The combined use of heroin and cocaine, or "speedballing," is a long-established practice in the drug culture that dates back to the 1930s. It first attracted widespread attention as the cause of death of comedian John Belushi in 1982. Traditionally, speedballing involves the simultaneous injection, or piggybacking, of heroin and cocaine. Speedballers report that the effect sought is the rush or "flash" of cocaine injection combined with the mellowing effect of heroin. Several years ago, an addict described the sensation to Dr. Hunt:

On a scale of one to ten, if I'm going to shoot a speedball, I'll probably go up to a level five (on his internal euphoria scale) right away. If I'm going to shoot coke , I'll go up to eight or nine, and I'm going to be really wild. So now I'll shoot dope to bring me from that eight or nine, to bring me down to that five so that I can enjoy it...

In the past, those who speedballed were most likely drug users whose primary drug was heroin, but who added cocaine in the injection as a "bonus" when they had the funds to buy it. In early ethnographic studies of drug use, concurrent use of cocaine among heroin users ran as high as 50-73 percent, predominantly in the form of speedballing.

In the past two years, Pulse Check sources have reported speedballing both among users who inject heroin and users who snort it. Among injectors, speedballing generally takes its traditional form: the two drugs are "cooked" together and injected. Among snorters, the combination takes on a new and slightly different character. In this case, the combination is utilized by persons who may see crack cocaine as their primary drug of abuse, but snort the now readily available and inexpensive heroin to "bring them down" or temper the effects of heavy cocaine use. This does not necessarily mean that the user is switching from crack to heroin; rather, it more likely implies that heroin is being added to the battery of drugs used. However, given its easy availability and the powerful psychological and physiological effects associated with use, heroin may indeed become the primary drug of abuse.

In this issue of Pulse Check, most sources report the occurrence of speedballing in their areas when asked about combination drug use. In addition, treatment providers report that 75 percent of clients in treatment for heroin abuse claim to have a problem with cocaine abuse as well. Law enforcement sources in Yakima, Eugene, Miami, Los Angeles, and Chicago all note that heroin users in their areas engage in speedballing occasionally. Ethnographic sources in Miami report that speedballing is popular with older established heroin users, but not with younger users. Similarly, a New York city ethnographic source reports an active speedball scene among long-term heroin users. The San Francisco ethnographic source notes a "convergence of (heroin and cocaine) markets" as well as an "increase in cocaine and heroin use combined."