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What Makes Street Heroin So Dangerous?

Buying heroin on the street is dangerous for a number of reasons. In addition to the nature of the drug itself—which is frequently cut with other substances and could be of varying strengths—someone who purchases heroin from a dealer is also exposing themselves to problems with law enforcement and keeping potentially dangerous company.

Read on to learn more about the common substances heroin is cut with, the dangers of mixing heroin with other drugs, and some of the other risks of using street heroin.

The Dangers of Heroin on the Street: Purity

Buying heroin from a drug dealer on the street is extremely hazardous. There is no Better Business Bureau for heroin dealers, and many sell inferior or questionable products without repercussions. This is especially true in terms of purity.

Sometimes, an individual may purchase heroin off the street that is either fake (baking powder is a common substitute) or is so weak and diluted that it has little or no effect on the user.

On the other hand, the person could be sold heroin that is much more powerful than expected or contains other drugs in addition to or instead of heroin, such as fentanyl. An individual who uses too pure a form of heroin or uses from a batch that is adulterated with an extremely potent opioid like fentanyl is highly susceptible to overdose—especially if they are novice users of the drug.

Cutting With Foreign Substances

Street heroin may be cut with certain substances to get more money out of a particular shipment, enhance or mimic the effects of the drug, or make it easier to administer the substance.1,2 Cutting can be a dangerous practice, and one that can lead to illness or overdose and death.

Cutting the drug can change heroin’s taste, smell, or high. But it almost always lowers the purity. Users who buy street heroin that is cut may have to spend more to get high, have problems determining the correct dose, and not know exactly what’s in their heroin.1

Common Adulterants

Historically, several additives have been used when cutting heroin, some of which are quite toxic. Strychnine, for example, is a poison that can cause respiratory failure and death.3

Sometimes, additives such as chalk, sugars, brick dust, powdered milk, and starch are part of the mix. These are dangerous because they do not dissolve in the bloodstream and can clog important blood vessels.2

Other substances, such as caffeine, acetaminophen, procaine, Valium, and lead may be added as well.2


Fentanyl is an opioid that has legitimate medical uses. But it is also incredibly potent and added to heroin to produce a more powerful effect.2 Because fentanyl can be 30-50 times stronger that heroin, it is especially risky, as not much of the substance is needed to produce an overdose.13

Fentanyl use is on the rise, as well as overdoses from it. In 2016 there were more than 20,000 overdose deaths related to fentanyl use.5


Another substance that is often added to heroin is carfentanil. It is very similar to fentanyl, but is approximately 100 times more potent. It is used to sedate large animals.6

Carfentanil is an extremely dangerous substance, and those who use it are at very high risk of overdose. It has been linked to a significant number of deaths across the country.14

Mixing With Other Drugs

Combining street heroin with other drugs can lead to severe health problems or even death.

Common Combinations

Comedian John Belushi and musician Layne Staley both died as a result of a “speedball,” a potentially lethal heroin and cocaine mix that is injected by the user.7, 8 Speedballing can result in stupor, paranoia, uncontrolled motor skills, stroke, heart attack, aneurysm, or respiratory failure.9

Combining heroin with stimulants such as cocaine, crack cocaine, and meth may produce a more powerful high than either drug on its own. Such combinations may produce other desirable effects for the user, such as relieving agitation or anxiety from cocaine use or added energy to counteract the sedative effect of heroin. However, this is also extremely dangerous and has led to many deaths.12

Serious health problems are also possible when people mix heroin with alcohol or sedatives. Both the combination of heroin and alcohol or heroin and benzodiazepines such as Xanax can suppress breathing and lead to death.10, 11

Street Names

Along with the many combinations of heroin and other drugs that are available, there are also a variety of nicknames or street names that refer to these combinations.

In addition to speedball, heroin and cocaine combined may be called:2

  • Belushi.
  • Boy-girl.
  • He-she.
  • Dynamite.
  • Goofball.
  • H&C.
  • Primo.
  • Snowball.

A combination of heroin and marijuana may be referred to as:2

  • Atom bomb.
  • Canade.
  • Woola.
  • Wollie.
  • Woo-woo.

Heroin and Ecstasy is often called:2

  • Chocolate chip cookies.
  • H bomb.

Heroin and LSD is referred to as:2

  • Beast.
  • LBJ.
  • Neon nod.

Further, heroin and crack cocaine is often called eightball, while heroin and cold medicine is referred to as cheese, heroin and Ritalin is called pineapple, and heroin and meth can be referred to as methball or screwball.2

Other Risks

Injecting heroin can lead to bacterial infections and the contraction of communicable diseases such as HIV or hepatitis viruses. This is because infections can easily spread via needles that have been used by someone else who has an infection.2

Also, unsterile manufacturing techniques, packaging, distribution, and storage conditions increase the likelihood of bacterial, viral, and fungal contamination of street heroin.2

Other medical consequences of using street heroin—either from injecting, adulterants in the drugs, or the lifestyle of the user—include:2

  • Renal failure.
  • Electrolyte disorders.
  • Hepatitis C.
  • Pneumonia.
  • Tuberculosis.
  • Endocarditis (infection of the inner lining of heart valves).

Helping Someone With an Addiction

If you know someone who is using heroin, it is important to reach out and try to help. You can try to talk to them about the problem or consider an intervention if they are unwilling to get help.

Professional treatment can help the person address both the physical and psychological components and consequences of addiction. There are a variety of treatment settings where someone who is addicted can get clean.

Detoxification is frequently the first step of treatment. It is the process of ridding a substance from the body. Though treatment will vary somewhat, many heroin recovery programs begin with a medical detox, in which medications are administered to decrease cravings and ease the symptoms of acute heroin withdrawal.

The main forms of substance abuse treatment are inpatient/residential and outpatient. Residential treatment programs offer 24-hour support and care. They may also include a variety of treatment options, such as individual therapy, family therapy, and healthy social activities.

Outpatient programs involve meeting up to several times per week, often in a clinic or office setting. Many outpatient programs are built on group therapy and may include completing homework outside of the group, sharing during group meetings with other members, and supporting other group members.

Support groups such as Narcotics Anonymous tend to be less formal, but can still be very beneficial. Support groups encourage attendees to share their experiences with addiction, and they provide a forum for peer support and understanding to anyone working towards recovery.

No matter the situation, there is a treatment program that is right for you or your loved one who is struggling with addition. You don’t need to wait for the person to hit “rock bottom.” It’s better to get treatment before the person faces severe health consequences, financial or legal problems, or even overdose.


  1. Lower East Side Harm Reduction Center. (2001). H Is for Heroin.
  2. Akhgari, M., Etemadi-Aleagha, A., and Jokar, F. (2016). Neuropathology of Drug Addictions and Substance Misuse. Volume 1: Foundations of Understanding, Tobacco, Alcohol, Cannabinoids and Opioids. Academic Press.
  3. Centers for Disease Control and Prevention. (2013). Strychnine.
  4. United States Drug Enforcement Administration. (N.D.). Drug Fact Sheets: Fentanyl.
  5. National Institute on Drug Abuse. (2017). Overdose Death Rates.
  6. U.S. National Library of Medicine: National Center for Biotechnology Information. (N.D.). Carfentanil.
  7. Higgins, B. (2012). John Belushi’s Death: Penny Marshall Sounds Off 30 Years Later. The Hollywood Reporter.
  8. Billboard. (2002). Report: Staley Died of Heroin/Cocaine Overdose.
  9. NIDA for Teens. (2013). Real Teens Ask About Speedballs.
  10. University of Utah Genetic Science Learning Center. (N.D.). How Drugs Can Kill.
  11. Carmona, C. (2016). What Opioid Hysteria Leaves Out: Most Overdoses Involve a Mix of Drugs. The Guardian.
  12. Trujillo, K. A., Smith, M. L., & Guaderrama, M. M. (2011). Powerful Behavioral Interactions Between Methamphetamine and Morphine. Pharmacology, Biochemistry, and Behavior99(3), 451–458.
  13. Drug Enforcement Administration. Fentanyl FAQs.
  14. National Institute on Drug Abuse. Emerging Trends and Alerts: DEA Issues Nationwide Warning on Carfentanil.

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