
  • Elevated body temperature
  • Accelerated heart rate
  • Increased blood pressure
  • Headaches
  • Abdominal pain
  • Insomnia
  • Alertness
  • Anxiety
  • Restlessness
  • Erratic behavior
  • Panic attacks
  • Seizures
  • Paranoia
  • Stroke
  • Psychosis
  • Heart arrhythmia
  • Heart attack
  • Coma

The long-term effects of heroin use include the following:

  • Collapsed veins
  • Infections at injection sites
  • Abscesses
  • Addiction
  • Infections of the heart and heart valves
  • Constipation
  • Abdominal cramping
  • Liver disease
  • Kidney disease
  • Pneumonia

The long-term effects of cocaine use include the following:

  • Nosebleeds
  • Nasal damage
  • Loss of sense of smell
  • Damage to the esophagus
  • Infection or bowel tissues
  • Weight loss
  • Malnutrition
  • Addiction
  • Lung damage from smoking

The individual response to mixing heroin and cocaine will be different based on how long the person has been consuming this drug combination, how much of each substance they are using, and whether there are additional risk factors, such as other substances being consumed.

people in a drug rehab room

What Is the Risk of Addiction?

The longer a person uses both cocaine and heroin, the more likely it is that the person will develop a serious addiction problem. Addictions form as a user develops a tolerance to a substance, which drives them to consume the substance in increasing amounts.

Dependency then develops as the person begins to experience distressful withdrawal symptoms when the increasing dosages wear off. As people struggle to manage these withdrawal symptoms, the addiction can drive increasingly dangerous and risky consumption patterns.

With higher amounts of the substance being consumed, the risk of overdose and death increases. Polysubstance use is implicated in the majority of drug overdose deaths.

A study from the American Journal of Public Health found that cocaine, heroin, and prescription opioids are the most common drugs involved in unintentional drug overdoses around the world.

Addictions become chronic conditions that contribute to increased risks of overdose and death across a person’s lifetime.

Is it Possible to Overdose on Speedballs?

Yes. Overdose is likely if a person continues to combine these drugs. This drug combination increases the risk of heart attack and death.

Because these drugs are purchased on illicit drug markets, there is always the possibility that other dangerous substances are present. Users who purchase drugs from street dealers are often not aware of the concentration and potency of any particular batch of drugs.

People who consume drugs regularly usually make calculations about how much of a drug they should consume based on their personal tolerance to the substance. These calculations can also cause people to consume more than they can tolerate if a specific batch of drugs is more potent than they are accustomed to.

Due to the wide-ranging potency of different batches of illicit drug supplies, based on cutting methods used by different manufacturers and distributors, the user is often not able to correctly estimate their tolerance.

This results in increased potential for accidental overdose and death due to polysubstance intoxication.

Again, there is no amount of heroin and cocaine mixing that can be considered safe. Even those who have developed tolerance to the drugs are still at risk of overdose and death.

What if Heroin and Cocaine Are Consumed Together?

If the combination of heroin and cocaine is consumed either accidentally or intentionally, pay attention to any symptoms that indicate potential overdose or physiological distress.

In cases of accidental overdose, medical attention should be sought as soon as possible when distressful symptoms arise.  The sooner a person is able to access medical care, the better their chances of being successfully treated and recovering. The longer a person waits before seeking medical care, the higher the risk of death.

Anyone concerned about a potential overdose should call 911 as soon as possible.


Changes in Dopamine Transporter Binding in Nucleus Accumbens Following Chronic Self-Administration of Cocaine: Heroin Combinations. ( October 2014). Synapse.

Cocaine. National Institute on Drug Abuse.

Commonly Abused Drugs Chart. (July 2018). National Institute on Drug Abuse.

Heroin.  National Institute on Drug Abuse.

U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids. (March 2018). Centers for Disease Control and Prevention.

Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature. (November 2015). American Journal of Public Health.

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