# 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, relapse and overdose.

## History

The classic speedball is heroin and cocaine. It could also mean morphine and an amphetamine.
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.
Pink cocaine or "tusi" usually includes an unknown mix of uppers and downers and is sometimes called a speedball. Cocaine mixed with ketamine is called a CK or Calvin Klein.
Reportedly speedballs now account for most of the overdose fatalities in San Francisco. Many people are not speedballing intentionally. Rather, it has become difficult to avoid because so much of the cocaine, crack and methamphetamine supply is adulterated with fentanyl. As of 2023 it is being called the "fourth wave" of the opioid epidemic.

## Physiological response

It is a widespread misconception that taking downers will reduce the risk of adverse cardiac effects from stimulants, or vice versa. Stimulants and opioids are more dangerous when mixed because they work in different ways. Stimulants wear off before opiates. When heart rate changes quickly, first increasing rapidly from the effect of the stimulant and then dropping quickly when the stimulant wears off and the full effects of the opiates are felt, this can cause a stroke or heart failure.
Speedballs are extremely dangerous. The variations in heart rate and contraction caused by taking the mix of uppers/downers can lead to stroke or death even in young, healthy persons.

## 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.