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Mixing Heroin and Other Drugs

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Heroin abuse is associated with a number of problems, including a high potential for accidental overdose and death. Despite these inherent health hazards, there is a growing trend among heroin users to mix heroin with other potentially dangerous substances – which only increases one's potential for overdose and death.1

dangers of heroin
Danger of death, by Stephane Gaudry, Flickr: Pandora's jar [CC BY 2.0].

Some people intentionally use heroin in combination with another substance, while others mix drugs accidentally without even knowing it. Unfortunately, this accidental mixing is quite common, as heroin addicts often do not know the purity of the substance they are purchasing. Even when purchasing from a known dealer, each

batch has potential to contain a combination of heroin and other dangerous additive substances.Those who combine heroin with other substances purposefully often do so as a way to enhance the heroin high.2,3 The drug is often combined with cocaine, alcohol or even other opioid painkillers for recreational purposes.

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Why Do People Mix Heroin with Other Drugs?

When heroin users can no longer can achieve these strong euphoric effects, even with high doses of the drug, they may turn to combining heroin with other substances in order to get their fix.4-7

One of the most significant risks when using heroin is that the drug is associated with a very high potential for dependency, and repeated use of the drug is associated with a rapid development of tolerance to its effects.

This means that, over time, the individual will need higher and higher doses of the drug in order to feel the desired effects of the high.1

Many times, the goal in these instances is for the individual to achieve a more intense high – akin to the initial highs experienced when they first began using heroin.

What Makes Heroin Drug Mixes So Dangerous?

Mixing drugs, including heroin, can be incredibly dangerous for a number of reasons. Risks of overdose and death may be substantially increased as drugs can interact by amplifying or masking the physiological effects on the body.5

Additionally, heroin users are often unable to know the purity or strength of the drugs they are taking. There may be unforeseen negative reactions that result from mixing heroin with unknown additive substances.3,4

Like with Like: Heroin Mixed with Depressants

Although heroin isn’t technically categorized as either a stimulant or a depressant, heroin is an opioid drug and has depressant-like effects on the central nervous system of the body – causing slowed heart rate and slowed breathing, among other symptoms.2

One doctor discusses the synergistic (exaggerated) effects of mixing drugs that have some similar effects. (40 seconds)

Depressant drugs are preferred by many because they can lead to intense and pleasurable sensations of being relaxed. However, when heroin is combined with another substance that acts as a depressant on the central nervous system, the combined effect may be too strong for the body to handle. In fact, the impact of overdosing on substances with depressant-like effects can slow down

individuals’ heart rate and breathing so much so that they can slip into a coma and even risk dying. Fentanyl, for example, is another opioid painkiller. Combining heroin with fentanyl not only exaggerates the depressant effect of slowing down heart rate and breathing, but it can also lead to uncomfortable side effects – including nausea, confusion and excessive sleepiness.4

Mixing Opposites: Heroin Mixed with Stimulants

Mixing heroin with drugs that have opposing effects – such as drugs that are classified as “stimulants” – can also be dangerous enough to be lethal. The risk for overdose increases when mixing depressants with stimulants, as one drug can mask the effects of the other.

The primary effects of stimulants are often directly opposite in nature to those of depressants. While depressants slow down heart rate and breathing, stimulants can make your pulse and respiratory rate climb.

Taking heroin with ecstasy or a methamphetamine, for example, can lead to overdose from this masking effect, as ecstasy and methamphetamine are both stimulants.

Cocaine is another stimulant that is commonly mixed with heroin. There are a growing number of individuals who choose to take heroin and cocaine together.4,5

This drug combination is often popularly referred to as “speedball.” Interestingly, this combination does not appear to heighten or “improve” an individual’s high experience.

River Phoenix heroin
River Phoenix died in 1993 from a "speedball" of cocaine and heroin. Photo by Alan Light [CC BY 2.0], via Wikimedia Commons.

River Phoenix was one well-known actor who died in 1993 from drinking a speedball of cocaine and heroin.

While the motivation for combining heroin and cocaine is not fully understood, speedball can cause significant adverse effects on the user’s health, including5:

  • Bronchial hyperactivity (muscle contractions within the individual’s airways in the lungs).
  • Wheezing.
  • Heart rate irregularities.

What Drugs Are Commonly Mixed with Heroin?

A wide variety of other substances have been commonly mixed with heroin, often in hopes of enhancing the experience of being high. According to law enforcement and addiction treatment professionals, the drugs most commonly used in concert with heroin include8-9:

  • Cocaine.
  • Marijuana.
  • Alcohol.
  • Crystal Meth.
  • Ecstasy.
  • Vicodin.
  • Xanax.

  • OxyContin.
  • Fentanyl.
  • Amphetamines.
  • GHB.
  • Ketamine.
  • LSD.
  • Mushrooms.

Each of these drug combinations carries with it some side effects and potential dangers that are unique to that mix. The heroin high may be more intense with some of these mixtures – but so, too, are the dangers.

How to Get Help If You or a Loved One is Mixing Drugs

Heron addiction is one of the most challenging drug addictions to break and its use is associated with a wide variety of risks, many of which can be quite serious.2,8 Moreover, heroin users who have begun to mix drugs may be at unique risk – given the dangers of combining substances – and may require a more in-depth treatment plan when it comes to their addiction.

If you or someone you love struggles with heroin use or has been known to mix heroin with other substances, many different treatment options are available that can help you more comfortably and successfully take your next steps towards recovery. Call to speak with one of our recovery advisors about learning how you can get help and break free from addiction.

Learn How to Get Out From Addiction

call : 1-888-496-8059


  1. Day C, Degenhardt L, Hall W. Changes in the initiation of heroin use after a reduction in heroin supply. Drug Alcohol Rev 2006;25:307-313.
  2. Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health 1972;62(7):995-1001.
  3. United Nations Office on Drugs and Crime: World Drug Report 2014.
  4. Ciccarone D. Heroin in brown, black, and white: Structural factors and medical consequences in the US heroin market. Int J Drug Policy 2009;20(3):277-282.
  5. Jones JD, Mogali S, Comer SD. Polydrug abuse: A review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012;125:8-18.
  6. Leri F, Bruneau J, Stewart J. Understanding polydrug use: Review of heroin and cocaine co-use. Addiction 2003;98(1):7-22.
  7. Boto de lose Bueis A, Pereira VA, Sanchez RJL, Maldonado PJA, Ayerbe GA, Garcia JD, Pujol de la Llave E. Bronchial hyperactivity in patients who inhale heroin mixed with cocaine vaporized on aluminum foil. Chest 2002;121(4):1223-1230.
  8. Stephens RC. The street addict role: A theory of heroin addiction. 1991 Suny Press. Albany, NY.
  9. National Institute on Drug Abuse: Heroin.

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