⚠️ Medical Disclaimer
This is educational information only. In a medical emergency, always call your local emergency services (911 in the US, 999 in UK, 112 in EU). This page does not constitute medical advice.
Universal Harm Reduction Principles
Harm reduction is a public health philosophy that accepts that some people use drugs and focuses on reducing the negative consequences of that use. The following principles apply regardless of which substance is involved:
- Test your substances — Use reagent test kits or drug checking services. Never assume a substance is what it's claimed to be, especially pressed pills.
- Start low, go slow — Begin with the smallest dose. Effects can be delayed. Wait before redosing.
- Never use alone — Have someone sober present, or use the Never Use Alone hotline: 1-800-484-3731
- Avoid dangerous combinations — Some combinations dramatically increase overdose risk. Research all combinations at TripSit Combo Checker
- Know overdose signs — Learn what an overdose looks like for each substance and know how to respond
- Have naloxone — If opioids are involved, keep naloxone (Narcan) available
Overdose Response: Opioids
🚨 Opioid Overdose Signs
Slow or stopped breathing (fewer than 1 breath per 5 seconds), blue lips or fingertips, unconscious or unresponsive, gurgling sounds, pinpoint pupils, limp body.
Call Emergency Services
Call 911 (US) or your local emergency number immediately. Describe exactly what you see. Good Samaritan laws in most US states protect callers from prosecution.
Administer Naloxone
If naloxone is available, administer it immediately: nasal spray (Narcan) — one spray in each nostril. Injection: 0.4mg intramuscularly. Naloxone reverses opioid overdose within minutes.
Rescue Breathing
If the person is not breathing, begin rescue breathing: tilt head back, lift chin, give one breath every 5 seconds. Continue until they breathe on their own or EMS arrives.
Recovery Position
If breathing resumes, place the person in the recovery position (on their side) to prevent choking. Stay with them — naloxone wears off in 30-90 minutes and they may need a second dose.
Substance-Specific Harm Reduction
MDMA / Ecstasy / Molly
Medium-High RiskDosage
Low: 75mg | Moderate: 80-120mg | High: 120-150mg+
Never exceed 1.5mg/kg body weight. Redosing increases neurotoxicity risk.
Dangerous Combinations
- MAOIs (potentially fatal)
- Lithium (seizure risk)
- Tramadol (serotonin syndrome)
- Other stimulants (cardiac risk)
Overdose Signs
Extremely high temperature (hyperthermia), seizures, confusion, irregular heartbeat. Call emergency services. Cool the person with ice/water immediately.
Test with Marquis (purple/black), Mecke (blue/black), and Simon's reagents. The "3-month rule" (use no more than once every 3 months) is widely cited to reduce neurotoxicity risk.
Cocaine / Crack Cocaine
High RiskKey Risks
Cardiac arrest, stroke, nasal septum damage, addiction. Fentanyl contamination is now a major risk in cocaine supply — always test.
Dangerous Combinations
- Alcohol — forms cocaethylene (more toxic)
- Heroin ("speedball") — very high overdose risk
- MAOIs — dangerous hypertension
Overdose Signs
Chest pain, racing heart, extreme agitation, hallucinations, difficulty breathing, seizure. Medical emergency — call EMS immediately.
Test with fentanyl test strips (fentanyl contamination is increasingly common). Test with Scott reagent for cocaine presence. Never use IV without sterile equipment.
Opioids (Heroin, Oxycodone, Fentanyl, etc.)
Very High RiskCritical Warning
Fentanyl contamination affects virtually all illicit opioid supply. A dose as small as 2mg (barely visible) is lethal. Always test with fentanyl test strips.
Keep Naloxone
Naloxone (Narcan) reverses opioid overdose within minutes. Get it free at NEXT Distro, most pharmacies without prescription. Carry it always.
Safer Use
- Never use alone
- Test every batch
- Start with a test dose
- Use sterile equipment
- Avoid mixing with depressants
Cannabis / Marijuana
Lower RiskEdibles Warning
Edibles take 1-3 hours to take effect. Avoid the common mistake of redosing before effects begin. Accidental overconsumption is the most common cannabis emergency.
At-Risk Groups
Individuals with personal or family history of psychosis should avoid cannabis, particularly high-THC products. Cannabis-induced psychosis is a real risk.
Safer Use
- Start with low-THC strains
- Vaping is less harmful than smoking
- Avoid synthetic cannabinoids entirely
Psychedelics (LSD, Psilocybin)
Medium RiskSet and Setting
Mental state and physical environment have an enormous impact on the psychedelic experience. Only use in a safe, comfortable environment with a trusted trip sitter if new to psychedelics.
Dangerous Combos
- Lithium + LSD = seizures
- MAOIs can intensify effects unpredictably
- Avoid stimulants
Safer Use
Test LSD with Ehrlich reagent (turns purple). Verify mushroom species identity carefully. Avoid if personal or family history of schizophrenia or bipolar disorder.
Ketamine
Medium RiskK-hole Risk
High doses cause intense dissociative states ("k-holes"). Though not directly lethal, the impaired state creates serious accident risk. Never use near water or operating machinery.
Long-term Risk
Frequent use causes ketamine bladder syndrome (KB) — severe, often irreversible urological damage requiring surgery. Limit use frequency dramatically.
Dangerous Combos
- CNS depressants (amplifies sedation)
- Alcohol (respiratory risk)
- Tramadol (seizure risk)
Methamphetamine
Very High RiskKey Risks
High addiction potential, severe cardiac risks, psychosis with repeated use, hyperthermia, and significant long-term neurological damage. Prolonged binges ("tweaking") carry serious risks.
Overdose Signs
Chest pain, extremely fast heart rate (over 150 bpm), very high body temperature, seizures, paranoia, stroke symptoms. Call EMS immediately.
Safer Use
- Sleep and eat regularly
- Avoid IV use
- Test with Marquis (orange)
- Stay hydrated
Test Kit Resources
DanceSafe
Non-profit providing drug checking services and reagent test kits. Active at festivals and events nationwide.
TripSit — Drug Information & Combo Checker
Comprehensive drug information database and dangerous combination checker. Peer support available 24/7.
RollSafe — MDMA Harm Reduction
In-depth MDMA harm reduction guide with testing, dosing, and neurotoxicity information.
NEXT Distro — Free Naloxone
Free naloxone and harm reduction supplies by mail in the United States.
Harm Reduction International
Global organization promoting evidence-based harm reduction policies and practices.