Mixing Fentanyl & Cocaine: Effects, Dangers, & Getting Help

Despite the negative and potentially severe health consequences that can occur due to polysubstance misuse, the practice of mixing opioids and cocaine has dramatically increased in the US since 2010.^{1, 2} This can be gleaned from overdose stats, which showed a continued increase in co-involvement of opioids in drug overdose deaths involving cocaine. From 2011 through 2021, the rate of overdose deaths involving both cocaine and opioids increased more quickly than overdose deaths that involved cocaine but no opioids. In 2021, drug overdose deaths involving both cocaine and opioids were 7.4 times the rate in 2011.¹⁴

During this period, opioid use has also shifted dramatically. Fentanyl is being used with increasing prevalence and has been primarily responsible for dramatic increases in opioid overdose deaths for several years.^1,2 According to one study, the percentage of US overdose deaths involving both fentanyl and stimulants increased from 0.6% in 2010 to 32.3% in 2021, with cocaine being the most common stimulant drug taken along with fentanyl in the Northeast in 2021.¹ This dangerous combination has contributed significantly to the number of overdose deaths associated with illicitly-manufactured fentanyl and the overall opioid epidemic that is affecting the entire country.²

If you or someone you care about are taking fentanyl and cocaine, it’s important to understand the associated risks and know how to seek help for polysubstance misuse. Evidence-based treatment can produce positive outcomes, help people stop using substances, and help them regain control of their lives.³

Why Would Somebody Mix Fentanyl and Cocaine?

Cocaine is a stimulant, and fentanyl is an opioid, so they each produce different effects.⁴ Traditionally, people who use stimulants and cocaine together have mixed heroin (an opioid) and cocaine in a practice known as “speedballing” as a way to experience the effects of both substances.⁵ With the increased availability of fentanyl as a standalone substance of misuse as well as an additive to other drugs, especially heroin, this practice has expanded to include the combination of fentanyl and cocaine.⁶

People who intentionally combine these substances and use them simultaneously may experience the stimulant effects of cocaine with the depressant effects of fentanyl, which they may feel counteracts or balances their effects.⁶ They may also feel that taking both an opioid and a stimulant enhances the high vs. taking only one or the other.^2,6, 15 Fentanyl depresses the cardiovascular and circulatory systems, while cocaine excites it and constricts the arteries, which results in opposing effects but can also cause unpredictable consequences, such as dangerous heart problems like arrhythmias.^{4, 6}

Research also indicates that some people may mix these substances to alleviate or prolong the onset of withdrawal symptoms.^{1, 15} For example, people may use cocaine as a way of dealing with unpleasant symptoms of opioid/fentanyl withdrawal, or they may take an opioid/fentanyl to calm down, induce sleep, or otherwise alleviate anxiety or distress produced by coming down off cocaine.^{1,8, 15}

However, people who use cocaine may also be unknowingly exposed to fentanyl if they purchase cocaine that is contaminated with fentanyl, in which case they are taking a combination of these two substances without their conscious knowledge, and potentially experiencing unexpected drug interactions and an increased risk of dangerous adverse effects, including overdose.⁶ 

Heroin may also be adulterated with fentanyl. A person intending to speedball with cocaine and fentanyl-contaminated heroin may be more prone to overdose, as fentanyl is significantly more potent than heroin.

Effects of Cocaine Use

Cocaine is an illicit stimulant drug that people use for different reasons, such as to increase energy or feel euphoria.^{2, 10}

The mental and physical effects of cocaine can vary by dose but may include:¹⁶

• Extreme happiness or euphoria.
• Mental alertness.
• Hypersensitivity to light, sound, and/or touch.
• Irritability.
• Paranoia.

Effects of Fentanyl Use

Fentanyl is a strong synthetic opioid that produces a euphoric high (i.e., intense pleasure) and effects similar to other opioids, but because it is more potent (up to 50-100 times stronger than morphine), it can lead to an increased risk of potentially dangerous health effects.¹¹

In addition to euphoria, fentanyl’s other effects can include:¹¹

• Drowsiness.
• Nausea.
• Confusion.
• Constipation.
• Sedation.
• Slowed, shallow, or irregular breathing).
• Overdose, leading to respiratory depression (slowed or stopped breathing), which can cause hypoxia, a condition where too little oxygen reaches the brain. This can result in coma, permanent brain damage, and death.

Overdose Risk of Mixing Fentanyl & Cocaine

Mixing fentanyl and cocaine is potentially dangerous because it can lead to unpredictable and potentially fatal outcomes.⁴ The risk of overdose is increased because of the combined effects and risks of each substance.^{2, 7}

If someone is experiencing an overdose, it is important to contact 911 right away and administer naloxone, if available.¹² Naloxone (Narcan, RiVive, Kloxxado) is a medication that can rapidly reverse an opioid overdose and restore breathing in a person who has overdosed, but it must be promptly administered and at a high enough dose.¹² Narcan and RiVive can be purchased over the counter from a pharmacy without a prescription, while Kloxxado and other formulations may require a prescription. Naloxone can be administered by anyone without medical training, but emergency medical personnel will also assess the situation and administer it as needed.^{11, 12} Naloxone has temporary effects, which is why people who have overdosed require immediate medical attention; additionally, sometimes, people may need more than one dose when stronger opioids like fentanyl are involved.^{12, 13}

Getting Help for Fentanyl and Cocaine Addiction

If you or someone you care about are struggling with fentanyl and cocaine misuse or addiction, you should be aware that treatment can help. Effective treatment can include medications, behavioral therapies, and counseling to help people safely stop using cocaine and fentanyl, make necessary behavioral changes to promote abstinence, and regain control of their lives.

You can find treatment by asking your doctor or a qualified mental health practitioner for referrals or using the Rehabs.com directory to find treatment centers across the country that meet your needs.

You can also look at the facilities listed below to see if they provide the program you are looking for:

• California: Laguna Treatment Center
• Florida: Recovery First Treatment Center
• Florida: River Oaks Treatment Center
• Nevada: Desert Hope Treatment Center
• Mississippi: Oxford Treatment Center
• Texas: Greenhouse Treatment Center

Does Insurance Cover Addiction Rehab?

For those who have insurance, using health insurance to pay for rehab should cover at least some of the cost of addiction treatment. Depending on your individual insurance plan, treatment at a specific facility may or may not be covered. It’s important that you know what is covered prior to attending a rehab. Use the free online insurance coverage checker tool below to find out if your health insurance provides coverage for addiction rehab and other rehabilitation treatment plans for substance abuse recovery.

Coverage may vary depending on your needs and insurance plan. To find out if your policy covers rehab, click here, or fill out the form below. Your information is kept 100% confidential. You can also click here to find a rehab near me.

It’s never too late to seek help. Consider reaching out to us today at to verify your insurance benefits.