There has been a surge in the use of a deadly drug cocktail known as the “super speedball.” This is a polydrug mixture that contains a stimulant and a depressant, usually an opioid, is commonly known on the streets as a speedball, powerball, or over and under. However, the super speedball is a cocktail that combines heroin, cocaine, and fentanyl, the highly potent synthetic opioid. Overdose deaths across the globe have risen due to the highly addictive and dangerous mixture in the midst of the ongoing opioid overdose epidemic.

Fentanyl, Heroin, and Cocaine: A Deadly Combination

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. It was first used medically to manage severe pain, such as that related to cancer or major surgery. The effects and potency of fentanyl drew in recreational drug users however, this introduced more risk, as even a small amount can cause overdose. Recreational fentanyl users can take it in various forms, including injectable solutions. As with other opioids like heroin, injecting fentanyl can cause an immediate intense high. Due to this, injection is a common practice among drug users and some drugs’ potency, like heroin, is enhanced when mixed with other drugs … stepping up that high even more. Cocaine, which is a stimulant, can be mixed with opioids like heroin or fentanyl, to cause a euphoric high. Enter the “super speedball,” a mixture of cocaine, heroin, and fentanyl. Making matters worse, the super speed ball is most commonly taken through injection, where the three drugs are mixed and injected into a vein or muscle via syringe. The method of injection delivers the most intense and immediate high, while posing the highest risk of overdose and other health problems. This makes super speedballing particularly dangerous and also unpredictable in the effect it will have on a user. Respiratory depression, coma, and extreme sedation may result from super speed ball and in some instances, it can cause heart failure and death.

What factors have contributed to the rise of the super speedball?

There are a number of factors contributing to the rise of the super speedball including the availability of fentanyl on the black market. In the late 1990s and early 2000s, prescription opioids became popular among recreational drug users. Pharma companies emphasized the effectiveness opioids had shown in treating pain and patients began seeking these drugs. Doctors prescribed these drugs more frequently and for longer periods of time. However, pharma companies tended to downplay the risks of addiction and overdose associated with prescription opioids. Many patients found themselves hooked and there became an even higher demand for these drugs on the black market. This led to law enforcement cracking down on prescription opioids and what was left was a void that got filled with the synthetic opioid, fentanyl. Fentanyal became the “it choice” as it was cheaper, easy to smuggle for drug dealers, and very potent. As a result of the rapid spread of fentanyl in the United States, the US Drug Enforcement

Administration started to warn in 2019 that fentanyl and heroin have been combined with cocaine to make “super speedballs”. Some cocaine users had also been unknowingly consuming speedball-like combinations after powdered fentanyl became cross-contaminated with cocaine supplies. Polydrug use was happening sometimes knowingly and sometimes unknowingly, but the addiction that comes along with it was festering, contributing to the rise of the super speedball. There has likely been an increase in polydrug use and overdose deaths as well due to the COVID-19 pandemic, as many people have experienced increased stress, isolation, and economic hardship. According to the Centers for Disease Control and Prevention more than 90,000 overdose deaths occurred in the United States in 2020, up from 72,000 the previous year. Even more alarming was that about 70% of these deaths involved fentanyl and other synthetic opioids according to the CDC.

How do we address the drug crisis?

Healthcare professionals and policymakers must take a multifaceted approach to addressing the opioid crisis and practices like super speed balling. Access to addiction treatment, harm reduction services utilizing naloxone, and fentanyl production and distribution must be considered. A key component is educating the public about the dangers of drug use and promoting alternative pain management methods. National Fentanyl Awareness Day was established in 2018 to help with these educational efforts and raise awareness about the risk fentanyl poses to our communities.

The super speedball’s rise indicates the dangers of drug use, and the need for comprehensive solutions to address the opioid epidemic. With combined efforts, we can prevent overdose deaths and provide support to those struggling with addiction. Scottsdale Recovery and Detox Center has been Arizona’s premier addiction center for over a decade. We are committed to helping our community and those nationwide creating a community of sober champions! Learn more by visiting or call 1-888-NODRUGS.

Talk to Someone Who’s Been There. Talk to Someone Who Can Help. Scottsdale Recovery Center holds the highest accreditation (Joint Commission) and is Arizona’s premier rehab facility since 2009. Call 602-346-9142.