Speedballing, the practice of combining a stimulant such as cocaine or methamphetamine with an opioid such as heroin or fentanyl, has gone from being a niche subculture to a generalized public health crisis. The practice dates back to the early 1900s, when World War I soldiers were often treated with a combination of cocaine and morphine.
Once associated with high profile figures such as John Belushi, River Phoenix and Chris Farley, this dangerous use of multiple substances has become one of the main causes of overdose deaths in the United States from early to the mid -2010.
I am an assistant public health professor who has written extensively about the use of methamphetamine and opioids and the dangerous combination of the two in the United States.
As these dangerous combinations of medications flood the market more and more, I see an urgent need and an opportunity for a new prevention and treatment approach.
Why the ‘speedballing’?
Since the 1970s, the term Speedballing originally referred to the combination of heroin and cocaine. The combination of stimulants and opiates – the “high” of the former with the soothing effect of the seconds – creates a dangerous physiological conflict.
According to the National Institute on Drug Abuse, overdose deaths related to stimulants increased significantly from more than 12,000 per year in 2015 to more than 57,000 in 2022, an increase of 375%. In particular, approximately 70% of overdose deaths related to stimulants in 2022 also involved fentanyl or other synthetic opioids, which reflects the growing prevalence of the participation of multiple substances in overdose mortality.
Users sought to experience the euphoric “high” stimulating and soothing effects of opioid. However, with the proliferation of fentanyl, which is much more powerful than heroin, this combination has become increasingly lethal. Fentanyl is often mixed with cocaine or methamphetamine, sometimes without user knowledge, which causes involuntary overdose.
The increase in speed is part of a broader tendency to use multiple substances in the US since 2010, overdose that involve both stimulants and fentanyl have multiplied by 50, and now represent approximately 35,000 deaths per year.
This has been called the fourth wave of the opioid epidemic. The supply of toxic and contaminated medications has exacerbated this crisis.
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A dangerous combination of physiological effects
Stimulants such as cocaine increase heart rate and blood pressure, while opioids suppress respiratory function. This combination can cause respiratory failure, cardiovascular collapse and death. People who use both substances are more like a probability of experiencing a fatal overdose compared to those who use opioids alone.
The contradictory effects of stimulants and opioids can also exacerbate mental health problems. Users may experience an increase in anxiety, depression and paranoia. The combination can also affect cognitive functions, which leads to confusion and a bad decision making.
Speedballing can also cause serious cardiovascular problems, such as hypertension, heart attack and stroke. The pressure on the heart and blood vessels caused by the stimulant, combined with the depressing effects of the opioid, increases the risk of these potentially fatal conditions.
Face the crisis
It is crucial to increase awareness about the dangers of speedballing. I think that educational campaigns can inform the public about the risks of combining stimulants and opioids and the possibility of involuntary exposure to fentanyl.
There is a great need to improve access to treatment for people with stimulating consumption disorder, a defined condition such as the continuous use of amphetamine, cocaine or other stimulating substances that cause clinically significant deterioration or anguish, from slight to severe. Treatments for this and other substance consumption disorders lack sufficient funds and are less accessible than treatments for opioid consumption disorder. Addressing this gap can help reduce the prevalence of speedballing.
The implementation of damage reduction strategies by public health officials, community organizations and medical care suppliers, such as the supply of reactive strips of fentanyl and naloxone, a medicine that reverts opioid overdose, can save lives.
These measures allow people to analyze their drugs to detect the presence of fentanyl and have immediate access to medicines to reverse overdose. The generalized implementation of these strategies is crucial to reduce overdose deaths and improve health results in the community.
*Andrew Yockey is an assistant public health professor at the University of Mississippi.
This article was originally published in The Conversation/Reuters.
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