Educational public-health information in the tradition of evidence-based
harm reduction (inspired by DanceSafe-style drug-information cards). This is
education, not medical advice, and not encouragement to use any
substance. Its only purpose is to reduce injury and save lives — because
people who are going to use anyway deserve to survive. When in doubt, don't;
and if someone is in danger, get help immediately.
⛑️ EMERGENCY FIRST — read this before anything else
Call 911 if someone has collapsed, can't be woken, has trouble
breathing, has a seizure, chest pain, very high temperature, or is in
any immediate danger. Medical help is never the wrong call.
US Poison Help: 1-800-222-1222 (free, confidential, 24/7) —
PoisonHelp.org.
988 — Suicide & Crisis Lifeline (call or text), 24/7.
Good Samaritan / overdose-immunity laws may offer limited protections
when someone calls for overdose help, but their scope and conditions vary
by location. Saving a life comes first.
CARD 1 — SAFETY FIRST (the pillars)
The core principles that reduce harm, in order of importance:
1. The safest choice is not to use. Everything below is for reducing risk
if someone chooses to anyway.
2. Test, don't guess. Unregulated products may be mislabeled or contain
unexpected substances. You cannot identify contents by appearance alone
(Card 3).
3. Never use alone. Use with trusted people who can respond, or call
Never Use Alone: 1-800-484-3731 (US) before using alone.
4. Use less, go slowly, and wait. Potency and onset vary; taking more
before effects appear raises risk.
5. Avoid mixing. Combining depressants can slow or stop breathing (Card 4).
6. Choose a safer setting. Stay with trusted people, keep a charged phone
nearby, and avoid driving, water, heights, and other hazards.
7. Have naloxone (Narcan) nearby and know the overdose signs (Card 2).
CARD 2 — RECOGNIZE & RESPOND TO AN OVERDOSE
Opioid overdose signs: unresponsive, slow or stopped breathing, gurgling
or snoring, blue/grey lips or fingertips, tiny pupils, limp body.
What to do — RIGHT NOW:
1. Call 911. Give the exact location and say what you see, such as "not
breathing."
2. Give naloxone (Narcan) if available. Follow the product label; if normal
breathing has not returned after 2–3 minutes, give
another dose with a new device. It is safe to give when you are unsure whether opioids are
involved.
3. Rescue breaths or CPR as directed by the 911 dispatcher; continue
until normal breathing returns or emergency help takes over.
4. Recovery position (on their side) only if they are breathing normally
but remain unconscious, so they don't choke.
5. Stay until help arrives. Naloxone wears off; overdose can return.
Stimulant overamping (meth/cocaine): overheating, chest pain, seizure,
extreme agitation, or confusion. Call 911. Reduce heat and noise; do not
restrain unless needed for immediate safety. Give naloxone if opioid exposure
is possible.
CARD 3 — TEST, DON'T GUESS
Fentanyl test strips can screen a properly dissolved sample. Follow the
strip directions; they do not measure amount or purity.
Reagent tests are presumptive screens, not proof of identity, purity, or
safety. Use more than one relevant test when possible.
A negative result never means "safe." Tests may miss fentanyl-like
substances, and a sample may not represent the whole product.
Xylazine and medetomidine strips may be available in some areas. If
someone is unresponsive or not breathing normally, call 911, give naloxone,
and support breathing as directed.
CARD 4 — NEVER MIX (the combinations that kill)
Depressant + depressant — opioids, benzodiazepines, alcohol, GHB, and
other depressants can compound sedation and slow or stop breathing.
Uppers + downers do not cancel each other; effects can be masked while
overdose and heart strain continue.
MDMA + MAOIs can cause life-threatening serotonin toxicity. Check
medicines with a pharmacist; never stop prescribed medication on your own.
Alcohol is especially risky with opioids, benzodiazepines, GHB, and other
depressants; with cocaine it adds heart strain.
The safest choice is not to mix. If exposure occurs and someone has
emergency signs, call 911.
CARD 5 — HYDRATION, HEAT & THE BODY (festival/dance safety)
Overheating is a real danger with stimulants/MDMA in hot, crowded
spaces. Take breaks, find cool air, rest.
Drink to thirst with small sips; do not force water or overdrink. Needs
vary with heat, exertion, and health. Too much plain water with MDMA can
cause dangerous low sodium (hyponatremia). Never give oral fluids to someone
who is confused or unconscious.
Warning signs to act on: confusion, very high temperature, fainting,
severe headache, seizure, or skin that is hot with absent or profuse
sweating → cool down and call 911.
CARD 6 — NALOXONE (NARCAN) SAVES LIVES
What it does: temporarily blocks opioid effects and can restore breathing
within 2–3 minutes.
Get it: naloxone is available over the counter at US pharmacies; cost
and stock vary. Some health departments, community programs, and
syringe-service programs provide it free or at low cost. Nasal spray is
easiest.
Carry it if you or people around you could encounter opioids, including
unexpected opioid exposure in an unregulated product. Tell others where it
is.
It is safe to give when unsure. It will not harm someone just because
opioids are absent, though it can trigger withdrawal when opioids are
present. Call 911, follow the label, repeat with a new device if needed, and
stay.
SUBSTANCE CARDS
Danger-and-emergency reference, not a how-to. For each: what it is, what's
killing people, and what to watch for. The supply is contaminated and
mislabeled — assume anything not from a pharmacy may be something else.
CARD 7 — FENTANYL & SYNTHETIC OPIOIDS
What: illegally made fentanyl can appear in counterfeit pills and
powders, including products sold as heroin, cocaine, methamphetamine, or
MDMA. You cannot see, taste, or smell it, and potency cannot be judged by
sight.
Nitazenes: synthetic opioids; some are more potent than fentanyl.
Naloxone works on opioid overdose, but more than one dose may be needed.
Overdose response: unresponsive or not breathing normally → call 911,
give naloxone, and support breathing as directed. Test when possible, but
a negative result does not rule out every fentanyl-like substance or uneven
distribution. Carry naloxone and never use alone.
CARD 8 — XYLAZINE ("TRANQ") & MEDETOMIDINE
What: non-opioid veterinary sedatives increasingly found with illicit
fentanyl. Naloxone does not reverse the sedatives, but give it because
opioids may also be present.
Xylazine danger: deep sedation, slowed breathing or heart rate, low blood
pressure, and serious wounds with repeated exposure.
Medetomidine danger: prolonged sedation, very slow heart rate, low blood
pressure, and potentially severe withdrawal that may require hospital care.
Do: call 911, give naloxone, and follow dispatcher directions for
rescue breathing or CPR. Seek medical care for wounds or severe withdrawal;
do not manage severe withdrawal alone.
CARD 9 — BENZODIAZEPINES & DESIGNER BENZOS
What: sedatives such as alprazolam (Xanax) and diazepam (Valium).
Counterfeit pills may contain fentanyl or unapproved benzodiazepines.
Danger: alcohol, opioids, and other depressants compound sedation and can
stop breathing. Blackouts and memory loss raise injury risk.
Do: do not mix with alcohol, opioids, or other depressants. Do not
abruptly stop regular benzodiazepine use without medical help; withdrawal
can cause seizures. For slow breathing or unresponsiveness, call 911 and give
naloxone if opioid exposure is possible.
CARD 10 — COCAINE & CRACK
Danger: heart attack, stroke, seizure, and overheating. Cocaine may also
contain fentanyl, creating unexpected opioid-overdose risk.
Overamping: chest pain, racing/irregular heartbeat, severe agitation,
seizure. Call 911.
Do: test when possible, do not use alone, and avoid alcohol or other
stimulants. If opioid exposure is possible, keep naloxone nearby.
CARD 11 — METHAMPHETAMINE
Danger: overheating, heart strain, stroke, seizure, and psychosis.
Methamphetamine may also contain fentanyl, creating unexpected
opioid-overdose risk.
Do: take cooling and rest breaks, test when possible, do not use alone,
and avoid mixing stimulants. Keep naloxone nearby if opioid exposure is
possible.
CARD 12 — MDMA / ECSTASY / MOLLY
Danger: products sold as MDMA may contain other substances. Overheating
and hyponatremia from too much water can be life-threatening. MAOIs and
some other medicines can cause dangerous interactions.
Overheating/serotonin syndrome: high temp, rigidity, confusion, seizure
→ 911, cool down. Never give oral fluids to someone who is confused or
unconscious.
Do: reagent and fentanyl tests can lower uncertainty but do not prove
identity, purity, or safety. Take cooling breaks and reduce exertion if
overheating. Drink to thirst with small sips; do not force water or
overdrink. Don't redose, and never combine with an MAOI — check other
medicines with a pharmacist; never stop prescribed medication yourself.
CARD 13 — KETAMINE & DISSOCIATIVES
Danger: loss of coordination can lead to falls, drowning, or choking;
repeated use can injure the bladder. Alcohol, opioids, benzodiazepines, and
other depressants increase sedation and breathing risk.
Unknown products: other dissociatives may be sold as ketamine, with
different potency and duration.
Do: stay away from water, traffic, heights, and driving; avoid depressant
mixtures; stay with trusted people. Give naloxone if opioid exposure is
possible.
CARD 14 — GHB / GBL (tiny margin, high danger)
Danger: the margin between desired effects and overdose can be small.
Alcohol and other depressants sharply increase sedation and breathing risk.
GHB/GBL has also been used in drug-facilitated assault.
Overdose: can't be woken, slow breathing, vomiting while unconscious →
911 and dispatcher-guided rescue breathing/CPR. Use the recovery
position only after normal breathing returns.
Withdrawal: after frequent GHB/GBL use, stopping suddenly can be
life-threatening and may cause seizures or psychosis. Seek urgent medical
help; do not attempt withdrawal alone.
Do: do not mix with alcohol or other depressants. Variable strength and
delayed effects make redosing especially risky. Never use alone.
Identity is uncertain. Products sold as LSD may contain NBOMe, DOx, or
other substances with different risks, including seizures and dangerous
blood-vessel constriction.
Also: panic, impaired judgment, and accidents; some medicines or health
conditions may increase risk. Ask a pharmacist about interactions and never
stop prescribed medication on your own.
Do: form and taste do not prove identity. Reagent tests can lower
uncertainty but cannot prove safety. Choose a calm setting, a trusted sober
sitter, and no driving, water, heights, or traffic.
Do: reagent tests can lower uncertainty but do not prove identity or
safety. Treat severe overheating, chest pain, seizure, or dangerous agitation
as an emergency → 911.
CARD 17 — SYNTHETIC CANNABINOIDS (K2 / SPICE)
What: synthetic cannabinoid chemicals may be sold on plant material, in
liquids, or in vapes. They are not cannabis; identity, dose, and
contaminants can be unpredictable.
Danger: seizures, rapid heart rate, severe agitation, psychosis, kidney
injury, unconsciousness, and death have been reported.
Do: avoid; treat severe reactions (seizure, chest pain, unresponsive) as
an emergency → 911.
CARD 18 — NITROUS OXIDE & INHALANTS
Danger: FDA warns against recreational nitrous inhalation. It can cause
loss of consciousness, falls, frostbite, oxygen deprivation, and vitamin
B12-related nerve injury. Other inhalants can cause sudden fatal heart
rhythms.
Do: never inhale directly from a tank, use a bag or enclosed space, or
drive. Vitamin B12 supplements do not make continued use safe. Seek
urgent care for numbness, weakness, bladder/bowel problems, or trouble
walking.
CARD 19 — ALCOHOL (the legal one people underestimate)
Alcohol poisoning signs: cannot be woken, slow or irregular breathing,
seizure, repeated vomiting, or pale/blue and cold skin. Alcohol with opioids,
benzodiazepines, GHB, or other depressants compounds breathing risk.
Withdrawal: after prolonged heavy drinking, stopping suddenly can be
life-threatening and may cause seizures. Seek medical help to plan a safe
recovery.
Do: call 911, stay, and follow dispatcher directions. Use the recovery
position only if breathing is normal; never leave someone to "sleep it off."
Give naloxone if opioid exposure is possible.
CARD 20 — NEW / UNKNOWN DRUGS (NPS)
New psychoactive substances can reach the market faster than reliable human
safety information.
- "Research chemicals" / NPS may have uncertain identity, potency, onset,
duration, and interactions. They can appear as powders, pills, blotter,
liquids, or vapes.
- Assume uncertainty: the label may be wrong, contents may be uneven, and
common test kits may miss the substance.
- Do: the safest choice is not to use an unknown product. No visible amount
or universal waiting period can make an unknown substance safe. Use
professional drug checking and local alerts when available; never be alone
and keep naloxone nearby.
- Check current alerts at DanceSafe, your local health department, and
drug-checking services.
Retail availability does not establish safety, lawful marketing, or FDA
approval.
- Tianeptine: not FDA-approved in the US; products sold as supplements have
caused addiction, severe withdrawal, poisoning, and overdose. For slow
breathing or unresponsiveness, call 911 and give naloxone if available.
- Concentrated or synthetic 7-OH: high-potency 7-hydroxymitragynine
products are distinct from trace levels in natural kratom leaf. FDA warns of
opioid-like addiction and overdose risk; avoid other depressants.
- Phenibut: not a lawful dietary-supplement ingredient. Dependence and
severe withdrawal can occur; alcohol or benzodiazepines increase sedation
risk.
- Do: do not manage severe withdrawal alone. Contact a clinician or Poison
Help (1-800-222-1222). Call 911 for seizure, psychosis, unconsciousness, or
breathing trouble.
DXM cough medicines: high doses can cause dissociation, vomiting, and
rapid heart rate. Combination products may contain acetaminophen or other
drugs that add life-threatening toxicity. Do not use DXM while taking an
MAOI or for 2 weeks after stopping one; ask a pharmacist if unsure whether a
medicine is an MAOI.
Diphenhydramine: high doses can cause dangerous heart rhythms, seizures,
delirium, coma, and death.
Delta-8 and other intoxicating hemp products: strength, ingredients, and
contaminants may vary; keep away from children and do not drive.
Amanita products: FDA says Amanita muscaria, muscimol, and ibotenic acid
are not authorized for use in conventional food and may be harmful.
Nitrous products: can cause loss of consciousness, frostbite, and
neurologic injury (see Card 18).
Poppers (alkyl nitrites): can cause dangerously low blood pressure or
methemoglobinemia (blood cannot carry oxygen normally); swallowing can be
fatal. Never combine poppers with erectile-dysfunction medicines called
PDE-5 inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis); the
blood-pressure drop can be dangerous.
Do: read active ingredients and warnings. For collapse, seizure, trouble
breathing, inability to wake, or any immediate danger, call 911 immediately.
Otherwise, for a suspected poisoning, call Poison Help: 1-800-222-1222.
REPUTABLE SOURCES (verify and go deeper)
DanceSafe — dancesafe.org (drug info + testing)
SAMHSA — 1-800-662-HELP (4357), findtreatment.gov
National Harm Reduction Coalition — harmreduction.org
Poison Help — 1-800-222-1222
Never Use Alone — 1-800-484-3731
988 Suicide & Crisis Lifeline — call/text 988
NorthStar provides this as free public-health education. It does not
diagnose, treat, or endorse drug use. Laws and resources vary by location;
your local health department is the best local source. If you or someone you
love is struggling, reaching out for help is strength, not weakness.