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. The illicit supply is unpredictable and increasingly
contaminated (see Card 3). You cannot tell what something is by look.
3. Never use alone. If you use alone, someone can't help you if something
goes wrong. Use the Never Use Alone hotline 1-800-484-3731 (US) —
they stay on the line.
4. Start low, go slow. Smaller amount, then wait — you can always take
more, you can't take less. Effects can be delayed.
5. Don't mix. Combining substances (especially depressants) is where most
deaths happen (Card 4).
6. Mind set and setting. Physical/mental state, environment, and company
change risk dramatically.
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. Say "someone is not breathing."
2. Give naloxone (Narcan) if available — use one nasal device in one
nostril; if normal breathing has not returned after 2–3 minutes, give
another dose with a new device. It's safe even if you're unsure.
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, confusion. Call 911. Cool them down, keep calm, don't
restrain. Naloxone won't reverse a pure stimulant overdose but give it if
opioids might be involved — it can't hurt.
CARD 3 — TEST, DON'T GUESS
Fentanyl test strips detect fentanyl in a dissolved sample of almost
any drug. A huge share of overdose deaths involve fentanyl found in pills,
powder, and stimulants the person didn't expect. Legal in most US states.
Reagent test kits (Marquis, Mecke, etc.) help identify what a substance
is not — a quick screen against fakes.
A negative test never means "safe" — strips can miss fentanyl analogs
and don't measure amount. Testing lowers risk; it doesn't remove it.
Xylazine ("tranq") is increasingly cutting the opioid supply and does
not respond to naloxone — still give naloxone (opioids are usually
present too) and always call 911.
CARD 4 — NEVER MIX (the combinations that kill)
Depressant + depressant — opioids + benzos + alcohol + GHB together
stop breathing. This is the deadliest combination there is.
Uppers + downers ("speedballing") — masks how impaired you are and
overloads the heart.
MDMA + MAOIs — dangerous and potentially fatal (serotonin syndrome).
Other medicines differ: check with a pharmacist, and never stop prescribed
medication on your own.
Alcohol + almost anything — raises risk across the board and worsens
dehydration and judgment.
When in doubt, one substance at a time, and wait.
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.
Hydrate with small, regular 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), which can be fatal. 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.
Rest and food matter — exhaustion and empty stomachs raise risk.
CARD 6 — NALOXONE (NARCAN) SAVES LIVES
What it does: reverses an opioid overdose within minutes by knocking
opioids off receptors so breathing restarts.
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 anyone near you uses opioids — or any street drug,
since fentanyl contaminates the supply.
It's safe to give when you're unsure: naloxone will not harm someone
just because opioids are absent, though it can trigger withdrawal when
opioids are present. Give it and call 911.
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 (the #1 killer)
What: extremely potent synthetic opioids. Found in fake pills (fake
"oxy"/"Xanax"/"Adderall"), heroin, cocaine, meth, and MDMA — often without
the user's knowledge. Very small amounts can be fatal, and potency cannot
be judged by sight.
Emerging threat — NITAZENES: a newer class of synthetic opioids, some
stronger than fentanyl, showing up in the supply. May need multiple
naloxone doses.
Do: fentanyl-test everything, carry naloxone, never use alone, tiny
amount first. Call 911.
CARD 8 — XYLAZINE ("TRANQ") & MEDETOMIDINE
What: non-opioid veterinary sedatives found in the illicit
opioid/fentanyl supply. Naloxone does not reverse either sedative, but
give it anyway because opioids are usually present too.
Xylazine danger: deep sedation, slowed breathing and heart rate, low
blood pressure, and severe wounds with repeated exposure.
Medetomidine danger: profound sedation, very slow heart rate, low blood
pressure, and potentially severe withdrawal; it does not directly suppress
breathing, but co-present opioids can.
Do: call 911. Follow dispatcher directions for rescue breathing or
CPR until normal breathing returns. Use the recovery position only if the
person is breathing normally but unconscious. Give naloxone for the opioid
part.
CARD 9 — BENZODIAZEPINES & DESIGNER BENZOS
What: sedatives (Xanax/Valium type). Fake pressed "benzos" are
everywhere and may contain fentanyl or novel benzos.
Danger: deadly with alcohol or opioids (breathing stops). Blackouts,
memory loss, hard-to-reverse overdose.
Do: never combine with other downers or alcohol; don't redose. For slow
breathing or unresponsiveness, give naloxone in case fentanyl is present,
call 911, and follow dispatcher directions for breathing support.
CARD 10 — COCAINE & CRACK
Danger: heart attack, stroke, seizure, overheating — even in healthy
young people. Increasingly cut with fentanyl (opioid overdose in someone
who never meant to touch opioids).
Overamping: chest pain, racing/irregular heartbeat, severe agitation,
seizure. Call 911.
Do: fentanyl-test it, don't mix with alcohol (forms cocaethylene, extra
heart strain), don't use alone.
CARD 11 — METHAMPHETAMINE
Danger: overheating, heart strain, stroke, seizure, psychosis with heavy
use; may be cut with fentanyl.
Danger: overheating + hyponatremia (too much water) — both can kill;
serotonin syndrome is a major risk with MAOIs, and other medicines can
interact. Pressed pills are often not MDMA (cathinones, meth, fentanyl).
Do: reagent-test, take cooling breaks, use small regular sips without
overdrinking, and don't redose. Never combine with an MAOI; check other
medicines with a pharmacist, and never stop prescribed medication yourself.
CARD 13 — KETAMINE & DISSOCIATIVES
Danger: loss of motor control (falls, drowning, choking), "k-hole,"
bladder damage with heavy use; deadly sedation mixed with other downers.
Emerging: novel dissociatives sold as ketamine.
Do: never in water/near hazards, never mix with alcohol/opioids/benzos,
sit/lie safely, don't use alone.
CARD 14 — GHB / GBL (tiny margin, high danger)
Danger: the gap between a dose and an overdose is very small. Deadly
with alcohol or other depressants — breathing stops. It has 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.
Do: never with alcohol, never redose "because it's not working yet"
(delayed onset is how people die), never use alone.
A major risk is WHAT IT ACTUALLY IS. Products sold as LSD — including
blotter, liquid, tablets, or other forms — may contain NBOMe or DOx;
these can cause seizures, dangerous vasoconstriction, and death.
Also: accidents from impaired judgment; panic; dangerous with
lithium/tramadol/some meds.
Do: never use form or taste to identify a drug. A reagent screen can
lower uncertainty but cannot prove identity or safety. Use a safe setting
with a sober sitter and screen for personal/family psychosis risk.
Do: reagent-test (they frequently masquerade as molly), treat any
overheating/agitation as an emergency → 911.
CARD 17 — SYNTHETIC CANNABINOIDS (K2 / SPICE)
What: chemicals sprayed on plant matter — NOT cannabis, far more
dangerous and unpredictable.
Danger: seizures, racing heart, kidney damage, psychosis, death; some
batches laced with other drugs.
Do: avoid; treat severe reactions (seizure, chest pain, unresponsive) as
an emergency → 911.
CARD 18 — NITROUS OXIDE & INHALANTS
Danger: oxygen deprivation (fainting, falls), and with heavy use, B12
depletion → nerve damage. Other inhalants can cause "sudden sniffing
death" (heart) even first time.
Do: sit down, never use a bag or enclosed space, never drive, and don't
combine. B12 supplements do not make continued nitrous use safe. Seek
medical care for numbness, tingling, weakness, bladder/bowel problems, or
trouble walking.
CARD 19 — ALCOHOL (the legal one people underestimate)
Danger: poisoning (can't be woken, slow breathing, vomiting while out,
cold/blue) is a medical emergency; deadly with any other depressant.
Do: if someone is unconscious and breathing slowly, call 911 and
follow dispatcher directions for breathing support. Use the recovery
position only if they are breathing normally; never let them "sleep it off."
CARD 20 — NEW / UNKNOWN DRUGS (NPS — "the new shit")
You were right: new substances hit the market constantly, faster than the law
or the science can track. Treat anything unfamiliar as maximum risk.
- "Research chemicals" / NPS = novel synthetics with little known about
safety, potency, or interactions. Sold as powders, pills, blotter, vapes.
- Assume: potency is unknown, effects/onset are unknown, it may be
something else entirely, and standard tests may miss it.
- Do: if you can't identify it, the safest answer is don't use it. No
visible amount or universal waiting period is safe for an unknown
substance. Use professional drug-checking when available; never be alone,
keep naloxone nearby, and know that 911 is always the right call.
- Check current alerts at DanceSafe, your local health department, and
drug-checking services.
CARD 21 — GAS STATION & SMOKE SHOP "LEGAL HIGHS" (part 1)
Sold behind the counter doesn't mean safe. These are legal-loophole products
that land people in the ER and cause real addiction.
- Tianeptine ("gas station heroin," ZaZa, Tianaa, Neptune's Fix): acts on
opioid receptors at high doses — genuine addiction, dangerous withdrawal,
overdose (slow breathing). FDA-warned. Naloxone may help; call 911. One
of the most dangerous things on the shelf.
- Kratom & concentrated 7-OH extracts: plant opioid-like effects; the new
high-potency 7-hydroxymitragynine extracts/pills are far stronger than
leaf and more addictive. Risky with other depressants; dependence and
withdrawal are real.
- Phenibut: marketed as a GABA "calm/focus" supplement but not a lawful
dietary-supplement ingredient — dependence can form and withdrawal can
be severe (seizures, psychosis); deadly sedation can occur when mixed with
alcohol/benzos.
- Do: treat these as real drugs, not supplements; don't stack with
alcohol/downers. If dependent, do not manage withdrawal alone — contact a
clinician or Poison Help urgently. Call 911 for a seizure, psychosis, severe
agitation, unconsciousness, or breathing trouble.
CARD 22 — GAS STATION & SMOKE SHOP "LEGAL HIGHS" (part 2)
DXM (cough medicine, "robotripping"): high doses cause dissociation,
racing heart, vomiting; deadly in combo products with acetaminophen
(liver failure) and dangerous with MAOIs or other serotonergic medicines.
Check with a pharmacist and never stop medication yourself. Read labels —
never take a combo product to get the DXM.
Diphenhydramine (Benadryl, the "Benadryl challenge"): high doses cause
dangerous heart rhythms, seizures, delirium, death. Not a safe high —
people have died. 911 for racing heart/seizure/confusion.
Semi-synthetic THC (Delta-8, Delta-10, THC-O, HHC): unregulated potency
and contaminants from unregulated manufacturing; THC-O may harm lungs
when vaped. Effects and purity vary wildly batch to batch.
Amanita muscaria gummies (muscimol): FDA says Amanita, muscimol, and
ibotenic acid are unauthorized food additives that may be harmful. Gummies
can cause nausea, delirium, sedation, and unpredictable exposure.
"Galaxy Gas" / flavored nitrous: see Card 18 — oxygen deprivation,
falls, and nerve injury.
Poppers (alkyl nitrites): can cause extreme low blood pressure,
abnormal heart rhythms, methemoglobinemia (blood cannot carry oxygen),
seizure, coma, or death. They are deadly if swallowed and especially
dangerous with ED medicines.
Do: legal ≠ safe or tested; read every label for hidden combos; start
with the assumption that potency is unknown; keep 911 in reach.
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.