Effects & Dangers of Mixing Cocaine and Heroin

Polysubstance use, the term used to describe using two or more substances at the same time, is dangerous yet unfortunately common.¹ Specifically, mixing substances like cocaine and heroin can be very risky and produce unpredictable results.¹

Keep reading to learn more about the combined effects of cocaine and heroin, why it’s dangerous to mix these substances, and how to find addiction treatment near you.

Combining Cocaine and Heroin

Many people misuse substances like cocaine and heroin at the same time, despite knowing the risks, both intentionally and unintentionally.¹Several studies have been conducted that provide a better idea of just how prevalent the combined use of cocaine and heroin is throughout the United States. Some of these studies and the information garnered from them report the following findings:

• According to a 2021 study based on data taken from the 2002–2017 National Survey on Drug Use and Health, cocaine use declined from 2002-2017, while both heroin use alone and the co-use of both substances together increased.²
• A 2023 study indicated that half of regular cocaine users knowingly used opioids, such as heroin, in the past 30 days, and 1 in 4 regular opioid users also knowingly used cocaine within the same span of time.³
• A CDC study of 24 states and the District of Columbia involving data from January-June 2019 found that almost one-third of 16,236 overdose deaths involved opioids and a stimulant, such as cocaine.⁴

Effects of Mixing Cocaine and Heroin

People who use cocaine and heroin at the same time put their health and wellbeing in jeopardy, as there are serious and potentially fatal effects that can occur as a result of this type of use.⁴ The types of effects that can develop, as well as the severity of them, can depend on numerous factors ranging from one’s age and genetics to how much is being used at one time and how frequently that use is occurring.⁵

Dangers & Effects of Heroin

Regardless of how heroin is administered (e.g., smoked, snorted, or injected), the use of it can cause an array of immediate, short-term effects, including:⁶

• Euphoria.
• Dry mouth.
• Nausea.
• Vomiting
• Severe itching.
• Drowsiness.
• Warm flushing of the skin.
• Cloudy mental functioning.
• A heavy feeling in the extremities.
• Slowed heart rate and respiratory rate.

With enough heroin, breathing may be severely slowed to a point where it is life-threatening and may lead to coma or death. Opioids like heroin also reinforce drug taking behavior, which may lead to regular use or addiction.⁶

Additional dangers and effects can occur when heroin is being regularly used over longer periods of time, including:^7,8

• Sexual dysfunction in men.
• Irregular menstrual cycles in women.
• Mental health disorders, including depression and antisocial personality disorder.
• Lung complications, such as pneumonia and tuberculosis, in those who smoke heroin.
• Damage to tissue in the nose and perforation of the nasal septum in those who snort heroin.
• Collapsed veins, bacterial infections in blood vessels, and soft-tissue infections from intravenous heroin use.
• Increased risk for contracting/spreading bloodborne illnesses, such as hepatitis and HIV, for those who use heroin intravenously.

Effects of Cocaine

When consumed, cocaine produces short-term effects almost immediately.⁹ These cocaine effects can last anywhere from a few minutes to upwards of an hour, depending on the route of administration.⁹ These effects can include the following:⁹

• Increased energy
• Increased alertness
• Euphoria
• Irritability
• Restlessness
• Anxiety
• Paranoia
• Dilated pupils
• Increased body temperature, heart rate, and blood pressure

Using cocaine on occasion or even just once can result in severe medical complications, with the most frequent being cardiovascular effects like disturbances in heart rhythm and heart attacks.⁹ Other serious and potentially fatal outcomes, such as seizure, stroke, and even sudden death can also occur.⁹

Chronic cocaine use can result in additional dangers, including:⁹

• Gastrointestinal problems, such as tears and ulcerations.
• Cardiovascular problems, such as stroke, aortic ruptures, and inflamed heart muscle.
• Neurological problems, such as bleeding in the brain, increased risk of developing Parkinson’s Disease, and a wide range of cognitive issues.
• Nosebleeds and loss of smell for those who snort cocaine.
• Respiratory problems caused by smoking crack cocaine.
• Increased risk for contracting/transmitting bloodborne diseases (e.g., HIV/hepatitis) in those who inject cocaine.

Interactions Between Cocaine and Heroin

As described above, both heroin and cocaine can cause serious (and even lethal) effects on their own, however when combined, the outcomes can be even more dangerous and unpredictable.¹

Actually, the effects of cocaine can mask those of heroin, including symptoms of an opioid overdose.² This increases the risk of an overdose, which can quickly become deadly.² In fact, one recent study found that people who used opioids and stimulants like cocaine at the same time have more than twice the risk of fatal overdose compared to those who only used opioids.¹⁰

Cocaine and Heroin Addiction

Heroin and cocaine are both addictive, illicit substances.⁷Both substances reinforce continued use, which can lead to the development of tolerance, dependence, and eventually to a compulsive pattern of use that defines addiction.

• Tolerance occurs when a person must take more of a substance, or take it more frequently, in order to achieve the desired effects.¹⁴
• Dependence refers to the physiological adaptations that occur in response to prolonged substance use, leading to withdrawal symptoms when use is significantly reduced or stopped abruptly.¹⁵
• Addiction is a chronic brain disorder marked by compulsive drug use, despite harmful consequences.¹⁵

Some research suggests that using cocaine and heroin together may increase their reinforcing effects, making them more potent than when used separately.^16,17 Drug combinations like these may be more resistant to treatment modalities that might otherwise reduce continued substance use.¹⁶

Cocaine and Heroin Addiction Treatment

Polysubstance addiction involving cocaine and heroin can be treated with a variety of evidence-based therapies and interventions, including pharmacotherapy, behavioral therapies, and psychosocial support.¹² Explore information about levels of care for those struggling with addiction, including:¹⁸

• , which helps people safely and comfortably undergo substance withdrawal so they can become medically stable and can continue to formal treatment.
• , which means a person lives onsite, receives 24/7 care and support, and participates in a variety of treatments.
• which are high–intensity outpatient programs offering 4-8 hours of daily treatment.
• , which are supportive outpatient programs providing 9-20 hours of weekly treatment.
• , which means a person lives at home but attends treatment at a rehab on a set schedule.
• , which refers to substance-free residences that provide structure, support, and reintegration assistance for people in recovery.
• , which refers to ongoing psychosocial interventions, such as 12-step groups or individual supportive therapy sessions, to help aid in recovery and prevent relapse.

Getting Help for Cocaine and Heroin Addiction

If you or a loved one is ready to seek rehab for a substance use disorder, explore your options and reach out to a rehab center using our rehab directory tool today!

No matter how things might seem at the moment, there is always hope, and people can and do recover from addiction. Research shows that treatment specific to an individual’s needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.¹⁹