HARM_REDUCTION× OVERDOSE OPIOIDS STIMULANTS +
00:00:01HARM REDUCTION GUIDE — INFORMATIONAL PURPOSES ONLY —
[SIGNAL] EMERGENCY CONTACT

Never Use Alone Hotline (US): 1-800-484-3731 · Stay on the line if you use alone. SAMHSA Helpline: 1-800-662-4357

Drug Harm Reduction Guide — Safety Principles and Substance Information

Core Harm Reduction Principles

Harm reduction is a public health approach that acknowledges drug use occurs regardless of legal status and focuses on minimizing associated health risks rather than requiring abstinence. Organizations including DanceSafe, The Loop, Transform Drug Policy Foundation, and national health agencies publish evidence-based harm reduction guidelines.

  • Test before use. Fentanyl test strips and reagent kits (Marquis, Mecke, Simon's) identify dangerous adulterants.
  • Start low, go slow. Unknown potency is the leading cause of overdose. Begin with a small fraction and wait for full onset.
  • Never use alone. Have someone present or call the Never Use Alone hotline (1-800-484-3731).
  • Carry naloxone. Naloxone (Narcan) reverses opioid overdose. Available without prescription at most pharmacies in North America.
  • Avoid combinations. Polydrug use — especially CNS depressants — exponentially multiplies overdose risk.
  • Know your source. Trusted, consistent supply reduces unknown adulterant risk.
  • Use clean equipment. Sterile needles, pipes, and surfaces prevent disease transmission.

// OVERDOSE RESPONSE

What to Do If Someone Is Overdosing

Opioid Overdose (Most Common)

Signs: unresponsive, slow/stopped breathing (<1 breath per 5 seconds), blue lips or fingertips, gurgling or choking sounds, pinpoint pupils.

  1. Call emergency services (911 / 999 / 112) — Good Samaritan laws protect callers in most US states
  2. Administer naloxone nasally or by injection immediately
  3. Place in recovery position if breathing, or begin rescue breathing if not
  4. Repeat naloxone dose every 2-3 minutes if no response (fentanyl may require multiple doses)
  5. Stay until emergency services arrive — naloxone wears off in 30-90 minutes; re-overdose is possible

Stimulant Overdose (Cocaine, Methamphetamine, MDMA)

Signs: racing heart, high temperature, chest pain, seizures, confusion, stroke symptoms.

  1. Call emergency services immediately
  2. Move to a cool environment and remove excess clothing if overheating
  3. Do not restrain a seizing person — clear the area of hazards
  4. Place in recovery position if unconscious and breathing
  5. Do not give water to an unconscious person

Depressant Overdose (Benzodiazepines, GHB, Alcohol)

Signs: unresponsive, slow breathing, low body temperature, loss of bladder control.

  1. Call emergency services
  2. Place in recovery position
  3. Note: naloxone does NOT reverse benzodiazepine or GHB overdose — medical intervention required
  4. Flumazenil (benzodiazepine antagonist) is available in clinical settings only

// FENTANYL TESTING

How to Use Fentanyl Test Strips

Fentanyl test strips (FTS) detect fentanyl and many of its analogues in drug samples at low concentrations. They are inexpensive, portable, and available from harm reduction organizations including BTNX and DanceSafe.

  1. Dissolve a small amount of the sample in water (use teaspoon of water per small residue)
  2. Dip the test strip for 15 seconds
  3. Wait 2-5 minutes and read the result
  4. ONE line = fentanyl DETECTED (positive for fentanyl)
  5. TWO lines = fentanyl NOT detected (negative result)
  6. Zero lines = invalid test — retest with fresh strip
[SIGNAL] IMPORTANT LIMITATIONS

Fentanyl test strips do not detect all fentanyl analogues equally. Nitazenes and other novel synthetic opioids may not trigger a positive result. A negative FTS result does not mean a substance is safe. Always use the start low, go slow principle regardless of test results.

// OPIOIDS

Opioid Harm Reduction (Heroin, Oxycodone, Fentanyl)

Opioids carry the highest overdose fatality risk of any drug class. Tolerance drops dramatically after even a short break from use — many overdose deaths occur after a period of abstinence when users return to previous doses. Risk is exponentially higher when combined with alcohol, benzodiazepines, or other CNS depressants.

  • Always test for fentanyl — illicit opioid supply is frequently contaminated
  • Never use alone — the Never Use Alone hotline (1-800-484-3731) stays on the line
  • Start at a significantly lower dose after any break in use
  • Keep naloxone (Narcan) accessible to people around you
  • Avoid mixing with alcohol, benzodiazepines, or muscle relaxants
  • Supervised consumption sites exist in several countries — find your nearest via EMCDDA

// STIMULANTS

Stimulant Harm Reduction (MDMA, Cocaine, Methamphetamine)

Stimulants carry cardiovascular, hyperthermia, and psychiatric risks. Adulterants including levamisole in cocaine and fentanyl in pressed pills are serious threats. MDMA is particularly dangerous when combined with other serotonergic substances.

  • Test MDMA with Marquis reagent (purple/black = positive), Mecke, and Simon's reagent
  • Test cocaine with a fentanyl strip — fentanyl-adulterated cocaine supply is widespread
  • Avoid MDMA in hot environments without hydration and cooling
  • Space MDMA use by at least 3 months to reduce neurotoxicity risk
  • Methamphetamine: severe cardiovascular risk with cardiac history; avoid redosing
  • Never combine cocaine with alcohol — produces cocaethylene, a cardiac toxin

// PSYCHEDELICS

Psychedelic Harm Reduction (LSD, Psilocybin, Ketamine)

Classical psychedelics (LSD, psilocybin) have low physiological toxicity but carry significant psychological risks in unsupported settings. Dissociatives like ketamine carry more direct physical risks at high doses.

  • Set and setting are the primary determinants of psychedelic experience quality
  • Have a sober trip-sitter present for high doses or first experiences
  • LSD is frequently sold as other psychedelics — test with Ehrlich reagent (purple = indole alkaloid)
  • Never combine psychedelics with lithium — risk of seizures and cardiac events
  • Ketamine: avoid frequent use — ketamine cystopathy (bladder damage) is dose and frequency dependent
  • Never drive or operate machinery during or after psychedelic use

// CANNABIS

Cannabis Harm Reduction

Cannabis carries lower acute toxicity than most other substances. Primary risks are respiratory (from smoking), cannabis use disorder with frequent use, acute anxiety, and psychosis risk in predisposed individuals or at high THC doses.

  • Prefer vaporizing over combustion to reduce respiratory exposure
  • Start with low THC concentrations — high-potency products frequently cause acute anxiety
  • Edibles have delayed onset (1-3 hours) — do not redose before full onset
  • Synthetic cannabinoids (Spice/K2) are significantly more dangerous than natural cannabis — avoid
  • Individuals with personal or family history of psychosis should minimize or avoid cannabis use

// BENZODIAZEPINES

Benzodiazepine Harm Reduction

Benzodiazepines (diazepam, alprazolam, clonazepam) produce physical dependence rapidly — even at prescribed doses over weeks. Withdrawal from benzodiazepines can be life-threatening; abrupt cessation after regular use must be medically supervised.

  • Never combine with alcohol, opioids, or other CNS depressants — high overdose risk
  • Do not use daily — physical dependence develops quickly
  • Tolerance increases rapidly — the temptation to increase dose is a dependency warning sign
  • If you have been using regularly, taper slowly under medical supervision rather than stopping abruptly
  • Novel designer benzodiazepines (flualprazolam, etizolam) have unpredictable potency — test with a reagent kit

// RESOURCES

Harm Reduction Support Resources

--:--:--⚠ INFORMATIONAL PURPOSES ONLY · For emergencies call 911 · Last updated:
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