Drug Use Harm Reduction Guide

Core Harm Reduction Principles

Harm reduction is a public health approach that accepts the reality of drug use and focuses on minimizing its negative consequences without requiring abstinence. It is evidence-based, non-judgmental, and recognized by major health organizations including the World Health Organization (WHO).

Universal Rules for Safer Drug Use

• Always test your substances — Use reagent test kits and fentanyl test strips regardless of the source
• Start low, go slow — Use a small test dose first, especially with a new batch
• Never use alone — Have a sober or monitoring person present
• Know what you are taking — Research the substance, dose, and interactions before use
• Have naloxone available — Even if not using opioids (fentanyl contamination is widespread)
• Don't mix substances — Combinations dramatically increase risk
• Consider set and setting — Your mental state and physical environment matter for safety

Substance Testing

Fentanyl Test Strips (FTS): Fentanyl contamination has spread beyond the opioid supply into stimulants, benzodiazepines, and other drug categories. Fentanyl test strips detect fentanyl and many analogues. Dissolve a small amount of the substance in water and dip the strip. A single line = fentanyl detected. Two lines = negative. Available from bunkpolice.com and many harm reduction organizations.

Reagent Test Kits: Chemical reagent tests indicate the presence of certain drug classes and help identify substances. Common kits:

• Marquis — turns purple/black for MDMA, orange-red for amphetamine, yellow for ketamine
• Mecke — blue-black for MDMA, yellow for DXM
• Mandelin — green for ketamine, orange for amphetamine
• Froehde — orange for 2C-x compounds
• Simon's — differentiates MDMA from MDA (turns blue only with secondary amines)

Opioids (Heroin, Fentanyl, Oxycodone, Morphine)

Overdose Signs: Slow, shallow, or stopped breathing; unresponsive or unconscious; blue or gray lips and fingertips; gurgling or choking sounds; pinpoint pupils; pale, clammy skin.

Overdose Response:

1. Try to rouse the person — call their name, sternal rub
2. Call 911 immediately
3. Administer naloxone (Narcan) — nasal spray: one spray per nostril; inject: thigh or upper arm
4. Lay person in recovery position (on their side) to prevent choking
5. Administer rescue breathing if not breathing (1 breath every 5 seconds)
6. Second dose of naloxone after 2-3 minutes if no response
7. Stay with person — naloxone wears off before opioids, person may re-enter overdose

Safer Use: Never use alone. Never mix with benzodiazepines, alcohol, or other depressants (synergistic respiratory depression is the primary mechanism of opioid overdose death). Start with a small test dose from every new batch — potency varies dramatically. Use fentanyl test strips on every batch.

Get Naloxone: Available without prescription at most US pharmacies. Free through many harm reduction organizations. NEXT Distro (nextdistro.org) provides free mail naloxone in many US states.

Stimulants (MDMA/Ecstasy, Cocaine, Amphetamines, Methamphetamine)

MDMA Overdose Signs: Extremely high body temperature (hyperthermia — the primary killer), seizures, rigid muscles, confusion, loss of consciousness. MDMA overdose is primarily a temperature crisis — cooling the person is the priority alongside calling 911.

Cocaine/Crack Overdose Signs: Chest pain, palpitations, shortness of breath, extreme anxiety, seizure, stroke symptoms (facial drooping, arm weakness, speech difficulty).

Safer Stimulant Use:

• MDMA: Test with Marquis and Mecke kits. Dose ≤120mg for average adults. Space uses ≥3 months apart to reduce neurotoxicity. Stay hydrated — but do not overhydrate (sip ~500ml/hour when dancing)
• Avoid mixing MDMA with MAOIs (potentially fatal), lithium (seizures), or tramadol
• Never redose cocaine — each additional line dramatically increases cardiac risk
• Methamphetamine: Fentanyl contamination is increasingly common — always test

Cannabis

Cannabis is generally considered low-toxicity but is not without risks. Cannabis hyperemesis syndrome (CHS) causes severe vomiting in heavy long-term users. High-potency concentrates can cause intense anxiety, paranoia, and temporary psychosis, particularly in individuals predisposed to mental health conditions. Cannabis use is contraindicated for individuals with personal or family history of psychosis or schizophrenia.

Safer Use: Choose products with known cannabinoid content. Start with low doses, especially with edibles (onset can take 1-2 hours). Avoid mixing with alcohol or other depressants. Avoid synthetic cannabinoids (K2/Spice) — these are unpredictable and dangerous.

Psychedelics (LSD, Psilocybin, DMT, 2C-x)

Classical psychedelics (LSD, psilocybin mushrooms, mescaline) have low physiological toxicity and are not associated with overdose death in healthy individuals. However, psychological risks — particularly for individuals with mental health history — are real. HPPD (Hallucinogen Persisting Perception Disorder) is a rare but documented risk with high-dose or repeated LSD use.

Dangerous Interactions: Lithium + psychedelics = risk of seizures and cardiac arrest. SSRIs/SNRIs reduce or eliminate psychedelic effects via serotonin receptor interaction but may cause serotonin syndrome in some combinations. MAOIs dramatically potentiate effects — use only with extensive research and extreme caution.

Reagent Testing: LSD: Ehrlich reagent turns purple. Absence of color reaction suggests absence of an indole compound — the substance is likely not LSD. Check TripSit's reagent guide for full reference tables.

Benzodiazepines (Xanax/Alprazolam, Valium, Etizolam)

Benzodiazepines alone are rarely lethal in overdose but can cause respiratory depression in combination with opioids or alcohol. The primary risk is physical dependence and dangerous withdrawal. Benzodiazepine withdrawal (unlike opioid withdrawal) can be lethal through seizures. Never stop benzodiazepine use abruptly after regular use — taper slowly under medical supervision if possible.

Designer Benzodiazepines: Many novel benzodiazepines (clonazolam, flualprazolam) are significantly more potent than pharma benzos. Extremely small dose differences separate therapeutic and dangerous doses. These are particularly dangerous for inexperienced users.

Ketamine

Ketamine is a dissociative anesthetic with medical applications. Recreational use risks include: bladder damage with heavy frequent use (ketamine cystitis — can become permanent), "K-hole" (profound dissociative state with loss of motor control), and dependence with heavy use. Ketamine is not recommended for individuals with heart conditions, schizophrenia, or history of psychosis.

Test: Mandelin reagent — orange/orange-brown indicates ketamine. Always test for fentanyl contamination (increasingly present in pressed ketamine).

Harm Reduction Resources