Opioids (Heroin, Fentanyl, Oxycodone, Morphine, Hydromorphone)
Opioids carry the highest risk of fatal overdose. The illicit supply is heavily contaminated with fentanyl and carfentanil — substances 50× and 10,000× stronger than morphine respectively. Naloxone is essential.
- Always test with fentanyl test strips (dissolve a small amount in water)
- If fentanyl is detected, use an even smaller starting dose
- Overdose signs: blue lips, pinpoint pupils, unresponsive, slow/stopped breathing, choking sounds
- Administer naloxone: 1 spray per nostril, wait 2–3 minutes, repeat if no response
- Put in recovery position, call 911, stay until help arrives
- Tolerance drops fast — a dose that was safe before a break can be lethal
Stimulants (MDMA, Cocaine, Crystal Meth, Speed)
Stimulant overdose is characterised by overheating, hypertension, and cardiac events rather than respiratory depression.
- MDMA: test with Marquis reagent (purple-black = positive). Dose 75mg or less to start. Avoid redosing. Drink ~500ml water per hour if dancing — not more (hyponatremia risk).
- Cocaine: avoid mixing with alcohol (produces cocaethylene, higher cardiac toxicity). Test for levamisole contamination where possible.
- Methamphetamine: high cardiovascular risk. Avoid if you have heart conditions. Do not mix with any other stimulant.
- Overheating signs: extreme body temperature, confusion, seizures, loss of consciousness. Cool with water, move to air conditioning, call 911.
Cannabis (THC, CBD, Edibles)
Cannabis is generally lower-risk but can cause significant psychological distress, especially with high-THC products or edibles.
- Edibles have a delayed onset of 30–120 minutes. Do not redose before onset.
- Cannabis-induced anxiety: quiet environment, grounding techniques, CBD can reduce acute THC effects
- Avoid mixing with depressants — cannabis can increase sedation
- Not safe for those with psychosis history or under 25 (brain development)
Benzodiazepines (Xanax, Valium, Clonazepam, Etizolam)
Benzos are highly dangerous when combined with any other CNS depressant. Many illicit benzo tablets are counterfeit and may contain novel benzodiazepines with unknown potency.
- Never combine with opioids, alcohol, or GHB — this combination is frequently fatal
- Test with benzo test strips where available
- Tolerance develops rapidly; do not use more than 2–3 days consecutively
- Withdrawal from high-dose/long-term use can cause seizures — medical supervision required
Psychedelics (LSD, Psilocybin, DMT, 2C-x, Ketamine)
Psychedelics are generally physically safe but require psychological preparation and appropriate setting.
- LSD: test with Ehrlich reagent (turns purple in presence of indoles). Avoid if personal or family history of psychosis.
- Psilocybin: lower risk of adverse physical effects. Set and setting are critical. Start with 1–1.5g dried mushrooms.
- Ketamine: dissociative effects. Avoid redosing frequently — bladder damage from chronic heavy use is permanent.
- 2C-x and novel psychedelics: start very low. Many have steep dose-response curves. Test with reagents.
- For difficult trips: calm environment, trusted sitter, benzodiazepines can reduce acute distress
GHB/GBL
GHB has an extremely narrow therapeutic window. The difference between a recreational dose and an overdose-inducing dose is small.
- Never combine with alcohol, benzos, or opioids — extremely dangerous
- Dose with a syringe for precise measurement (never a spoon)
- Redosing is very dangerous — effects can combine unpredictably
- Unconsciousness is common at high doses; recovery position is critical