Jason Zelus, MSW, LCSW
Executive Director
Jason has great compassion for those affected by addiction, and his passion for facilitating positive change led to the formation of Zelus Recovery.
Speedballing is taking a combination of a stimulant and a depressant, like cocaine and heroin, at the same time. Poly-drug use (taking more than one drug at a time) is even more dangerous than just using one drug at a time—especially when those drugs are illicit. Fentanyl continues to be an issue in Idaho, often showing up in counterfeit pills, meth, cocaine, and heroin.1 When someone, especially someone with a low tolerance for opioids (like experimenting teens), is exposed to fentanyl, they are at a very high risk of overdose.
This article will help you learn more about the risks, short- and long-term effects, and signs of drug use in teens. If you’re concerned about your teen, don’t wait. Contact the teen addiction experts at Zelus Recovery in Meridian, ID.
Get help for yourself or someone you love today
Table of Contents
- What is a speedball?
- Why teens speedball: Desired effects vs. real risks
- Speedball vs. goofball and other polydrug mixes
- Short- and long-term effects of speedballing in teens
- Overdose risk is higher with fentanyl
- How long do speedball effects last?
- Signs your teen might be speedballing
- What to do in a suspected speedball overdose
- Does a speedball show up on a drug test?
- Treatment that works for stimulant/opioid use
- Speedball FAQs
What is a speedball?
A speedball is a combination of cocaine and heroin. Other versions of the drug also exist, but they always contain a stimulant (an “upper”) and a depressant (a “downer”). Some common speedball combinations today include cocaine, meth, fentanyl, and prescription painkillers. Speedballs are often injected with a needle, but may be snorted.
Why teens speedball: Desired effects vs. real risks
Teens experimenting with drugs aren’t setting out to hurt themselves on purpose. Many start speedballing because they’re curious, get pressured by their friends, or are misinformed about how dangerous it is. Some teens believe that because they’re taking a stimulant too, the effects of the opioid won’t be as risky.
The risks, though, are much higher. Mixing drugs elevates the chance of accidental overdose, which can be fatal.2 Teen brains are also still developing, which is a likely cause of risk-taking and impulsive behaviors. Drug use affects brain development, and teens who start using substances early have a higher risk of addiction. Studies also show that people with a substance use disorder who started in adolescence have a higher risk of mental health issues, behavioral problems, trouble at school or work, risky sexual behaviors, and legal consequences.3 Treatment, even outpatient options, is effective for teen addiction. Intensive outpatient and partial hospitalization programs may even allow them to keep up in school while getting the help they need.
Read more: IOP vs. PHP treatment
Speedball vs. goofball and other polydrug mixes
“Goofball” is another term for a stimulant/depressant mix, and most commonly refers to mixing opioids (often heroin) and meth. You might also hear the terms “Belushi,” “Bombita,” or “Takeover/Dirty Fentanyl” so refer to similar upper/downer combinations.4
Some people mix stimulants with other stimulants, which is also extremely dangerous. Combinations of cocaine and PCP are sometimes called “Space” or “Wack.” Slang terms for drug combinations can be highly regional, and new terms appear all the time, especially among teens who want to keep drug use a secret. Check out the Boise Police Department’s resource on drug slang for more.
Short- and long-term effects of speedballing in teens
Short-term effects
Short-term effects can appear quickly and may include:
- Rapid or irregular heartbeat
- Slowed or shallow breathing
- Anxiety, panic, or paranoia
- Confusion or disorientation
- Nausea or vomiting
- Loss of consciousness (“nodding off”)
Because stimulants and depressants mask each other’s effects, it can be difficult to tell how serious the situation is until it becomes critical.
Long-term effects
Repeated speedballing can lead to:
- Increased risk of addiction
- Ongoing anxiety, depression, or mood instability
- Cognitive and memory problems
- Greater likelihood of overdose in the future
- Interference with healthy brain development
For teens, these long-term effects can impact school, relationships, and emotional growth.
Overdose risk is higher with fentanyl
In 2024, nearly 40% of all overdose deaths in Idaho involved fentanyl, and there were 443 non-fatal emergency department visits for opioid overdose. The risks of fentanyl aren’t just national; they’re right here in Idaho. Fentanyl is so dangerous because it’s so strong, and illicit versions use counterfeit formulas, making them even more potent. Since speedballs include opioids, there’s a high risk that they also include fentanyl. Some people are even exposed to fentanyl without intending to because it gets mixed in with other drugs like cocaine and heroin.
How long do speedball effects last?
It depends. For many people, the effects can last several hours. But, since speedballs are mixes of drugs, every person will have a different experience every time. Factors that influence how long it takes to come down from a speedball include:
- Specific drugs involved
- Dosage and purity
- Body chemistry
- Mental health
The risk of overdose remains high even after someone “peaks” or experiences the strongest effects. Plus, speedballs contain stimulants, which might make the effects of opioids feel less intense, leading someone to do more.
Signs your teen might be speedballing
Recognizing when your teen is using speedballs can be challenging. Unless you see them actively using, you’ll probably be left with some physical and behavioral signs. Even then, just noticing some signs doesn’t confirm they’re using, you just have what you need to start the conversation.
Behavioral signs
- Sudden secrecy or isolation
- Lying about whereabouts
- Changes in friend groups
- Declining grades or skipping/avoiding school
Physical signs
- Extreme energy followed by exhaustion
- Constricted or dilated pupils
- Irregular sleep patterns
- Track marks on arms, between fingers, or on toes
- Nosebleeds and/or sinus problems
Emotional signs
- Mood swings or irritability
- Anxiety and/or depression
What to do in a suspected speedball overdose
An overdose is a medical emergency. Call 911 right away if you suspect an overdose. Since speedballs involve opioids, you can give Narcan, but it will only work on the opioid they’ve taken—not the stimulant. Wait with the person until emergency help arrives.
If they have nodded off, roll them to their side and/or make sure their airways are clear so they can continue breathing. If they are agitated, be calm and try to help them calm down, too.
Does a speedball show up on a drug test?
Yes. Drug screenings test for multiple different drugs, including cocaine, meth, heroin, and fentanyl—common ingredients of speedballs. Whether someone tests positive for a substance depends on the time of use, how often someone uses, what dose they use, their body size, and many other factors.
Saliva, urine, blood, and hair tests can all be used to check for drugs in someone’s system. Drug tests may be given to Idaho adolescents if they’re suspected of using drugs at school or school-sponsored events, or if they are involved in a legal matter, like being pulled over for driving under the influence. They’re also tested when they go to rehab for teens so providers can monitor their progress.
Treatment that works for stimulant/opioid use
Addiction treatment is effective. At Zelus Recovery, we’re experienced in helping both adolescents and adults overcome addiction to stimulants, opioids, and multiple substances. Our medical team uses evidence-based treatment methods, including talk therapy, family sessions, and medication-assisted treatment when appropriate.
While we do offer drug detox at our Boise center, that is reserved for adults. We’re a great step-down option for teens leaving an age-appropriate detox program or who don’t need 24/7 care. That’s because we’re one of the few teen rehab programs near Boise that allow school attendance during treatment because our outpatient programs are flexible.
Don’t wait to get help for your teen.
Speedball FAQs
A speedball is the use of a stimulant and a depressant at the same time. Most commonly, this means combining a stimulant like cocaine or methamphetamine with an opioid such as heroin or fentanyl. The opposing effects place significant strain on the heart, lungs, and brain, making speedballing especially dangerous.
While speedballs were traditionally associated with cocaine and heroin, today they often involve fentanyl or other synthetic opioids. Many people unknowingly consume fentanyl because it is frequently mixed into stimulants like cocaine. Any combination of a stimulant and an opioid can function as a speedball.
No. A “speedball drink” usually refers to a beverage that mixes caffeine (like coffee or espresso) with alcohol. While mixing caffeine and alcohol has its own risks, it is not the same as a drug speedball, which involves illicit substances and carries a far higher overdose risk.
A speedball typically refers to cocaine combined with an opioid, while a “goofball” often refers to methamphetamine mixed with an opioid. Although the slang differs, both involve mixing a stimulant and a depressant and carry similarly high risks of overdose and medical complications.
People may speedball in an attempt to intensify the high or to “balance out” the effects of each drug. Some believe the stimulant will prevent sedation from opioids, or that the opioid will reduce anxiety from stimulants. In reality, these beliefs are misconceptions that significantly increase overdose risk.
Speedballing forces the body to respond to conflicting signals at the same time. Stimulants increase heart rate and oxygen demand, while opioids slow breathing. These opposing effects strain vital organs and can mask warning signs, making overdose more likely than with either drug alone.
There is no predictable timeline. Stimulant effects often wear off faster than opioid effects, which means overdose can occur hours after use, even when someone appears awake or alert. Duration depends on the substances involved, dosage, and individual factors.
Possible signs include extreme energy followed by sudden fatigue, rapid mood swings, irregular breathing, confusion, agitation, or unusual anxiety or paranoia. Behavioral changes such as secrecy, sleep disruption, or withdrawal from responsibilities can also be warning signs. No single symptom confirms use, but patterns matter.
Signs may include slow or stopped breathing, bluish lips or fingertips, loss of consciousness, confusion, chest pain, seizures, or unresponsiveness. A speedball overdose is a medical emergency and requires immediate help.
Naloxone (Narcan) can reverse the opioid portion of a speedball overdose and may save a life. However, it does not counteract stimulant effects, so emergency medical care is still necessary even after naloxone is given.
Drug tests may detect stimulants or opioids. At-home drug tests have limitations and may not detect all substances involved in speedballing.
