Understanding polydrug use: review
of heroin and cocaine co-use
by
Leri F, Bruneau J, Stewart J
Center for Studies in Behavioural Neurobiology,
Concordia University, Montreal and Research Center,
Centre hospitalier de l'Universite de Montreal,
Montreal, Canada Correspondence to:
Francesco Leri
University of Guelph Department of Psychology
Guelph Ontario N1G 2W1 Canada
E-mail: fleri@uoguelph.ca
Addiction 2003 Jan;98(1):7-22

ABSTRACT

The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment. The pharmacological reasons for cocaine use in opioid-dependent individuals, however, are poorly understood and little is known about the patterns of heroin and cocaine co-use. We reviewed anecdotal evidence suggesting that cocaine is co-used with opioid drugs in a variety of different patterns, to achieve different goals. Clinical and preclinical experimental evidence indicates that the simultaneous administration of cocaine and heroin (i.e. 'speedball') does not induce a novel set of subjective effects, nor is it more reinforcing than either drug alone, especially when the doses of heroin and cocaine are high. There is mixed evidence that the subjective effects of cocaine are enhanced in individuals dependent on opioids, although it is clear that cocaine can alleviate the severity of symptoms of withdrawal from opioids. We also reviewed preclinical studies investigating possible neurobiological interactions between opioids and cocaine, but the results of these studies have been difficult to interpret mainly because the neurochemical mechanisms mediating the motivational effects of cocaine are modified by dependence on, and withdrawal from, opioid drugs. Our analysis encourages further systematic investigation of cocaine use patterns among opioid-dependent individuals and in laboratory animals. Once clearly identified, pharmacological and neuroanatomical methods can be employed in self-administering laboratory animals to uncover the neurobiological correlates of specific patterns of co-use.

Speedballs
Prenatal cocaine
Dopaminergic flies?
Dopaminergic agents
Cocaine immunization
The coke-craving brain
Cocaine and the lonely rat
Monoamines, cocaine and rats
Freebasing flies go hyperkinetic
Speedballing: co-administering cocaine and heroin
Speedballing to attenuate negative effects of cocaine use?
Pharmacodynamic interaction between heroin and cocaine?
Speedballing euphoria: role of dopamine and mu opioid receptors

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