HARM REDUCTION // HEALTH & SAFETY

Harm Reduction — Evidence-Based Drug Safety Guide

// EMERGENCY NOTICE

If someone is overdosing: Call 911 immediately. Good Samaritan laws protect callers in most US states and many countries. Stay with the person until help arrives. Administer Naloxone if opioids are suspected.

EMERGENCY PROTOCOLS

Overdose Response — Immediate Actions

// OPIOID OVERDOSE (HEROIN, FENTANYL, OIDS)

Signs: slow/stopped breathing, blue lips, unresponsive, pinpoint pupils

Call 911 immediately
Administer Naloxone (Narcan) — nasal spray or injection
Place in recovery position (on side)
Perform rescue breathing if not breathing
Repeat Naloxone in 2–3 minutes if no response
Stay until emergency services arrive

// STIMULANT CRISIS (COCAINE, METH, MDMA)

Signs: chest pain, seizure, extreme agitation, overheating, rapid/irregular heartbeat

Call 911 — cardiac events are life-threatening
Keep person calm, seated or lying down
Cool the person if overheating (wet cloth, fan)
Do NOT give water if seizing or unconscious
Move to safe, cool, quiet space
Monitor breathing until help arrives

// SEDATIVE OVERDOSE (BENZOS, GHB, ALCOHOL)

Signs: unresponsive, slow breathing, limp, not waking

Call 911
Place in recovery position immediately
Monitor breathing constantly
Note: Naloxone does NOT work for benzos/GHB
Keep them warm
Do not leave them alone under any circumstances

SUBSTANCE TESTING

Testing Protocols — Know What You're Taking

Fentanyl Test Strips

Fentanyl test strips detect fentanyl and most fentanyl analogues (carfentanil, acetylfentanyl). A positive result means fentanyl is present in the sample. Method: dissolve a small amount in water, dip strip, wait 2–5 minutes. One line = positive (fentanyl detected). Two lines = negative. Available from DanceSafe.org, harm reduction programs, and pharmacies in most states.

Reagent Testing Kits

Reagent kits verify substance identity through color reactions. Essential for purchased substances — darknet market vendors occasionally mislabel products deliberately or accidentally. Key reagent tests:

Marquis: MDMA (purple/black), amphetamines, opioids
Mecke: MDMA (blue/black), opioids, cathinones
Mandelin: Ketamine (orange), MDMA, amphetamines
Simon's: Differentiates MDMA from MDA (MDMA = no reaction)
Scott: Cocaine identification

Start Low, Go Slow

For any new batch or new vendor, use the smallest possible test dose and wait the full duration before redosing. Tolerance, purity variation, and adulterants can produce dramatically different effects from seemingly identical products.

// DANGEROUS COMBINATIONS — NEVER MIX

Opioids + Benzodiazepines: Synergistic respiratory depression — extremely lethal combination, responsible for majority of overdose deaths
Opioids + Alcohol: Respiratory depression multiplied — highly dangerous even at low doses of each
Stimulants + MAOIs: Serotonin syndrome risk, potentially fatal
MDMA + MAOIs: Severe serotonin syndrome — emergency risk
GHB + Alcohol: Unpredictable respiratory depression, loss of consciousness
Cocaine + Heroin (Speedball): Masking effect — stimulant wears off first leaving opioid dose unmet by cardiovascular response

// INTERACTION CHECKER

Use TripSit Combo Checker before mixing any two substances. Many dangerous interactions are not immediately obvious.

SUBSTANCE-SPECIFIC GUIDES

Harm Reduction by Substance

OPIOIDS (Heroin, Fentanyl, Oxycodone, Morphine)

Always test with fentanyl test strips — street supply is heavily contaminated
Never use alone — have someone present who can call 911
Keep Naloxone (Narcan) accessible at all times
Start with minimum possible dose, wait full duration before redosing
Avoid mixing with any CNS depressant (alcohol, benzos, antihistamines)
Tolerance drops rapidly — previous dose after abstinence is overdose risk
Do not share injection equipment — HIV, Hepatitis C transmission
Naloxone available free at many pharmacies — ask for it

// FENTANYL RISK NOTICE

Illicitly manufactured fentanyl (IMF) is 50–100× more potent than morphine. A dose the size of a few grains of salt can be lethal. Carfentanil — detected in street supply — is 100× more potent than fentanyl. Test every batch, every time. CDC Fentanyl Resources →

STIMULANTS (Cocaine, Methamphetamine, Amphetamine)

Test with Scott reagent (cocaine) or Marquis (amphetamines)
Monitor core temperature — overheating is a primary cause of stimulant deaths
Stay hydrated but do not over-hydrate (especially MDMA)
Avoid combination with cardiac medications or MAOIs
Establish clear redosing limits before starting
Cocaine is highly cardiotoxic — chest pain = emergency
Long-term use causes cardiovascular damage — seek medical monitoring

// RESOURCES

MDMA (Ecstasy, Molly)

Test with Marquis + Mecke + Simon's reagent — extensive adulteration documented
Dose by weight: 75–125mg typical range. >150mg increases neurotoxicity risk
Do not redose more than once — diminishing returns, increasing risk
Space use by minimum 3 months — neurological recovery time
Drink ~500ml water per hour if dancing; less if sedentary (hyponatremia risk)
Cool down regularly — overheating is primary cause of MDMA fatalities
Never combine with MAOIs — risk of fatal serotonin syndrome
Never combine with lithium — seizure risk

// RESOURCES

CANNABIS (THC/CBD)

Edibles: start with 5–10mg THC, wait 2 hours before redosing — onset is delayed
High-potency concentrates (dabs) carry significant acute intoxication risk
Cannabis psychosis risk is elevated with high-THC products, especially in those with schizophrenia family history
CBD can reduce anxiety from THC — useful as "antidote" for panic
Avoid use in under-25s — brain development impact documented
If overwhelming: black pepper (terpenes), cold water, calm environment

// RESOURCES

PSYCHEDELICS (LSD, Psilocybin, DMT, Ketamine)

Set and setting are paramount — prepare a safe, comfortable environment
Have a trusted, sober "trip sitter" if possible
Avoid if history of psychosis, schizophrenia, or first-degree relatives with these conditions
Test LSD with Ehrlich reagent — many NBOMe analogs are more dangerous
Psilocybin mushroom species ID before consumption — some mushrooms are lethal
Ketamine: avoid using alone, dissociation increases fall/accident risk
If in distress: calm environment, grounding techniques, benzodiazepine (small dose)

// RESOURCES

BENZODIAZEPINES & SEDATIVES (Xanax, Valium, GHB)

NEVER combine with opioids or alcohol — leading cause of overdose death
Benzodiazepine dependence develops within 2–4 weeks of daily use
Benzo withdrawal can be fatal — do not stop suddenly after heavy use
GHB has an extremely steep dose-response curve — tiny amounts separate recreational from overdose dose
Designer benzodiazepines (etizolam, flualprazolam) have longer half-lives and higher potency
If dependent, seek medical detox — never attempt cold turkey

// RESOURCES

SUPPORT RESOURCES

Harm Reduction Organizations

// CRISIS LINES

SAMHSA (US): 1-800-662-4357
Crisis Text Line: Text HOME to 741741
Frank (UK): 0300 123 6600
DAN (Australia): 1300 85 85 84
Emergency: 911 / 999 / 000 / 112

// INFORMATION

// NALOXONE ACCESS