DRUG HARM REDUCTION: COMPLETE SAFETY GUIDE

Onset: 30-90 min oral. Duration: 3-6 hours. Dose: 75-125mg (body-weight dependent: ~1-1.5mg/kg). Redosing: 50-75% of initial dose, once only, within 60-90 min of onset.

Key risks: Hyperthermia (overheating) — stay cool, avoid overexertion. Hyponatremia (water intoxication) — sip 500ml water/hour if dancing, not more. Serotonin syndrome risk when combined with other serotonergics (SSRIs, MAOIs, lithium).

Testing: Use Marquis, Mecke, and Simon's reagent kits. Fentanyl test strip. Genuine MDMA should turn purple-black with Marquis.

Recovery: 5-HTP (after 24h gap), magnesium glycinate, rest, nutrition. The 3-month rule: limit use to once every 3 months minimum.

Routes: Smoked, vaporized, oral (edibles). Onset varies dramatically: smoked 5-10 min, edibles 30-120 min (highly variable). Duration: 2-4 hours smoked; 4-8+ hours edibles.

Key risks: Edible overdose is extremely common and non-lethal but very distressing — symptoms include intense anxiety, paranoia, and elevated heart rate. Lay down in a calm environment, drink water. It will pass.

Cannabis Hyperemesis Syndrome (CHS): Long-term heavy users may develop cyclical vomiting. Hot showers temporarily relieve symptoms. Resolution requires cessation.

High-THC concentrates: Require very careful dosing (start with a match-head sized amount). Tolerance may drop significantly after breaks — dose accordingly.

Key risks: Adulterants (levamisole causes agranulocytosis — immune suppression; fentanyl causes overdose). Always test. Cardiovascular risk elevated even in young, healthy users. Never mix with alcohol (creates cocaethylene, more cardiotoxic).

Overdose signs: Chest pain, irregular heartbeat, severe anxiety, paranoia, hyperthermia. Call EMS immediately. No antidote — supportive care only.

Harm reduction: Use small test lines. Do not share straws/pipes (disease transmission risk). Take breaks between doses. Stay hydrated. Have Narcan present if purity unknown (fentanyl contamination).

Crack/freebase: Faster onset, shorter duration — higher compulsivity risk. Pipe use only — do not share pipes.

CRITICAL: Fentanyl contamination in the illicit opioid supply is responsible for the majority of overdose deaths. Test every batch with fentanyl test strips. This is non-negotiable.

Tolerance: Drops to near-zero after just 2-3 days of abstinence. Return to previous doses after any break = high overdose risk. Always redose at a fraction of previous amounts.

Naloxone (Narcan): Carry it. Know how to use it. It reverses opioid overdose. Nasal or intramuscular. Multiple doses may be needed for fentanyl. Available without prescription in most US states and many countries.

Safer use: Never use alone. Never mix with other CNS depressants (alcohol, benzos, muscle relaxants). IV use carries additional risk (infection, vein damage, HIV/Hep C) — nasal insufflation reduces (but doesn't eliminate) risk.

Danger: Benzodiazepines have a withdrawal syndrome that can be life-threatening (unlike opioid withdrawal). Seizures can occur with abrupt cessation after regular use. Never stop cold turkey — taper under medical supervision.

Overdose: Benzos alone are rarely fatal in healthy adults, but combined with alcohol or opioids, they dramatically increase overdose risk (CNS depression). Most overdose deaths involving benzos are polydrug.

Novel Benzodiazepines (RC benzos): Many designer benzos (clonazolam, flualprazolam, etizolam) are far more potent than diazepam. Dose conservatively. Tolerance and dependence develop rapidly — even after days of use.

Physical safety: Psychedelics are physiologically very safe — low toxicity, not physically addictive, no recorded fatal overdose from LSD or psilocybin alone. However, psychological risk is real: ego dissolution, anxiety, psychosis-like states. Set and setting are critical.

Testing: LSD: Hofmann's reagent + Ehrlich reagent. Real LSD turns purple with Ehrlich. Psilocybin mushrooms: Visual identification (Masson's taint or mass spec for certainty).

Dangerous combinations: Never combine with lithium (seizure risk). MAOI combination with psilocybin dramatically intensifies effects — only with extreme care. Cannabis can significantly amplify intensity mid-trip.

Trip sitting: If someone is having a bad trip — calm voice, calm environment, simple reassurance ("you took a drug, it will wear off"), physical grounding (touch is helpful), lower stimulation.

Key risks: Cardiovascular stress, insomnia, appetite suppression, neurotoxicity with heavy use, psychosis with prolonged use or high doses. High addiction potential.

Overdose signs: Chest pain, extremely elevated heart rate, hypertension, hyperthermia, severe agitation, hallucinations. Medical emergency — call EMS.

Harm reduction: Take breaks from use. Maintain sleep and nutrition even when appetite suppressed. Avoid combination with other stimulants. Mental health screening important — stimulants can trigger underlying psychotic conditions.

Adulterants: Street amphetamine is often cut with caffeine, MSM, or in some regions fentanyl analogs. Test strips essential.

Routes: IM, nasal insufflation, oral (less common). Nasal: 50-150mg recreational. Duration 45-90 minutes.

Overdose/K-hole: Very high doses produce a dissociative "k-hole" — not a true overdose but can be overwhelming. The person cannot move or communicate but will recover. Keep safe and still. Call EMS if breathing is compromised.

Ketamine bladder syndrome: Regular or heavy use causes severe bladder damage (irreversible at advanced stages). Reduction or cessation is the only treatment. Use intervals to mitigate risk.

Dangerous combinations: Alcohol, benzodiazepines, and opioids increase CNS depression risk. Psychedelics can create intensely disorienting combinations.