Mixing Cocaine With Other Drugs: How Does This Affect Detox?

Cocaine is an addictive stimulant substance derived from South American coca plant leaves. People may use cocaine in several ways, including snorting it through the nose, dissolving it into water and injecting it, rubbing it on the gums, or smoking a processed, freebase form of the drug (crack cocaine). A common intravenous drug combination is cocaine and heroin, which is typically referred to as a “speedball.”¹

On its own, cocaine use can produce feelings of extreme euphoria, mental alertness, and increased energy; however, cocaine use may also cause paranoia and irritability and can lead to bizarre, unpredictable, and even violent behavior.¹

Cocaine users may mix the stimulant with other substances, such as heroin, benzodiazepines, or alcohol, for a variety of reasons.^2-4,11 Polydrug abuse can greatly impact the detoxification process, as some medical complications associated with alcohol and benzodiazepine withdrawal, such as grand mal seizures or delirium tremens, can be life-threatening.³

Why Do People Combine Cocaine & Other Substances?

People may also use cocaine and heroin simultaneously (a practice known as “speedballing”), as the combination of the stimulant with the opioid can create a “push-pull” reaction in the brain and body. Cocaine and heroin are used together for a number of different reasons, depending on the intended goal. People may use both drugs in attempts to enhance the euphoria or high, in hopes that the individual negative side effects are minimized.⁶ Some people may use cocaine in an attempt to mitigate the intensity of heroin withdrawal symptoms.⁵ However, combining heroin and cocaine can have potentially deadly consequences. In addition to causing severe confusion, stupor, impaired coordination and cognition, speedballing can also increase the risk of aneurysm, heart attack, and stroke.⁶

Further, the use of speedballs can also increase the risk of overdose due to profound respiratory depression. This is because cocaine can mask the sedating effects of heroin, causing the individual to use more heroin than they typically would. Cocaine intoxication doesn’t last nearly as long as heroin’s, so once the cocaine wears off, then heroin’s effects are felt in full. This is when respiratory failure, overdose, and death can occur.⁶

Finally, people may also mix benzodiazepines, such as Xanax or Klonopin, with cocaine under the assumption that they can minimize some of the unpleasant symptoms associated with stimulant use, such as anxiety or agitation.¹¹ Some patients risk respiratory depression if they take high doses of benzodiazepines to ward off the unpleasant symptoms of withdrawing from cocaine.⁷

While using cocaine is inherently dangerous on its own, combining it with other substances is particularly risky. Polydrug abuse often increases the likelihood of serious medical consequences or death.

The Detox Process

People struggling with a cocaine addiction often benefit from receiving detox services to support the uncomfortable physical and psychological symptoms associated with acute withdrawal.

Cocaine withdrawal symptoms can develop within a few hours to several days after the last use. Many people experience a “crash” after heavy cocaine use, and withdrawal symptoms can appear relatively quickly, as cocaine has a short half-life, meaning that the body eliminates it quickly.¹²

Although cocaine withdrawal by itself is not generally fatal, depression can occur in those going through withdrawal. This depression can become severe in some cases and may be associated with suicidal thoughts and behaviors.^3,11 Further, seizures can also occur during cocaine detoxification, although it is considered a medical complication and not typical of the cocaine withdrawal syndrome.³ Because of these risks, a detox program can greatly benefit someone attempting to quit cocaine, as staff members provide support and care necessary to jumpstart recovery.

You may be wondering what it’s like to enter a detox program. While every program is different, the Substance Abuse and Mental Health Service Administration (SAMHSA) emphasizes that there are 3 key parts of detox that every program should have. These elements include:³

• Evaluation: During this phase, the medical team tests for the presence of drugs in the bloodstream and screens for physical and mental health disorders. A doctor or other mental health professional conducts a biopsychosocial assessment, which examines the person’s social, psychological, and physical health. The evaluation is then used to create an individualized detox plan.
• Stabilization: During this phase, the staff members provide proper interventions to manage acute intoxication (if applicable) and withdrawal symptoms to reach a stable, sober state.
• Referral to addiction treatment: During this phase, staff members educate the patient on the importance of receiving comprehensive substance abuse treatment to help build a foundation for obtaining and maintaining sobriety.

Although the FDA has not clinically approved any medications to manage cocaine withdrawal, researchers have begun exploring some potential options. For example, amantadine and disulfiram (Antabuse) may help decrease cocaine use in individuals experiencing intense withdrawal symptoms, and modafinil, a stimulant drug prescribed for narcolepsy and other sleep-related disorders, is being investigated for use during cocaine detoxification. More research is needed to confirm the utility of these medications.³

Cocaine detox can be managed on either an inpatient or outpatient basis. Inpatient detox programs provide 24-hour detox treatment and support to mitigate potential dangers of withdrawal and to adequately treat any conditions or complications that may be present or may arise throughout the process. Outpatient programs entail scheduled meetings with a counselor or medical professional at a detox facility, while allowing the patient to return home in the evening. The level of care will be determined depending on a variety of factors, including symptom severity and suicide risk.³

The Impact of Polydrug Use

As previously mentioned, polydrug use can significantly impact the cocaine detox process, making it far more risky than on its own. During withdrawal, people who also abuse alcohol, benzodiazepines, and some other sedating drugs risk grand mal seizures, which can be fatal, or delirium tremens, which is characterized by hallucinations and delusions, and can increase the risk of death due to erratic, bizarre, or violent behaviors.³ Some individuals who engage in co-occurring alcohol and cocaine use may experience cardiac complications during withdrawal, including arrhythmia and heart attack.³ At this point, it is impossible to pinpoint who will or will not experience these dangerous symptoms during the detox process, but heavy, long-term users tend to have a greater risk.

Because the withdrawal symptoms resulting from mixing cocaine with other drugs can lead to significant suffering and even death, it is often recommended that polydrug users seek a 24-hour care setting for support and monitoring. Such support can help alleviate the discomfort, reduce the risk of relapse, and ensure the patient’s safety.³

That being said, if you are unsure about what level of care you need, it is always wisest to receive a thorough assessment from a doctor or mental health professional before choosing a program. The assessment provides an overview of a person’s physical and psychological health and can help to determine the type and duration of detox treatment necessary.

Other Detox Medications

Many polydrug users benefit from medication to reduce cravings and mitigate withdrawal symptoms. Those who use more than one drug may need additionally specialized treatment and intervention for treating all the substances they use, but some examples of common detox medications include:^3,10

It is important to note that anyone struggling with polydrug use can benefit from the support and structure offered within professional treatment settings. Although detox can feel like a terrifying first step, learning about the process and knowing what to expect can simplify you or your loved one’s decision in seeking help.

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