Ibogaine is prepared for consumption in three main ways.

Iboga root bark

This method of consumption is the traditional route used in Bwiti rituals. The root bark itself can be chewed but is often pulverised and swallowed in spoonfuls or transferred into capsules. The root bark has a bitter taste, and this method has a longer onset time than others, with the effects often lasting longer too.

Ibogaine content in the root bark is usually low as it is not purified like with other methods. In Bwiti rituals, the root bark is often consumed continually over a period of three days.

Ibogaine Hydrochloride

Ibogaine is extracted from the root bark and converted into the hydrochloride salt form via a chemical process. This route of consumption has a faster onset time due to being metabolised more quickly in the body. Ibogaine hydrochloride is a shimmery white powder, which is put into capsules, ingested orally or diluted in liquids.

Recently, there has been an increase in semi-synthetic production of ibogaine hydrochloride using the precursor voacangine (from the Voacanga africana tree), which is a more sustainable route than using the Tabernanthe iboga shrub, as it is currently critically threatened.

Total alkaloid (full spectrum) extracts

The desired alkaloid, ibogaine, is extracted from the root bark. This results in a powder which contains a higher concentration of ibogaine than the root bark. The powder is put into capsules before consumption.

This method has a gentler, slower onset than the hydrochloride form. It is sometimes used alongside it as a booster dose after an acute detoxification period during substance abuse treatment. It is rarely used as an independent treatment in large doses.

Ibogaine produces its effects in the body by binding to various receptors in the brain. Firstly, it binds to 5-HT_2A serotonin receptors, activating them and modulating the release of neurotransmitters such as GABA, glutamate and dopamine. These serotonin receptors have some control of cognition, memory, appetite, and mood, for example.

Secondly, it binds to k-opioid receptors in the brain, activating them and therefore mediating consciousness, motor control, mood and perception of pain.

Ibogaine is also known to have neuroprotective effects on dopamine and motor neurons, and stimulates the growth of new dopaminergic neurons, which is thought to support the mitigation of cravings for other substances, such as opioids. Dopamine is the main neurotransmitter associated with reward and pleasure and is released when one experiences something that is rewarding. When these dopaminergic neurons are diminished, less dopamine is released from other usually rewarding activities, potentially increasing the cravings for addictive drugs. Evidence for the drug’s effectiveness in this way has been exemplified by the reduction of cocaine and morphine self-administration in animals.

The effects of ibogaine differ from those of classical hallucinogens such as DMT, LSD, mescaline, and psilocybin.

Low doses of ibogaine can have stimulating effects. At higher doses, often referred to as a “flood dose”, it acts as a oneirogen, producing waking dreamlike states.

Effects of the experience include:

• closed eye visualisations
• retrieval of repressed memories
• profound self-reflection
• ataxia
• nausea
• restlessness
• loss of appetite

The effects begin around 1-3 hours post ingestion and can last for 12-36 hours.

Towards the end of the experience, most users experience what is called a “grey day”. As the effects of the ibogaine begin to wear off, the user may experience negative thoughts and feelings and feel guilty, irritable, and upset. The ibogaine experience is long and emotionally taxing, leading to an often uncomfortable recovery period.

Anecdotal reports state that the negative thinking patterns experienced during this “grey day” (which can last for longer than just one day) are those which the user is later liberated from.

Ibogaine is not widely available for medical treatment. However, various clinics have been set up in the US and in Europe which use ibogaine in the treatment of substance abuse. Most notably, ibogaine can be used to help those addicted to certain opioids by treating withdrawal symptoms and reducing or even eliminating cravings and the desire to take the drug again.

A more scientific investigation must be conducted into the use of ibogaine to treat certain mental health disorders. However, anecdotal reports state that taking ibogaine has improved their mental health. The experience can allow people to regain and reflect on memories and process trauma that they have experienced.

Taking ibogaine may cause users to experience some unpleasant side effects. These include:

• Irregular heartbeats (arrhythmias)
• Low blood pressure
• Seizures
• Gastrointestinal issues

Ibogaine should be taken in a safe and comfortable environment with trusted people present. This will help to alleviate any stress or discomfort which may be experienced and ensure that support is available if needed. Starting with a low dose can also help to reduce the risk of side effects and unpleasant experiences.

Due to some of the negative side effects of ibogaine listed, those with existing heart conditions, blood pressure issues, a history of seizures, and certain mental health conditions such as schizophrenia should avoid partaking in an ibogaine experience.

Certain medications may also react badly with ibogaine. These include medications which affect the heart (e.g., beta-blockers and anti-arrhythmic medications), SSRIs and antipsychotics.

Ibogaine should not be taken alongside other drugs.

Mixing drugs increases the risks of all substances involved and can be very dangerous.

After undergoing an ibogaine experience, users should abstain from taking any other drugs for at least 90 days. This is to decrease the chances of any dangerous interaction between ibogaine and other substances in the body. Complete detoxification of the body from any drugs (including alcohol) is also recommended before undergoing the experience to minimise risks of harmful interactions in the body.

There is currently no evidence that ibogaine is an addictive substance. Due to the intensity of the ibogaine experience, it is very unlikely that users would like to repeat it regularly.

It is vital not to take ibogaine alongside any other drugs. Doing so greatly increases the risks and can lead to fatalities.

Ibogaine reduces physical tolerance to opioids and alcohol. Therefore, extra care should be taken with regards to dosage if a user decides to consume these substances after taking ibogaine.

Ibogaine should be taken in a safe and controlled environment, with a trusted person present.

Ibogaine will make you feel better instantly

Ibogaine will not make users feel instantly cured. The “grey day” after the experience is uncomfortable and can be extremely difficult. However, after this time period has ended, the positive effects of the experience will begin to be felt and can be taken forward into life. Work to ensure that the positive effects continue must be done by the person who has undertaken the ibogaine experience.

Ibogaine is a ‘cure all’

Whilst ibogaine can be very useful in treating the withdrawal symptoms of many opioids, it cannot do so for all of them.

There is also very little scientific evidence to support the use of ibogaine for treating mental health disorders despite anecdotal reports.

Tabernanthe iboga, the primary source of ibogaine, is critically threatened. This primarily impacts those living in Gabon who rely on the plant for medicine and spirituality.

All exports of iboga are currently banned in Gabon, and projects have been started attempting to regenerate the population of Tabernanthe iboga.

Iboga is protected under the United Nations Nagoya Protocol on Access and Benefit Sharing.

These sustainability concerns have encouraged the move towards using the voacanga tree for the extraction of ibogaine more frequently.

Fentanyl itself exists as a white powder that dissolves in water. It is often administered to patients in the form of a lozenge, transdermal patch or by injection.

Illicitly produced fentanyls may also appear as a grey or off-white powder. Eye droppers, nasal sprays and tablets designed to mimic prescription pills containing fentanyls have been observed on the drug market.

Medicinal fentanyls can be administered by intravenous injection, transdermal patches, tablets and lozenges.

Outside of medical use, fentanyls are used in many ways. They can be snorted, injected intravenously, smoked and ingested via oral sprays. People may also chew on prescription fentanyl patches to release the contents into their mouth.

Illicit fentanyls are also often mixed with other drugs such as heroin, cocaine, methamphetamine and MDMA. Fentanyls have high potency, making them a cheaper option to produce and transport. This, therefore, can lead to users accidentally ingesting fentanyls when intending to consume a different drug.

Like other opioids, fentanyls bind to opioid receptors in the brain (predominantly the µ-opioid receptors), in areas which control pain and emotion in humans.

Tolerance and dependence rapidly develop after repeated use of fentanyls.

Depending on the mode of administration, the effects of fentanyls can be felt immediately (injection), or in around 15-30 minutes (tablets, lozenges and nasal sprays). When injected, the effects last for around 30-60 minutes. Whereas, when ingested via tablets, lozenges and nasal sprays, the effects last for up to 4-6 hours.

These effects include

• Euphoria
• Drowsiness
• Sedation
• Nausea
• Confusion
• Constipation
• Muscle stiffness
• Respiratory depression

Fentanyl itself was first synthesised in 1960 and used to treat severe pain. It is still used in medicine for this reason.

It may be administered along with a general anaesthetic agent during surgery and is often prescribed to people after operations or after serious injuries. It can also be used to treat pain experienced by cancer patients. People experiencing chronic pain may also be prescribed fentanyl if other pain medicine they have been using is no longer effective.

Overdose

Taking an overdose of fentanyl leads to respiratory depression, which can cause brain damage and death. The lethal dose of fentanyl is approximately 2 mg in humans.

Fentanyls rapidly penetrate the brain and so respiratory depression and death can occur very rapidly. In addition to reducing the rate of breathing, fentanyls also produce muscle stiffness in the diaphragm and chest muscles (referred to as wooden chest) making it harder to breathe.

The effects of overdose can be temporarily reversed by administering naloxone. It may be necessary to administer more/higher doses of naloxone to reverse fentanyls than for heroin. Medical assistance should be sought immediately when an overdose is suspected.

If a person has taken an overdose, they may fall unconscious and become limp. Their skin may also become clammy, and the fingertips and lips of lighter-skinned people and the inside of darker-skinned people’s lips may turn blue.

To reduce the risk of overdose, users should start by taking a small dose and see how they feel, rather than taking a large dose all at once. It is also advised to have a trusted person around when using fentanyls, so that they can aid in the event of overdose.

Addiction

Fentanyls are addictive drugs due to their high potency and the rapid rate at which tolerance to them develops.

Addiction can occur both following illicit use and with repeat prescriptions. Those who take fentanyl as prescribed by a doctor may become dependent and experience withdrawal symptoms when their prescription ends.

Withdrawal symptoms include:

• Muscle and bone pain
• Difficulty sleeping
• Diarrhoea and vomiting
• Cold flashes
• Uncontrollable leg movements
• Severe cravings

If you are using fentanyls, it is important to be aware of the signs of addiction and tolerance. For example, experiencing strong cravings and requiring increasingly higher doses to produce the same effects. Medical help is available to those experiencing addiction.

There are a few health conditions which may make using fentanyls more dangerous. For example, any lung conditions (such as asthma) and arrhythmia (irregular heartbeats).

Some people are allergic to fentanyls and may go into anaphylactic shock after use.

Fentanyls should never be mixed with other drugs.

It is especially dangerous to mix fentanyls with other opioids, alcohol, or other sedative drugs such as benzodiazepines or gabapentinoids. Mixing fentanyls with these drugs greatly increases the risk of overdose.

When fentanyls are used as an adulterant for other drugs, the risk of overdose is increased as the user is most likely unaware of the amount of the fentanyl present. Drug testing kits are available to detect the presence of fentanyls and should be used to reduce the risk of accidental overdose when consuming an illicit drug which may be adulterated with them.

Fentanyls can be very addictive.

Fentanyls can produce a very pleasurable experience for users, leading them to want to use the drug continually. When using fentanyls repeatedly, tolerance to the drug increases and withdrawal symptoms are experienced between doses. Users may then take the drug in order to cope with these unpleasant withdrawal effects, and an ever-increasing dose is required to produce the same effects. Use of the drug often becomes less pleasurable over time and is more used to soothe withdrawal symptoms than for any euphoric experience.

Withdrawal symptoms include:

• Muscle and bone pain
• Difficulty sleeping
• Diarrhoea and vomiting
• Cold flashes
• Uncontrollable leg movements
• Severe cravings

As with any drug addiction, addiction to fentanyls can cause problems at work or school and put strain on relationships with family and friends, as well as the physical and mental health issues that can ensue. People who are addicted to fentanyls will continue to use them despite these issues and may engage in risky behaviour in order to obtain more of the drug.

Long-term use of fentanyls can lead to organ damage, respiratory issues (if smoked) and brain changes, alongside the emotional damage that addiction to fentanyl causes.

Injecting fentanyl carries an increased risk of infection from viruses (such as hepatitis B or C) or bacteria, especially when sharing needles with other people. Injecting repeatedly causes scarring of veins and leads to their collapse.

Avoiding use, minimising use, avoiding addiction.

Whilst the body does not immediately develop a physical dependency, people will often like the drug and want to repeat the experience from the first use. If you encounter fentanyls regularly in your social or family life, this constant availability will add to the temptation to repeat an initial experience, as will stresses in life.

If you do use fentanyls occasionally and do not wish to stop despite the risks, it is important to be vigilant and reactive to signs of dependence. Growing tolerance for fentanyl (needing more to feel the same effects) is an important warning sign of some of the changes in your brain chemistry that lead to cravings and withdrawal effects when you don’t use.

How are you taking it?

Injecting fentanyls carries with it more risks than smoking or snorting them. Firstly, with fentanyl injection the total dose is taken in one go, so it is easier to overdose. It is much better to take a small amount to start with. As injecting fentanyls produces such a big rush, it is easier to become addicted to fentanyls when injecting.

If a user is injecting, they can still do many things to reduce unnecessary harms. Deliberately, or accidentally sharing used needles and syringes carries the risk of infection from viruses such as HIV and Hepatitis B or C. Using new sterile equipment reduces the risk of infection. In many countries, advice on safer injection and free equipment can be accessed at needle exchanges.

Are you taking anything else? Mixing other drugs with fentanyls can be very risky

Taking fentanyl with any other drug that can stop breathing (e.g., alcohol benzodiazepines or gabapentinoids) increases the risk of overdose. Additionally, taking fentanyls with stimulants like cocaine and speed (amphetamine) can increase the risk of overdose. This is due to the tendency to take a redose of both the stimulant and the fentanyl when the stimulant wears off. The effects of the stimulant often wear off more quickly than the fentanyl, leading the user to take an overdose of fentanyl.

When using fentanyls, it is a good idea to carry naloxone in case of overdose. Users will not be aware when they are overdosing, so trusted people should be present when using fentanyls. This means that they can administer naloxone if an overdose is suspected. Whilst medical assistance should be sought immediately when overdose is suspected, naloxone can neutralise the effects of overdose whilst waiting for medical help to arrive. Naloxone binds to the same receptors as fentanyls do, preventing the fentanyl from binding and producing any further effects.

Is fentanyl resistant to naloxone?

No, fentanyl and its analogues are not resistance to naloxone. Due to its potency, more may be required to treat an overdose, however, naloxone still targets the same receptors that fentanyl does.

Can you overdose by touching fentanyls?

No, it is not possible to overdose simply by touching fentanyls. The drug must enter the bloodstream or come into contact with a mucus membrane in order for the effects to be experienced. Transdermal fentanyl patches have a specific formulation which allow the drug to be absorbed via the skin.

Adderall is taken in the form of a pill, usually either blue or orange. The extended-release version comes in a capsule.

Adderall is consumed by oral ingestion. Its duration is between 4 -6 hours and peaks at around 90 minutes.

It is typically available in tablets of 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg and 30mg strengths. It may also come in the form of an extended-release tablet of identical doses.

Adderall is a chemical compound that is made up of powerful blends of the amphetamine salts dextroamphetamine and levoamphetamine, which are isomers of the original amphetamine molecule and come in a 3:1 ratio. The blend consists of the following: One-quarter racemic (d,l-)amphetamine aspartate monohydrate, one-quarter dextroamphetamine saccharin, one-quarter dextroamphetamine sulfate, and one-quarter racemic (d,l-)amphetamine sulfate

Adderall is an amphetamine-based drug. Amphetamines exert their pharmacologic action by blocking the reuptake of noradrenaline (NA) and dopamine into presynaptic neurons, increasing the release of these into the extraneuronal space. Dextroamphetamine, acts peripherally by release and reuptake inhibition of the neurotransmitter’s acetylcholine and histamine but not glutamate via the VMAT2 transporter. Amphetamines release stores of NA and dopamine from nerve endings by opening the respective channels.

Amphetamines also release stores of serotonin from synaptic vesicles. Like methylphenidate (Ritalin), amphetamines prevent the transporters for dopamine and NA from recycling them. These combined effects rapidly increase concentrations of dopamine and NA in the synaptic cleft, promoting nerve impulse transmission in neurons that have those receptors.

Physiologically, Adderall increases bothheart rate and blood pressure. For most people however, these effects are modest.

Adderall is detectable in the body following a number of different types of drug tests. The length of time that they are detectable for does, however, vary from test to test.

• In the blood, Adderall is detectable up to 46 hours after use.
• In urine, it is detectable for 72 hours after use.
• In saliva, it is detectable for 20 to 50 hours after use.
• In hair, it is detectable up to 3 months after use.

Adderall primarily works to increase concentration and general cognition. These effects are much greater in those with ADHD. There is evidence that Adderall can lead to improvement in attention performance, working memory and inhibitory control in healthy adults. A number of studies have demonstrated Adderall’s ability to enhance the cognition of adults with tests of problem solving and executive function. However, these effects are generally found to be quite modest.

The effects of Adderall reach can be observed anywhere between 30 to 60 minutes after ingestion, and the peak concentration in the blood occurs at around 3 hours post-ingestion. The effects will last for between 4 and 6 hours for instant release, and around 8 hours for extended-release tablets.

Adderall is primarily used to treat attention deficit hyperactivity disorder (ADHD). ADHD is a common neurobehavioral disorder affecting between 3 and 7 per cent of school-aged children. In the majority of cases, ADHD persists into adulthood.

The disorder results in delayed learning ability, impaired academic achievement and delayed maturation. Symptoms commonly include having trouble concentrating or completing simple of complex tasks, forgetfulness, hyperactivity, being easily distracted, impulsive behaviour and the inability to get along with others.

Although it is rarely prescribed in the UK, its use for the treatment of ADHD in the US is widespread.

Short-term physiological effects include:

• Decreased appetite
• Involutory body movements
• Hyperactivity
• Jitteriness
• Nausea
• Itchy skin
• Irregular heart rate
• Hypertension
• Headaches

Possible long-term physiological effects:

• Weight loss
• Decreased appetite
• Cardiomyopathy
• Heart palpitation
• Tachycardia
• Elevated blood pressure
• Fatigue

Possible adverse psychological reactions:

• Anxiety
• Depression
• Mood swings
• Psychosis
• Aggression
• Sleep difficulties
• Paranoia
• Hallucinations

To mitigate these risks, users should firstly speak to a medical professional before using Adderall. It will also be important to begin on a low dose to avoid unnecessary over-consumption of the drug. Lastly, users try to minimise the time which they are taking the drug, in order to avoid the potential of addiction and developing long-term adverse effects.

Adderall should not be used in persons who have not tried other psychotherapy before, have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol, take monoamine oxidase inhibitors, or have Tourette syndrome, which is one of several chronic tic disorders

Generally, the combination of drugs should be avoided as much as possible unless specifically prescribed by a medical professional. See this chart for an overview of drug interaction of a wide range of illegal and legal drugs.

With Adderall, the use of stimulants should be avoided. This is because Adderall is also a stimulant, and by combing it with another, it can exacerbate the potential for severe physiological and psychological adverse reactions.

The use of Adderall should also be avoided when taken in conjunction with the following substances, as it may lead to additional, severe harms:

• Duloxetine
• Levothyroxine
• Escitalopram
• Omeprazole
• Tramadol
• Monoamine oxidase inhibitors (MAOIs)

Alcohol and Adderall

When taking Adderall, users should avoid the intake of alcohol. Adderall is a stimulant, whilst alcohol is a depressant. This means that the two drugs work to counteract each other. As a result, users might feel the need to take additional doses of each drug to obtain their desired effect. This could lead to increased adverse reactions. By drinking alcohol alongside taking Adderall, the negative symptoms of both drugs will also be exacerbated.

Like other amphetamines, users of Adderall can develop an addiction to the drug. This can also result in withdrawal symptoms such as paranoia, depression, difficulty breathing, dysphoria, gastric fluctuations and tiredness. These symptoms lead chronic users to re-dose frequently and as such increase the possibility of addiction. Someone who has a dependency on Adderall should never stop taking the drug abruptly, and instead needs to do so gradually and under medical supervision.

It is not harmful because it is produced by pharmaceutical companies.

Research has shown that users of Adderall and similar substances do not consider it to be physically or psychologically harmful due to them being associated with instrumental pursuits of academic and productivity-related goals. This belief also stems from the fact that Adderall is produced, regulated and prescribed by the medical establishment.

This is, however, a myth. Adderall can produce serious adverse effects such as various cardiovascular events, worsening mental illness, and even increase the risk of sudden death.

It is only a stiff cup of coffee.

Many users believe that Adderall is nothing more than a stiff cup of caffeinated-coffee. However, the drugs’ composites are much more serious than caffeine. Adderall is composed of different amphetamine salts that increase extracellular levels of dopamine, serotonin and noradrenaline. This myth is problematic because it minimises the seriousness of potential adverse reactions to Adderall.

It makes you smarter.

It is commonly believed that, by taking Adderall, the user can become instantly smarter. There is evidence that healthy adults may receive small to moderate cognitive benefits in the areas of working memory, response inhibition and processing speed. However, these effects do not automatically make the user smarter, but instead simply complement existing cognitive abilities. Furthermore, a lot of studies have found that these beneficial cognitive effects are only very modest. In fact, there is evidence that argues to the contrary, demonstrating that stimulant misuse is negatively correlated with academic functioning.

If the user finds Adderall to be helpful, then they must have ADHD.

As Adderall is primarily used to treat ADHD, users commonly believe that if they take Adderall and benefit from it in some way, then they must have ADHD. However, this occurs due to a misunderstanding as to what ADHD actually is. The disorder is often trivialised to being nothing more than the periodic inability to concentrate. ADHD is a lot more complicated than this however, and is additionality characterised by impulses and continual restlessness.

PCP can be found as an oil, liquid, powder, pill or crystal. It is most commonly smoked, often mixed with cannabis or tobacco, but can also be insufflated (snorted), taken orally (as a pill or powder), or injected.

When smoked with cannabis or tobacco, the usual dosage is 1-10mg of PCP, while tablets usually contain between 1-6mg. When taken orally or inhaled, 10mg of PCP can produce sedation, whereas when injected only 0.25mg is needed.

Taking PCP by injection is strongly advised against. This is because very low doses are required to cause effects meaning there is a higher risk of overdose.

As production is unregulated, it is difficult to know the exact dose being taken. There is also a poor relationship between PCP intoxication and the blood serum concentration of PCP in patients, meaning we have a limited understanding of safe doses of PCP. It is thought that doses greater than 10mg usually result in mild coma and doses of 25mg or more can result in deep coma, convulsions and even death.

PCP action is not entirely understood but is thought that it mainly acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, meaning the drug blocks the action of glutamate at NMDA receptors. PCP also stimulates an enzyme called tyrosine hydroxylase resulting in an increase in dopamine, norepinephrine and serotonin production. Dopamine and serotonin production is associated with many other hallucinogenic drugs and could be responsible for the hallucinations and euphoria caused by PCP. At high PCP doses, strong NMDA antagonism results in complete analgesia and anaesthesia.

The effects, onset time and duration are dependent on the dose taken and the route of administration.

Onset time:

Effects are usually felt anywhere between 15-60 minutes after oral consumption, but are felt just 2-5 minutes after inhalation.

Duration:

The effects of PCP usually last between 6 and 24 hours but could be up to 48 hours.

Effects:

The effects of PCP are numerous and highly variable but are often summarised using the mnemonic RED DANES: rage, erythema (red skin), dilated pupils, delusions, amnesia, nystagmus (uncontrolled lateral eye movements), excitation and skin dryness. Effects may vary depending on dosage.

Low doses (2-5mg, orally ingested):

• Euphoria
• Hallucinations
• Dissociation – feeling of detachment from your body/surroundings
• Sadness, anxiety, paranoia, confusion – often felt in waves
• Numbness – as the analgesic effects begin
• Unpredictable behaviour
• Aggressive or violent behaviour
• Reduced pain sensation

Moderate to high doses (5-25mg, orally ingested):

• Confusion
• Further reduced pain sensation
• Stupor
• Mild coma – often occurs at doses greater than 10mg

Very high doses (>25mg, orally ingested)

• Convulsions – uncontrolled shaking
• Deep coma with no response to pain
• Death – can be caused by complications as a result of inhibited pain response (e.g. burns or drowning in a bath), violent behaviour, hyperthermia, hypothermia (e.g. falling asleep outdoors in cold weather), and breathing problems

Comedown: Some users may feel a comedown as the drug wears off. This may last for around 24 hours and feels similar to a hangover. Symptoms can include nausea, headaches and trouble sleeping.

Tolerance

Chronic users can develop a higher tolerance to PCP with frequent use, meaning that they need increasingly higher doses to experience the same effects.

Since the use of PCP as a medical anaesthetic for humans was replaced with Ketamine in 1965, and then later for animals, there have been no reported medicinal uses of PCP.

Some of the effects of PCP can have dangerous consequences, resulting in long-lasting mental effects, physical injury or even death. Although these usually only occur at high doses, it is important to know the risks.

Risks include:

• Analgesia (loss of pain sensation)
  • This can lead users to hurt themselves, either intentionally or without knowing, and may mean that they do not seek appropriate help for an injury.
• Violent/unpredictable behaviour
  • Violent behaviour is often reported in people intoxicated with PCP, and is one of the leading causes of death.
• Cardiovascular effects
  • PCP can cause hypertension (high blood pressure) and tachycardia (fast heart rate). These are usually mild but can be severe in rare cases, and cardiac arrest has been reported following PCP intoxication.
• Kidney damage
  • Rhabdomyolysis is seen in roughly 2.5% of people admitted to hospital with PCP intoxication. This is when myoglobin is released from the muscles into the blood stream causing damage to the kidneys, or even kidney failure.
  • The exact causes are unknown but could occur as a result of intense muscle contractions caused by PCP or due to PCP acting directly at the muscles.
  • Rhabdomyolysis can be identified by dark, reddish urine and sore or weak muscles and requires immediate medical attention.
• Overdose
  • As previously mentioned, we have a poor understanding of safe PCP limits but it is suspected that doses exceeding 25mg can constitute an overdose.
  • Symptoms of an overdose include: agitation, nystagmus (uncontrolled side-to-side eye movements), prolonged coma, hypersalivation, hypertension, convulsions, opisthotonos (muscle spasms causing arching of the back and neck), respiratory depression and catatonia (awake but unresponsive).
  • Immediate medical attention is required if a PCP overdose is suspected.

Long term mental effects of PCP use include:

• Chronic use can lead to acute anxiety, depression and psychosis.
• Toxic Psychosis
  • Some PCP users experience psychosis after the effects of PCP have worn off. This can involve hallucinations, paranoid delusions and delusions of influence or religious grandiosity.
  • These symptoms often disappear after a few days but can last from weeks to months, requiring treatment. A psychotic state lasting for more than 2 months may indicate that a pre-existing psychosis has been exacerbated.
  • Schizophrenic-like syndromes have been reported in PCP users after chronic low-dose use as well as after single use.
• Users have also experienced symptoms of frontal lobe syndrome such as speech impediments and memory loss long after taking PCP, as well as ‘flashbacks’, which is when users experience the feeling of being on PCP long after the drug has worn off.
• PCP can cause changes in NMDA binding in the hippocampus that remain after PCP use. This may be responsible for altered speech and memory, and psychosis.

As PCP has a sedative effect, it should never be mixed with other depressants, such as alcohol, benzodiazepines or opioids, as this can increase risk of coma. Mixing with depressants can also lower your heart rate and breathing to dangerously low levels.

PCP can be addictive. Chronic users may find it difficult to give up and can develop a higher tolerance to PCP with frequent use meaning that they need increasingly higher doses to experience the same effects.

Addicts may also experience withdrawal symptoms when they stop taking the drug. Short-term withdrawal symptoms include high body temperature, seizures, agitation, muscle twitching and hallucinations. These effects can appear a while after the PCP wears off as the drug can remain in the body for around eight days. Long-term withdrawal symptoms may include depression, memory loss, cognitive dysfunction, impaired speech and weight loss.

We know little about whether any health conditions could make PCP more dangerous. However, there are a few pre-existing conditions that are suspected to increase the risk of some of the more dangerous effects of PCP.

It is suspected that a pre-existing psychotic disorder may increase the likelihood of toxic psychosis following PCP intoxication. It is also possible that other mental health conditions such as anxiety or depression could be exacerbated by PCP use. It has also been suggested that being prone to aggression could make PCP users more likely to exhibit violent behaviour while on PCP. Youth previous psychiatric problems may also be risk factors.

Little is known about whether pre-existing conditions of the cardiovascular system (e.g. high blood pressure, arrhythmias) can make PCP more dangerous. However as PCP is a cardiac irritant, users with conditions that put them at increased risk of cardiovascular problems should be cautious of using the drug.

PCP is classified as a Class A drug under the UK Misuse of Drugs Act and as Schedule II under the United States Controlled Substance Act. This means it is illegal to possess, supply or produce PCP in the UK and USA.

Low doses

PCP gets more dangerous with higher doses. Doses of less than 5mg are considered low and tend not to produce most of the more dangerous symptoms.

Sober sitter

The dissociation, hallucinations and delusions caused by PCP can be confusing. Taking PCP with a sober sitter present, rather than alone, can help users to maintain their grip on reality and manage dangerous or unpredictable behaviour.

Setting

PCP can cause unpredictable and potentially violent behaviour, and the loss of pain sensation can cause users to injure themselves. Staying in a safe and familiar environment, away from things that might cause injury can reduce the chance of harm.

Don’t combine with sedatives or depressants

As PCP can have sedative effects, combining with other sedative or depressants (e.g. alcohol, benzodiazepines, opioids) can increase risk of coma and cause depressed breathing and heart rate.

Know the signs of overdose

Symptoms of an overdose include: agitation, nystagmus (uncontrolled side-to-side eye movements), prolonged coma, hypersalivation, hypertension, convulsions, opisthotonos (muscle spasms causing arching of the back and neck), respiratory depression and catatonia (awake but unresponsive). If you recognise any of these in yourself or someone else, seek medical attention.

Stay hydrated

PCP can cause increased body temperature. Dehydration can be avoided by drinking water.

Don’t inject PCP

When taken by injection, very low PCP doses are required to cause effects meaning there is a much higher risk of overdose.

Don’t use often

Some of the more dangerous or long-lasting side effects of PCP become more common with frequent use.

PCP makes people violent

Violent behaviour is often associated with PCP use however the actual prevalence of PCP-induced violence is debated.

Many who disagree with the idea that PCP makes people violent point out that the majority of research into PCP and violence works with PCP users who have been incarcerated or hospitalized and could only represent the more extreme examples of PCP abuse. Additionally, when PCP users in the general population are studied, many authors agree that violence in PCP users is much less common than is portrayed in the media.

Some people also suggest that only certain risk factors cause PCP users to become violent while intoxicated. McCardle and Fishbein found that PCP users who exhibit violent behaviour tend to be younger, have more psychiatric hospitalizations and are generally more aggressive whether intoxicated or not.

There is limited research that investigates the connection between PCP use and violence, and studies often have methodological weaknesses and produce contradictory findings. Therefore we cannot determine the extent to which PCP induces or exacerbates violent behaviour and it is worth considering that this is still a possibility when taking the drug.

Modafinil comes in the form of a white tablet. Typically, the drug comes in dosages of either 100mg or 200mg. The suggested daily dose for the treatment of narcolepsy is between 100-400mg.

The majority of recreational users report using 200mg as their preferred dose, with a few using up to 400mg, and some excessive dosages being 1000mg and over.

Modafinil is now off-patent and is available with a number of licensed ‘branded generics’ with their own trade names. Provigil is the main UK trade name, but modafinil is also available worldwide with a range of trade names such as Modalert, Alertec and Modavigil.

is a stereoismer of modafinil and is often marketed alongside or in replacement of modafinil. They have similar effects and are taken at similar dosages.

Modafinil is a stimulant. The exact way in which modafinil works in the brain is still relatively unknown as it has a complex mechanism of action. However, it is known that it acts on a number of neurotransmitters. It has been shown that modafinil works primarily through noradrenaline and dopamine transporter inhibition. It also acts on serotonin, histamine, gamma-aminobutyric acid and glutamate. Increases in the hypothalamic release of histamine also occurs as a result of modafinil’s action on the orexin system.

Physiologically, modafinil increases blood pressure and resting heart rate.

The onset time of the effects of modafinil can be anywhere between 30 and 90 minutes. The effects reach its peak between 2 and 4 hours after ingestion and can last between 12 and 15 hours. The main effects have been likened to a very high dose of caffeine. It is reported to improve concentration, decision-making and planning, whilst dramatically reducing tiredness.

As it is a stimulant, users of modafinil can experience similar adverse effects to other stimulants. These can include:

• insomnia
• headache
• paranoia
• irritability
• stomach aches
• loss of appetite
• nausea
• diarrhoea
• weight loss
• blurred vision
• dizziness

In rare cases, a high dose of modafinil can also cause psychosis.

However, despite its pharmacological similarity to other stimulants, it has been reported that these effects are not as serious as other stimulants.

Modafinil has been used to treat narcolepsy since the 1980s. Narcolepsy is a sleep disorder that is characterised by excessive daytime sleepiness. Unlike with other stimulants  the use of modafinil doesn’t seem to lead to rebound (hyper) sleepiness when stopped.

Nowadays, it is primarily used as a cognitive enhancer, but has also been used by the military and those who have sleeping problems due to irregular work shifts.

There is also an emerging body of evidence of its usefulness in treating cocaine addiction.

Lastly, it has been shown that modafinil could be useful in treating disease-related fatigue, attention-deficit disorder, Alzheimer’s disease, age-related memory decline, depression, idiopathic hypersomnia, cognitive impairment in schizophrenia and myotonic dystrophy. However, evidence for its usefulness in treating these disorders is not yet significant enough to warrant its widespread use for them.

Modafinil has a half-life of 12 -15 hours, with the drugs main effects peaking at around 2 – 4 hours and then lasting for around 12 hours or more. Therefore, if a user experiences adverse side-effects, it can be particularly uncomfortable as these are likely to last for a long duration.

As it is a sleep-inhibiter, users can also experience sleep insomnia. Prolonged periods of sleeplessness can cause increased stress and will impair immune functions. It can also increase the risk of cardiovascular disease, diabetes, metabolic syndrome and depression. There is also a link between sleep deprivation and bacterial infections in the blood because of dampened immune responses.

The possibility of addiction to modafinil has been doubted by some with only a few cases having been reported.

However, because modafinil acts on neurotransmitters such as dopamine, it has been suggested that addiction is possible with modafinil because of its mood-altering effects.

There have also been a few reports of users experiencing withdrawal symptoms such as poor concentration, sleepiness, low energy, depression, anxiety and shortness of breath. These are, however, rare and in most cases very mild.

Not much is known about the long-term effects of modafinil. However, it has been demonstrated that prolific and prolonged use of the drug could cause serious disruptions to the users sleep architecture.

It has also been shown to have the effect of increasing dopamine in the brain, which contributes to abnormal dopamine function when not taking the drug. This could have long-term implications by increasing the potential for the drug to be abused by vulnerable users.

These long-term effects can also occur when high doses are used regularly.

Mental Health

Modafinil can cause anxiety, paranoia and jitteriness. Because of this, those with mental health issues such as anxiety, depression or a history of psychosis should be extremely cautious when using it.

Dosage

As the effects of modafinil can last for over 12 hours, any adverse effects might last a long time and so can become particularly uncomfortable and harmful. It is therefore a good idea to start with a low dose to get a better idea of the level of the users’ tolerance.

Oral Contraception

It has been shown that modafinil can reduce the effectiveness of the oral contraceptive pill. This reduced effect can also last 1-2 months after taking modafinil.

Appetite

Modafinil can also cause a decrease in appetite. Users should therefore ensure they are eating consistently throughout the day, and it is especially important that you are keeping well hydrated because dehydration can cause loss of strength, stamina and the exacerbation of common symptoms of stimulants such as anxiety, headaches, jitteriness and dizziness.

Insomnia

In order to counter the possible effect of insomnia, it is best to take modafinil at least 8 to 10 hours before the user plans on sleeping to ensure the main effects have sufficiently worn off.

Impurities

It is also illegal to supply modafinil without a prescription. However, many sellers advertise modafinil for sale without a prescription. These sellers are unregulated and so it is not possible to guarantee that it will definitely be modafinil that is being sold. As a result, users should always test their drugs before using them.

‘It can make you smarter’

Modafinil cannot make the user smarter. In the last decade, many students and working professionals have started to use the drug to increase the amount of work they are able to complete.

There is some evidence that it increases working memory, the users’ ability to plan and to concentrate better, however this does not mean you will automatically become smarter. In fact, some users have reported that instead of having increased concentration on their work, they instead concentrate on certain distractions like watching videos or using social media and struggle to get back to concentrating on what they intended to do.

2C-B is typically found as a powder (often white crystals), pill or in a capsule. These are typically taken orally and the standard oral dose is between 15-25 mg.

2C-B can also be insufflated (snorted), although this carries increased risk because the dosage required to achieve active effects is much lower than an oral dose. There are anecdotal reports of pain when snorting 2C-B.

We strongly advise against nasal insufflation of 2C-B

There is still very limited research into the mechanisms of action of 2C-B in the human brain and body. However, it is suggested that 5-HT2 and α-adrenergic receptors are involved. The 5-HT2A receptor is associated with classical psychedelics, including LSD and psilocybin, whereby the drug binds and act as agonists. There is conflicting evidence concerning the mechanism of action of 2C-B, as some research suggests that 2C-B acts as a partial agonist at the 5-HT2A receptor, whilst other research suggests that 2C-B acts as an antagonist at the 5-HT2A receptor. It has also been suggested that the 5-HT2C receptor may be involved in the response activated and that the α1-adrenergic receptor is responsible for the stimulant effects.

The onset time of 2C-B is typically between 45-75 minutes after oral consumption. A ‘come up’ period with a duration of 15-30 minutes is commonly described and can include feelings of anticipation and anxiety, as well as bodily sensations including tingling and pins and needles.

Although there are anecdotal reports of the effects of 2C-B, recent observational studies have provided valuable insight into the emotional and pharmacological effects of 2C-B. The effects of 2C-B are heavily dose-dependent and typically include:

• Enhanced mood and feelings of euphoria
• Laughter
• Visual and auditory alterations and hallucinations
• Enhanced energy
• Sexual arousal/enhanced libido
• Nausea, vomiting and diarrhoea

After the synthesis of 2C-B by Alexander Shulgin in 1974, there were reports that he recommended its use in therapy to a limited number of psychotherapists due to the empathogenic effects of 2C-B.

There is very limited clinical research into the medical uses of 2CB, however an observational study showed that 2C-B acts as an entactogenic drug. Entactogens have effects which include emotional openness, oneness and introspection. MDMA is also described as an entactogen and this property is attributed to its potential use as a tool in psychotherapy for several psychiatric conditions, including PTSD. Therefore, it has been suggested by some that 2C-B may pose the therapeutic benefit that Alexander Shulgin had claimed.

2C-B induces a psychedelic experience including alterations to mood, as well as visual and auditory hallucinations. The nature of a 2C-B trip can be emotionally challenging for some people, inducing states of anxiety and paranoia. Similar to all psychedelics, the psychological risks can be minimised by ‘set and setting’, ensuring that both your mind-set is stable and well prepared, and that the environment is comfortable and safe.

Anecdotal reports suggest that recreational doses of 2C-B are associated with low toxicity and are physiologically well tolerated. However, there is a lack of scientific studies on the toxicity and long-term effects of 2C-B. A recent observational study investigated the immediate pharmacological effects of 2CB, demonstrating increased heart rate and blood pressure after 2CB consumption. Therefore, 2C-B may be dangerous for those with heart conditions.

The dosage of 2C-B is in the milligram region and the effects are highly dose dependent. There is a very steep dose response curve, which means that small changes to the dose that may be undetectable by eye could have drastic effects on the 2C-B experience. Alexander Shulgin states in PiHKAL that “over the 12 to 24 milligram range, every 2 milligrams can make a profound increase or change of response.” Therefore, it is critical that doses are measured accurately.

Snorting of 2C-B is highly inadvisable and there are anecdotal reports of pain associated with insufflation. Extra caution is required with snorting as the dose required is much smaller than an oral dose and the onset is very rapid, often within minutes.

2C-B can be tested using the Marquis Reagent (NIK® test A) and will produce a yellow/green colour. However, extra caution is needed as 2C-I (another 2C drug with different effects) will also give a yellow/green colour using the Marquis Reagent (NIK® test A). There are other drug testing kits available that can be used for further clarification of substances, but it is important to appreciate the limitations in determining the differences between the 2C series of drugs which includes 2C-B, 2C-D, 2C-E, 2C-I, and 2C-P.

Read more about 2C-B harm reduction here.

Similar to other psychedelic drugs, a history of mental health illness (such as schizophrenia, psychosis or bipolar disorder) may increase the likelihood of an unpleasant experience (‘bad trip’) and there is the risk 2C-B may exacerbate these conditions. However, there is still a very limited understanding of the dangers associated with the use of psychedelics in those with pre-existing mental health conditions. There has been a report of psychosis after 2C-B, however it is important to state that the purity of the 2C-B was not confirmed in this case.

2C-B increases heart rate and blood pressure. These effects could be more dangerous for those with a history of heart conditions or high blood pressure. Some have suggested that 2C-B may present more risks for those with diabetes or epilepsy.

It is important to understand the metabolism of 2C-B by the body and the potential implications this may have. 2C-B is metabolised by enzymes called monoamine oxidases (MAOs) A and B, and therefore this could pose a risk for those on Monoamine Oxidase Inhibitors (MAOIs).

Prescription drugs with an associated risk:

• MAOIs (some antidepressants)
• Tramadol
• Antipsychotics
• Antihypertensives
• Central nervous system depressants
• Vasodilators

2C-B should not be consumed with alcohol or other drugs. An understanding of the effects and mechanisms of 2C-B can provide insight into the risks associated with mixing 2C-B with other drugs.

Key drug combinations to avoid are listed below:

• 2C-B should not be mixed with tramadol due to the increased risk of seizure

• 2C-B should not be mixed with ayahuasca or ‘changa’ as they both contain MAOIs

• 2C-B should not be mixed with other stimulants including cocaine and amphetamines

• 2C-B should not be mixed with cannabis

• 2C-B should not be mixed with other psychedelics as this carries the risk of making the trip more intense

• 2C-B should not be mixed with any recreationally used prescription drugs that are known to potentially interact with 2C-B. This includes all those listed here.

2C-B addiction is unlikely because 2C-B is considered to have a low potential for addiction, similar to other psychedelic drugs.

2C-B produces a psychedelic experience with some stimulant-like properties. Informed harm reduction advice can help to mitigate some of the associated risks.

Being educated and prepared

It is important that you fully educate yourself on the health risks and drug interactions associated with 2C-B, and ensure that an accurate and suitable dose is consumed. 2C-B has some stimulant properties and therefore it is important to remain hydrated, especially if dancing.

Set and setting

‘Set’ refers to a person’s mind-set including their mood, thoughts and expectations. This can have a significant effect on the experience of the trip and therefore it is advised that 2C-B is only consumed when a person is in a positive and stable state of mind. ‘Setting’ refers to the environment and social situation in which the drug is consumed. Although some consider 2C-B a milder psychedelic, it is advisable that it is consumed in a safe and familiar environment.

Sitter

The presence of a sober sitter is recommended for those with limited experience of psychedelic drugs. The sitter can provide reassurance and support during and after the trip.

Other 2C drugs

2C-B is part of the 2C family of psychedelic phenethylamines, many of which were originally synthesised by Alexander Shulgin. Other popular 2C drugs include 2C-D, 2C-E, 2C-I and 2C-P. However, the effects of each 2C drug will vary and education of the differences is recommended before consumption of other 2C drugs.

DMT comes in various forms, which are suitable for different methods of consumption and will alter the duration of the experience. Pure DMT is a white crystalline powder or solid, but it is more commonly found as a yellow-pink powder or solid. It can also be found in herbal mixtures called ‘changa’.

1. Smoked (DMT): DMT powder can be smoked in a pipe or bong, or vaporized including through the use of vape pens. Freebase DMT is typically associated with smoking.
2. Smoked (Changa): Changa is an herb mixture containing both a DMT-containing extract and monoamine oxidase inhibitor (MAOI)-containing extract from plants. The combination of DMT and a MAOI is built upon the chemical principle of ayahuasca, whereby the addition of a MAOI will prolong the trip. Changa can be smoked in a joint, pipe, bong or vaporized with a vape pen.
3. Injected: DMT must be injected in its salt form (DMT fumarate).
4. Ingested/Orally: Consumed orally in the form of ayahuasca.

Although DMT occurs naturally in plants, it can also be synthesised chemically, producing DMT in its base or salt form. The term ‘freebase DMT’ refers to DMT in its pure alkaloidal form and is insoluble in water, whilst ‘DMT fumarate’ refers to the salt form and is water soluble.

DMT is a psychedelic tryptamine. It is an indole alkaloid and has a chemical structure similar to the neurotransmitter serotonin. This similarity in structure between DMT and serotonin allows it to bind to serotonin receptors. Specifically DMT acts as an agonist of the 5-HT2A receptor, whereby it binds and stimulates a response. It is thought that 5-HT2A receptor agonism plays a major role in the hallucinogenic effects of DMT. The 5-HT2A receptor is associated with several other classical psychedelics, including psilocybin and LSD, and consequently these psychedelics can often be referred to as serotonergic psychedelics.

Psychological effects

DMT is rapidly acting and effects are typically observed around 2-5 minutes after consumption and last around 15-20 minutes. Despite its short-lived effects, DMT is known as one of the most powerful psychedelic drugs. The subjective effects of DMT can often be meaningful but will vary with dosage. These include:

1. Eliciting intense visual alterations and hallucinations, specifically colourful and geometric forms
2. Profound spiritual or mystical experiences
3. Varying alternations in mood and emotion, including experiences of euphoria, calm, fear and anxiety
4. Perceived encounters with external entities, which are often described as elf-like.
5. Altered sense of time and place
6. A sense of depersonalisation or out of body experiences
7. Potential auditory hallucinations
8. Evocation of powerful memories

Physiological effects

DMT is associated with low toxicity and is easily metabolised by the body. However, there are physiological implications and associated risks to be aware of. These include elevated blood pressure and increased heart rate, which is particularly risky for those with heart conditions. The impaired cognitive and motor function poses a personal safety risk and presents further reason for DMT to be consumed in a safe environment with a sober sitter. It should be noted that at high doses there are some reports of seizures, respiratory effects and comas.

DMT, when consumed in the form of ayahuasca, has a long history of traditional medicinal use for numerous indigenous tribes across the Lower and Upper Amazon. The therapeutic potential of ayahuasca as a therapy tool in psychotherapy has generated significant clinical interest and several clinical trials have reported beneficial effects in the treatment of addiction and depression.

The growing mainstream appreciation for the therapeutic potential of ayahuasca (DMT-containing brew) and other classical psychedelics has generated increased scientific interest as to whether DMT has therapeutic potential. Scientific studies have demonstrated similarities between DMT and psilocybin, whereby DMT is able to produce a comparable mystical experience to that of psilocybin. It is suggested that psilocybin alters brain activity and enables the brain to reset. Therefore, recent evidence that DMT causes changes in human brain activity could be of therapeutic value. These similarities suggest that DMT may have a similar therapeutic potential to psilocybin in treating psychiatric disorders such as depression and anxiety.

DMT is a powerful psychedelic drug and, as with any drug, it’s important that there is an appreciation for both the psychological and physiological risks associated with its use.

DMT induces a particularly potent psychedelic experience consisting of intense visual alterations and hallucinations, alongside alterations in emotion and mood. The intensity of the trip can be emotionally challenging for some people, inducing states of panic, anxiety and paranoia. For some people DMT produces an out-of-body experience or depersonalisation, which can be an overwhelming experience. Similar to all psychedelics, the psychological risks can be minimised by ‘set and setting’, ensuring that both your mind-set is stable and well prepared, and that the environment is safe and encouraging. A sober sitter is an important safety measure to mitigate psychological harm.

Read more on DMT harm reduction in the harm reduction advice section.

Similar to other psychedelics, history of mental health illness (such as schizophrenia, psychosis and bipolar disorder) may increase the likelihood of an unpleasant experience and there is the risk DMT may exacerbate these conditions. However, there is still a limited understanding of the risks associated with the use of psychedelics in those with pre-existing mental health conditions.

It’s important to understand that DMT affects the serotonin system and therefore should not be taken in consumption with other drugs that also alter the serotonin system. This can result in a potentially life-threatening condition called serotonin syndrome. This includes some antidepressants and selective serotonin reuptake inhibitors (SSRIs).

Prescription drugs with an associated risk:

1. SSRIs
2. Antipsychotics (although many will also block the actions of DMT)
3. Opioids, especially
4. Antihypertensives
5. Central nervous system depressants
6. Vasodilators

DMT should not be mixed with alcohol or other drugs and an understanding of the effects and mechanism can provide insight into the risks associated with mixing it with other drugs.

Key drug combinations to avoid are listed below:

1. DMT shouldn’t be mixed with tramadol due to the increased risk of seizure
2. DMT shouldn’t be mixed with other stimulants including cocaine and amphetamines
3. DMT shouldn’t be mixed with cannabis
4. DMT is a powerful psychedelic and mixing it with other hallucinogens carries the risk of making the trip more intense
5. DMT shouldn’t be mixed with any recreationally used prescription drugs that are known to potentially interact with it. This includes all those listed above

DMT, along with other classical psychedelics, is not addictive. However, tolerance can develop with frequent use, whereby a higher dose is required to achieve the same effect.

DMT is a powerful psychedelic drug that can produce a rapid and intense hallucinogenic experience. Informed harm reduction advice can help to mitigate some of the associated risks.

Being educated and prepared

It is important that you fully educate yourself on the health risks and drug interactions associated with DMT. It is important to ensure that the correct form and method of consumption is used, as well as a suitable dose. The particularly intense nature of DMT makes it important that sufficient preparation is done. This includes an awareness of the psychological and physical effects that DMT may induce. Preparation is also linked to the person’s mind-set.

Set and setting

‘Set’ refers to a person’s mind-set including their mood, thoughts and expectations. This can have a significant effect on the experience of the trip and therefore it is advised that DMT is only consumed when a person is in a positive and stable state of mind. ‘Setting’ refers to the environment and social situation in which the drug is consumed. DMT should be consumed in a safe and calm environment, due to the intensity of the trip and the potential motor impairments.

Sitter

The presence of a sober sitter is particularly recommended with DMT. The sitter can provide reassurance and support during and after the trip. The sobriety of the sitter is essential and can provide a sense of clarity and guidance through any disorientating or overwhelming experiences.

Does the human brain produce DMT?

There has been extensive debate as to whether DMT is produced in the human brain. A lot of the debate has been focused around the pineal gland, a tiny organ in the centre of the brain, which had been popularised by many as the primary producer of DMT. However, currently scientific evidence to support this theory remains very limited.

Trace amounts have been detected in human blood and urine, supporting the idea of the endogenous production of DMT in the human body. Although a recent study detected DMT in the pineal gland of rats, there has been no evidence of this in the pineal gland of the human brain. A subsequent study demonstrated that DMT is still produced in the rat brain after removal of the pineal gland, adding further fire to the debate as to whether the pineal gland is the primary source of DMT. Understanding endogenous DMT production in the human body and its potential roles in physiology remains an understudied area and extensive further studies are needed.

Are DMT and 5-MeO-DMT similar?

5-MeO-DMT stands for 5-Methoxy-N,N-Dimethyltryptamine. While they may look similar, and have similar chemical structures, they induce different experiences and should not be confused. For more information on 5-MeO-DMT click here.

Ayahuasca is a reddish-brown tea. Traditionally, ayahuasca contains the Banisteriopis Caapi vine and psycotra viridis as its base. However, there may be regional variations in the preparation and it is common for other plants to be included in the admixture. Some additions may have psychoactive properties of their own, and these may also be potentiated by the β-carbolines of the MAOI. Substitutions are also possible; plants such as Mimosa, Acacia, Syrian Rue containing the same active compounds sometimes replace their original counterparts.

DMT is an indole alkaloid, acting as an agonist upon the 5-HT2A receptors (along with all other classic psychedelics such as LSD, psilocybin, 5-meo-dmt, etc). It is capable of producing strong visionary effects and other indicators of altered state of consciousness. Under normal circumstances, DMT is inactive when consumed orally, as it is denatured by an enzyme found in the stomach before it can take effect.  Therefore, it is more commonly vaporised, or, as has been the case in some clinical trials, administered intravenously. In ayahuasca preparations however, the addition of a MAOI (β-carboline compounds such as harmine, and harmaline) slows this process of enzyme oxidation, allowing oral preparations to produce a profound psychedelic experience, sometimes referred to as an ‘ayahuasca trip’.

To find out how DMT works in the brain, click here.

As with other 5-HT2A agonists (such as LSD, psilocybin, 5-meo-dmt etc), a serotonergic response is observed. The subjective effects – which last approximately four hours – are highly variable and often difficult to describe, but can include:

1. Intense closed and open eye visuals
2. Re-experiencing of memorable events
3. Distortions in sense of time, place, and sometimes sense of self
4. Possible auditory and sensory hallucinations
5. A deep state of introspection
6. Profound spiritual experiences
7. Perceived contact and interaction with other entities
8. Temporary alterations in mood and emotion that can range from terror to euphoria.

‘Autobiographical’ elements of content are often reported by those experiencing ayahuasca-induced visuals. The resurgence of memories, and a ‘third person’ perspective on life events have frequently been reported.

The psychedelic effects may be preceded by nausea, vomiting, and sometimes diarrhoea. This emetic action is perceived of as a cathartic expulsion in traditional settings, and is welcomed as part of the overall experience.

Emerging research into ayahuasca on brain function and potential clinical applications attest to some positive effects on mental wellbeing.

In clinical settings, preliminary observations indicate anxiolytic and antidepressant effects, along with reductions in suicidality in people with treatment-resistant depression. It may have a role in supporting people through addiction rehabilitation; clinical trials have demonstrated improvements in hopefulness, empowerment, mindfulness, and quality of life and outlook have been observed in those with dependency on other substances, as well as reductions in self-reported use of tobacco, alcohol and cocaine.

The therapeutic potential of ayahuasca has been reported after use in religious and ritual practices. It is consumed as a religious sacrament in a number of Brazilian syncretic churches. Studies have consistently reported higher wellbeing scores in churchgoers who are regular ayahuasca consumers (usually twice per month), when compared with members of non-ayahuasca churches.

Ayahuasca has a long history of use, with very few reported incidents of harm. Clinical studies (both animal and human) indicate it to be extremely safe when appropriate dosage, setting and supervision is applied. There is very little risk of toxicity, as is the case with most of the classical psychedelic drugs. The most frequently reported adverse event is an intense, challenging experience that can be emotionally difficult. For some, prior traumas can be revisited, and sometimes painful emotions require processing. Usually, this is temporarily unpleasant and causes no lasting harm.

As with all substances, there is risk around the composition of the preparation. Toxicological studies of ayahuasca ‘brews’ have revealed that concentrations of both DMT and the β-carboline MAOIs vary substantially across preparations. Many different types of additional plant matter  have been reported, some of which may pose risk of interaction or potentiation. Storage duration and transport conditions have also been shown to affect composition, with significant changes observed to the harmala alkaloids (present in the MAOI).

Caution is also advised in any setting where usual decision-making and awareness may be compromised. The risk of sexual assault and accidental injury or death is higher where psychoactive substances are used.

Although ayahuasca is pharmacologically safe at usual doses, there are some pre-existing conditions and medications that may preclude the use of ayahuasca. Common prescription drugs with interaction risks include:

1. Other MAOIs (sometimes prescribed as antidepressants)
2. Antipsychotics
3. Antihypertensives
4. Selective Serotonin reuptake inhibitors (SSRIs)

SSRIs, commonly prescribed for depression, present a hypothetical risk of Serotonin Syndrome when combined with MAOIs. Some medications may also limit the efficacy of ayahuasca, especially if they bind on the same receptors. Prescribed medications should not be suspended without consulting your doctor first.

Diagnoses of some types of mental illness (such as schizophrenia, history of psychosis, and bipolar disorder) are considered an exclusionary criteria in many settings.

Typically, full or partial fasting or is recommended prior to an ayahuasca experience. This not only reduces the chances of vomiting, it also promotes maximum absorption of the ayahuasca, and prevents potentially dangerous drug-food interactions. For example it is believed that foods high in tyramine (such as many cheeses and meats) may interact with β-carboline alkaloids present in ayahuasca.

Ayahuasca should not be consumed together with alcohol or other drugs. In particular, amphetamines should be avoided, due to their hypertensive action which when combined with a MAOI could prove fatal. Although, this particular drug interaction does not appear to be documented with ayahuasca. Detailed information on drug interactions can be found here.

Ayahuasca is commonly used in traditional settings with other ethnobotanical or otherwise naturally derived psychoactive substances. These include:

1. Tobacco (rapé; mapacho)
2. Kambo (from the Kambo frog)
3. 5-MeO-DMT (from the Bufo Alvarus toad)
4. Peyote (mescaline cactus)
5. Psilocybin (from certain types of mushroom)
6. Yopo (N,N-DMT, 5-MeO-DMT and Bufotenine containing seeds).

Caution should be exercised even if these options are presented as a usual part of the programme. Although there is little anecdotal evidence of adverse effect, few studies have looked at the clinical implications of taking these substances in close proximity.

Ayahuasca, like the other classical psychedelic drugs, is not addictive. Despite the documented (and further anecdotal) benefits, the trip process can be unpleasant and difficult, and therefore does not lend itself to regular use. Psychedelics in general also demonstrate a pharmacological mechanism of short-term reduced efficacy (tolerance) which inhibits their prolonged or frequent use. In fact, ayahuasca is valued for its anti-addictive properties and its potential role in supporting those with dependency on other substances is being explored.

If you have already made the decision to consume ayahuasca there are a number of precautions you can take to reduce the risk of harm. Adequate supervision is strongly advised; a person who is both sober and experienced with the psychedelic state can support any challenging aspects of the trip experience. If this is in a retreat setting attention should be paid to screening processes, preparation, supervision arrangements and integration, as well as the independent reviews by previous participants where available. The setting should be as comfortable and secure as possible and free of interruptions. As mentioned, any pre-existing conditions or medications should be discussed with a physician wherever possible.

Ayahuasca is hailed by some proponents as an all-round panacea for physical and mental health. While there are many interesting research avenues being/to be explored, it is dangerous to assume that any one substance can ‘cure’ ailments for which we do not (yet) have an evidence base for. This particularly applies to any choices one may make about rejecting or discontinuing mainstream medical accompaniment. Prescription medication should not be suspended to take part in, or as a result of, an ayahuasca experience without medical guidance.

It would be a harmful misconception for ayahuasca to be viewed as a recreational drug, or for ceremonies and other organised settings to be viewed as ‘drug-fuelled’ gatherings. On the contrary, the taking of ayahuasca is often referred to as trabajo (‘work’) in traditional contexts; from the nausea and vomiting, to the solitary introspection and the potentially challenging emotional experiences, it is not considered an easy or reliably pleasant activity. It is not therefore used as a recreational substance and is rarely taken at parties, festivals and nightclubs.

Bufo Alvarius Toad (Colorado River Toad)

As a defence mechanism, the Colorado River Toad secretes a white milky substance called ‘Bufotoxin’ from areas behind its eyes called ‘parotoid glands’. When dried this contains up to 30% 5-MeO-DMT by mass, alongside other substances such as Bufotenine, DMT, NMT, DET, N-Methylserotonin and Bufogenin. There is no evidence of a difference between synthetic 5-MeO-DMT and that secreted by the Bufo Alvarius toad, meanwhile there are concerns regarding the environmental impact that Bufotoxin collection may be having on local toad populations at the United States and Mexico border.

The 5-MeO-DMT content of natural toad secretions can vary greatly between samples, which makes accurate dosing more difficult. This can be dangerous because 5-MeO-DMT is very powerful, even at low dosages, and the effects are highly dose-dependant, following a steep dose-response curve.

Synthesised 5-MeO-DMT

5-MeO-DMT is most commonly consumed in the form of a synthetic white, crystalline powder. Typical doses of 5-MeO-DMT are very small, typically 5mg, so care should always be taken by using accurate scales and researching the appropriate doses. 5-MeO-DMT in this form is typically either vapourised in a pipe and inhaled or less commonly insufflated (snorted).

Anadenanthera seeds (Yopo)

Some trees under the genus Anadenanthera contain 5-MeO-DMT. There is a long history of use of these seeds as shamanic snuffs in South America. Once the seeds have been toasted they are ground, sometimes mixed with other materials such as Ash and Tobacco, and forcefully blown up the nose of a user via a tube.

Ayahuasca

Ayahuasca is a traditional tea, originating from South America. It is made from a mixture of psychedelic plants and a vine containing a mono-amine oxidase inhibitor. The MAOI prevents gut enzymes from breaking down the psychedelic components of the leaves, making them orally active. Some Ayahuasca recipes include 5-MeO-DMT containing plants, however, this combination has been shown to be fatal, and there is evidence to show that mixing 5-MeO-DMT with MAOIs can be potentially dangerous.

For more information about Ayahuasca, see our Ayahuasca Drug information page.

After being vaporised and inhaled 5-MeO-DMT quickly passes the blood-brain barrier. It shares a similar chemical structure with the neurotransmitter serotonin, which means it can fit into some of the serotonin receptors in the brain where it acts as an agonist, meaning it stimulates the receptor – especially the 5-HT2A subtype of the serotonin receptor.

Stimulation of these Serotonin receptors leads to the psychedelic state e.g hallucinations, and can affect mood and body temperature.

5-MeO-DMT is a relatively short-acting psychedelic drug and the ‘trip’ usually lasts less than 30 minutes when smoked, and up to 45 minutes when insufflated. When vapourised and inhaled the effects begin almost instantaneously, which means it is very important to be in a safe and comfortable environment to avoid accidents

Users often report overwhelmingly intense experiences which can sometimes be difficult to remember. Accounts of mystical union, feelings of non-duality and experiences of a transpersonal nature are not uncommon. Often uncomfortable bodily sensations such as a rapid heart rate, nausea and pressure in the chest can be present.

The alterations to perception as a result of taking 5-MeO-DMT often include auditory and visual hallucinations, internal scenes, time perception distortions and cognitive and/or emotional shifts. Some users report that 5-MeO-DMT is less visually intense than NN-DMT.

Similar to other psychedelic drugs like psilocybin and LSD, experiences can range from being euphoric and spiritually significant to dysphoric and psychologically scarring.

There is research which suggests that 5-MeO-DMT could have associations with improvements in anxiety and depression. It is sometimes used as an adjunct to Ibogaine therapy for the treatment of addiction. This may be effective because 5-MeO-DMT has been shown to down-regulate a receptor involved in the reward mechanism of drug abuse. The same study found that cells treated with 5-MeO-DMT show a similar response to anti-depressant medications. Further research is needed to investigate 5-MeO-DMT’s potential anti-depressive properties.

There have been suggestions that 5-MeO-DMT could be of use in understanding the neurobiological basis of hallucinations and for antipsychotic drug development.

Sleep disturbances, persistent anxiety and panic attacks have been reported in some individuals after a single experience with 5-MeO-DMT.

Unwanted or overwhelming realisations or insights can be hard for some people to integrate after their experiences. Some accounts describe persistent psychological disturbances and resurfacing of the effects lasting for weeks after use. Using a low, precisely measured dose can help to avoid unexpected or overly powerful effects.

As 5-MeO-DMT is most commonly smoked, anyone with a lung condition or asthma would be at a higher risk of adverse effects. Additionally, as 5-MeO-DMT can increase heart rate, people with cardiac problems should avoid using it.

People predisposed to or suffering from schizophrenia or psychosis might experience an onset or worsening of symptoms from 5-MeO-DMT use.

There is evidence to show that mixing 5-MeO-DMT with MAOI drugs can be dangerous and increase the risk of harm. There have been deaths from this combination.

There is also an increased risk of cardiac complications if combined with stimulants.

Alcohol should also be avoided to reduce the risk of vomiting and aspiration.

A study of 5-MeO-DMT users concluded that it is generally ‘used infrequently, predominantly for spiritual exploration’ and ‘has low potential for addiction’.

82% of the sample reported using 5-MeO-DMT for spiritual or healing/psychological purposes, indicating that it is not a substance which is commonly used recreationally.

Additionally, the majority of the sample indicated that they used it less than once a year, with the majority of use taking place in ceremonial or supportive contexts. Therefore, compulsive re-dosing and addictive behaviour patterns are unlikely to be seen with 5-MeO-DMT.

5-MeO-DMT in moderate to high doses will often leave the user incapacitated, so it is important to have someone present to prevent an individual from injuring themselves if they start moving around. Because of this, it is also advisable to be aware of the environment in which it is consumed, avoiding obvious hazards such as bodies of water and steep drops.

Occasionally, effects can vary from abnormal vocalisations and unusual body movements to complete unresponsiveness. Therefore, the person accompanying a 5-MeO-DMT user should know how to place someone in the recovery position, as vomiting is sometimes reported. Bear in mind that unconsciousness, along with breathing difficulties, is a sign of overdose and should be monitored.

Although 5-MeO-DMT is sometimes used in South American Ayahuasca recipes, it is generally considered dangerous to mix with any MAOI.

As 5-MeO-DMT is active in doses from as small as 3mg, weighing the dose carefully with a precise scale is important to avoid accidental overdose.

There is the potential for 5-MeO-DMT to be confused with N,N-DMT, a mistake which can be potentially problematic due to 5-MeO-DMT being 4-10x more potent than N,N-DMT and having a lower toxicity threshold. For more information on N,N-DMT, see our DMT Drug Information page. Home testing kits are available to buy online which can distinguish between the two. Always start with low doses to be safe.

There is a popular myth regarding ‘licking’ toads to get high. This is dangerous with Bufo Toads as Bufotoxin contains ‘digoxin-like cardiac glycosides’ which can be fatal. There have been reports of poisonings and even deaths from the ingestion of Bufo Toad toxins by humans.

There several types of Kratom, characterised by different colour ‘veins’ in the leaves and sometimes different growing regions, which are said to have impact the plant’s primary indications. Differences in preference for particular types of kratom are not yet well understood. Laboratory analysis has so far detected no significant difference in the major alkaloids in the resulting plant matter, and the plants which produce the different colour veins are not separate ‘strains’ of kratom in the true botanical sense. It is possible that asides from these two well-known alkaloids, there are other compounds within the plant which also produce an effect, either alone or in combination, which may account for these subjective differences.

Kratom is consumed orally. It is usually sold as a dried greenish powder, which can be swallowed neat, chewed, or prepared as a tea or cold beverage. Less frequently, it is sold in capsule or concentrated extract form.

Kratom contains over 40 different alkaloids, plus a number of other compounds. The two which attract the most attention are mitragynine and 7-hydroxymitragynine; alkaloids which act as partial agonists on the opioid receptors, meaning they produce somewhat similar, but milder, effects to opioid-based medications. This is partly due to the low concentrations of psychoactive compounds within the plant matter (usually 1 – 1.5%) meaning relatively large amounts of kratom needs to be consumed before a noticeable psychoactive effect occurs. Bodily effects maybe noticeable at slightly lower doses; some users report the principle (or only) effect as being an absence of fatigue or pain. Interestingly, mitragynine also has a broad affinity with many other receptors in the body, potentially explaining its complex effect on energy and mood.

There is evidence that in smaller quantities, kratom can produce a mild stimulatory effect, hence its traditional use as a aid with hard, physical labour. These stimulatory effects are not generally considered intense enough to attract the interest of those who use ‘party’ or ‘club’ drugs such as amphetamines. In larger doses, it may have an analgesic quality, and also possess sedating and muscle-relaxing effects.

Kratom is not widely used for recreational purposes – it is more commonly used for self-medication. Emerging data suggests that outside of its traditional context, kratom is more frequently used in an attempt to address chronic pain, sleeplessness, and/or to support opioid addiction withdrawal and recovery. More research is needed to scientifically assess its potential therapeutic applications, but the anecdotal evidence for these effects is strong.

Kratom is less likely to cause harm to health than many other illicit drugs and prescription medications, particularly those from the opioid family, of which it mimics some effects.

None the less, there some side-effects of kratom. Similar to opioids, it can produce agitation, tachycardia, constipation, vomiting and nausea. It does not, however, appear produce the respiratory depression which is characteristic of opioid overdoses. There have been a small number (this varies according to the source consulted) of fatalities internationally where kratom was implicated. This was usually because kratom was detected on post-mortem toxicology. However, in almost all cases, a number of different drugs were detected, which may contributed to, or been responsible for, the death. According to the US Center for Disease Control (CDC)  ‘Postmortem toxicology testing detected multiple substances for almost all decedents…Fentanyl and fentanyl analogs were the most frequently identified co-occurring substances.’ It also needs to be considered that as the vast majority of regular kratom users report experiencing chronic pain, or are in recovery from addiction to another substance, they are already at increased risk of death in any given year. Interestingly, no deaths attributed to kratom have been reported in Asia.

People who have impaired liver function, or who are taking prescription medications which may be changed by the liver, may be more at risk of harm, as kratom is believed to temporarily slow down functioning of this organ.

Taking more than one psychoactive drug at a time is always riskier than taking a single substance. Consuming Kratom alongside other opioids (whether illicit drugs or prescribed medications) may be very dangerous, as this likely to potentiate the effects, and the risks of each substance increase. Using alcohol will also raise the likelihood of experiencing negative effects. Little is known about this combination, but in general, central nervous system depressants such as alcohol pose even more risk when combined with either stimulants or sedatives.

There is some evidence that kratom may cause dependence, if taken in sufficient quantities for an extended period of time. Some people report difficulty in stopping or reducing daily use. Withdrawal symptoms are likely to be much milder than those associated with opioids, bearing in mind one of the most common uses of Kratom is to lessen the effects of opioid withdrawal in those with existing issues with addiction. As previously mentioned, the most common mode of use is oral ingestion, which does not lend itself as easily as to addiction, as the onset of effect is longer and milder due to the metabolisation process which accompanies this.

Kratom is a comparatively low-risk substance when taken in small doses. Those who have decided to use kratom are advised to begin with small amounts, as individual tolerance levels will vary. Taking too much kratom can be unpleasant; nausea vomiting and dizziness are common side effects in such instances. Concentrated preparations, such as liquids, are best avoided – accurate dosing is difficult as the strength is often unknown There may be other ingredients present which pose risks of their own – as with any drug purchased in a non-regulated market, there is always the possibility of adulteration. As noted above, kratom can produce mild withdrawal symptoms after regular use, so caution is advised with regards to frequency of consumption.

The US Food and Drug Administration declared kratom to contain ‘opioid agonists’ in 2018, and The CDC states that Kratom is not an opioid. Nonetheless, its action on the Mu-opioid receptors means kratom is sometimes erroneously ‘lumped together’ with opioids such as morphine and heroin. It does not display the same properties, and does not pose the same level of risk of abuse, or in terms of respiratory depression (Opioids such as heroin, suboxone etc can slow breathing down to such an extent that it can cause death – a 2019 review concluded this was not the case with kratom).

In 2016, the Drug Enforcement Administration expressed intent to place both mitragynine and 7-hydroxymitragynine into schedule 1, which would have made possession or sale of kratom illegal across the US. Protesters organised a march and a petition, which garnered over 120,000 signatures to oppose the ban. Of the 23,116 comments which were submitted during the public consultation, 99.1% supported kratom, and included positive accounts from a large number of law enforcement officials, heath care professionals and scientists, who overwhelmingly stressed its potential role in addressing the opioid epidemic currently facing the US.

The emergence of synthetic cannabinoids has mirrored the same trends seen with other new psychoactive substances. Due to the ongoing prohibition of cannabis, emergence of the synthetic cannabinoid market over the last decade has met demand by being a legal or quasi legal alternative. Consequently – users could avoid possession charges and pass drug tests, particularly in prisons/on parole and in the workplace. Secondly, new psychoactive substances, as they were legal, were considerably cheaper than their illicit alternatives.

As people found many of the side effects strong and unpleasant, the use of synthetic cannabinoids decreased in the general population. Two key populations remain – prisoners and the homeless. As mentioned, synthetic cannabinoids are a) highly potent and b) hard to detect. Accordingly, they are ideal for smuggling into prisons, where supply is scarce. The high potency also accounts for the high incidence of use in the homeless – they produce a profoundly dissociating and depersonalising experience which helps insulate the user from the cold, harsh, and unpleasant environment of being on the streets.

Cannabis is a natural plant that grows both in the wild and is cultivated for its medicinal properties and for recreational use. Though synthetic cannabinoids are considered chemical relatives or analogues to substances in cannabis, they are not actually found in plant-based cannabis and therefore have chemical and pharmacological properties largely unknown outside of the laboratory.

Synthetic cannabinoids are mistakenly considered to closely mimic the effects of cannabis, but in fact there are significant differences. As their name suggests, synthetic cannabinoids, like THC and other substances in cannabis, affect the brain by stimulating activity at various cannabinoid receptors.

Although research is limited, preliminary studies suggest that positive effects include:

1. Feeling stimulated and energetic;
2. Increased appetite;
3. Producing a dream-like state,

Negative effects include:

1. Overdose and temporary psychotic states and unpredictable behaviours;
2. Sudden increase in body temperature, heart rate, coma and risk to internal organs (PMA);
3. Hallucination and vomiting;
4. Confusion leading to aggression and violence;
5. Seizures
6. Respiratory failure
7. Intense comedown that can cause users to feel suicidal.

The severe side effects are likely due to two key reasons:

1. Very high potency & strong binding to receptors in the brain;
2. An absence of naturally occurring cannabinoids found in herbal cannabis (like cannabidiol/CBD) which normally counteract the effects of THC.

These substances are generally much more harmful than plant-based cannabis. Many of the adverse reactions to synthetic cannabinoids have been reported to involve dangerous, lethal physical symptoms. These include seizures, aggression and agitation, as well as respiratory failure and loss of consciousness. Adverse reactions to natural cannabis typically involve symptoms resembling anxiety and panic, which though worrisome, are not lethal.

Yes. Synthetic cannabinoids are pro-psychotic, and individuals with a history or family history of psychosis and mental health conditions are at elevated risk. They are also pro-convolsant, and individuals with a history or family history of epilepsy and other seizure disorders are at elevated risk.

Very little is known. A 2013 survey by the Scottish Drug Foundation found:

1. Increase in mental health issues including psychosis, paranoia, anxiety, ‘psychiatric complications’;
2. Depression;
3. Physical and psychological dependency happening quite rapidly after a relatively short intense period of use (weeks).

A synthetic cannabinoid is cannabis made in a laboratory

Synthetic cannabinoids and the active psychoactive ingredient in cannabis, THC, are very different drugs. They bring about serious, life threatening side effects and are only linked to cannabis in that they bind to the same receptor in the brain as THC.

Chewing

Fresh leaves can be chewed. A salvia ‘quid’ (lump of leaves) is crushed slowly with the teeth and held in the mouth for about half an hour. Dried leaves are soaked in water before chewing. The salvinorin A is absorbed through the lining of the mouth, so chewing quickly and swallowing is ineffective. Some people brush the inside of their mouth with mouthwash, or eat chillies before chewing, in order to increase blood flow to the mouth lining and so boost the absorption of the chemical.

Just 10 strong leaves have given people a powerful psychedelic experience, so users should be cautious with quantity and start with a small amount the first time. With this precaution, chewing is likely to be the least risky way of using salvia. The effects take about 15 minutes to kick in and last for around an hour before fading, peaking in about 30 minutes.

A variety of tinctures made to be taken by mouth have also been observed. These are concentrated and require even more caution to prevent a stronger-than-desired experience.

Smoking

Some people smoke dried salvia leaves for a more intense experience of the drug. Using a water-pipe (bong) and a cigarette lighter is a popular method. Using matches is risky, as you are likely to drop the match as soon as the drug kicks in. The problem with smoking dried salvia leaf is that you need to inhale a great deal of thick smoke over 2 or 3 minutes to get an effective dose. This is unpleasant, unhealthy, and difficult to achieve for most people.

However, salvia for smoking is now mostly purchased in the form of dried, ground-up salvia leaf which frequently has had a concentrated salvia extract added. This allows the entire dose of Salvinorin A to be consumed in just a few puffs or even just one inhalation. This comes with a high risk of having an unpleasantly overwhelming experience. Extreme caution must be taken with these products. Users should begin with a small dose to decrease the chances of having an overwhelming and or negative experience.

Concentrated salvia leaf looks a bit like dark dried herbs. This product is usually described by how many times the potency of the original dried salvia leaf has been fortified (e.g. 5x extract, 20x, or even 60x). Quality control for products like these is virtually non-existent, meaning that if you buy salvia, you cannot rely on the claimed strength of the extract being accurate. There is also the possibility that salvinorin A may be replaced by another substance.

Anecdotal reports suggest that people have had very powerful experiences from products labelled as being any of the available strengths.

When smoked, the effects of salvia begin within seconds, peaking in around 5 to 10 minutes, before fading gradually over half an hour.

Salvia is a very unusual dissociative hallucinogen which does not have the same action in the brain as LSD and other classical psychedelics, or dissociative drugs like ketamine. Its effects are thought to be due to its action on the κ-opioid receptor. The exact mechanism of how this interaction produces the experience of salvia is unknown. However, it is thought that the κ-opioid receptor plays a role in regulating perception.

The anti-inflammatory and analgesic effects are thought to be due to interaction with κ-opioid receptors and cannabinoid type 1 receptors.

Summary of effects:

• Laughter
• Visual and auditory hallucinations
• Distortion of time and space
• Sense of uneasiness
• Detachment from reality
• Recollection of memories
• Nausea
• Dizziness
• Confusion
• Lack of coordination

Salvia combines hallucinogenic and dissociative effects. Small doses of salvia may make you feel odd and giggly. At high doses, it can scramble current perceptions, memory, and imagination, possibly leading the user to lose all sense of who and where they are and what is happening around them.

Alternatively, users may experience a meaningful trip. For example, revisiting experiences from their past, which may appear to be as clear and real as normal experience. This means that unlike most hallucinogens, when a salvia trip is intense, the user may be unable to distinguish between what is real and what is a hallucination. They may even forget they have taken a drug, which can cause intensely disturbing ‘derealisation’ and fragmentation of identity.

Salvia is not a drug that reliably makes users feel ‘good’. People often take it out of curiosity and interest in exploring altered mental states, rather than for pleasure or fun. A few use it for personal spiritual reasons, but it appears that most users do not tend to repeat these powerful experiences very often.

Every person will experience something different on salvia, and no two trips will be the same. Salvia can make your perception of time and the place you are in different. People can find themselves laughing hysterically. It can bring about cartoonish hallucinations, and even a total immersion in a dream reality outside of the normal universe. Encounters with other beings have also been reported.

The whole body feels involved in a salvia trip, and sensations of falling, being pulled around, or floating are common. Some salvia effects are perhaps most comparable to other controlled psychedelic hallucinogens like LSD and DMT, although salvia works very differently in the brain.

Salvia currently is not used as a treatment in mainstream medicine, however, drugs that affect the κ-opioid receptor are thought to be worthwhile starting points in treatments for addiction.

Salvia has been used by the Mazatec people in a medicinal context for centuries. Alongside use for its psychoactive properties, it has also been used as a treatment for arthritis, gastrointestinal problems, headaches, and addiction.

There is no evidence that salvia is toxic to the body or brain. However, there has not been detailed scientific investigation on the potential of salvia to be harmful. Some experience headaches or feel foggy minded for a while afterwards.

In some countries, salvia is controlled, so make sure you investigate this first.

Traumatic experiences (bad trips and lasting symptoms)

Not enjoying salvia is common, but a truly traumatic experience seems very rare. The chance of it happening to you can probably never be ruled out but is much more likely on very high doses. The risk of a traumatic experience is heightened if you have never taken salvia before and are unprepared for its potentially powerful effects. If you are feeling negative emotions like anxiety, self-doubt, or depression before you take the drug, these feelings may be amplified by the drug.

Although the salvia experience does not last long, some people report it feeling like it lasts for hours, or even forgetting that another sort of existence exists outside of the bad trip. During the trip, people can have panic attacks, become agitated, and try to escape their surroundings. This risks injury to themselves and anyone who tries to restrain them.

There have also been cases, not formally reported in medical journals, of people who have found that a single salvia experience left them with derealisation that lasted many days or more. They felt spaced out, miserable, and disconnected from reality. Others claim to have suffered lasting alterations of perception that echo the hallucinations during their trip (HPPD). It is important to repeat that these effects have not been scientifically documented, but they are serious enough to be aware of. There may be millions of people who have taken salvia without harm, and very few have suffered these serious lasting problems.

Injuries

When consuming salvia, the user may be totally unaware of their real surroundings, but will often want to move around, which makes them vulnerable to dangerous accidents. Dangerous objects (car keys, knives) should be made inaccessible. Someone tripping is less likely to suffer harm if they have constant supervision of a ‘trip sitter’. Unless it is unavoidable, the sitter should not try to physically restrain someone who is tripping so much that they are unaware of their surroundings, as the user may become frightened and lash out violently. If an appropriate setting is chosen, restraint should not be needed.

People experiencing mental health conditions such as bipolar disorder, or any psychotic illness should not take salvia.

In one almost unique case where a man developed a lasting psychotic illness after smoking salvia, it was thought that he may have been predisposed to schizophrenia, and the salvia brought on the appearance of symptoms.

Salvia does not appear to be addictive, both physically and psychologically.

Due to the intensity of the experience, most users do not choose to regularly repeat it.

Salvia is legally available in many European countries, but this should not be taken as a reflection of its power. It can be distressing and even harmful, especially when used by people who are not prepared. There will always of having a negative experience with salvia, but thoughtful preparation can help reduce the risks.

Chewing or smoking salvia

Considering what type of experience you want to achieve is important. For many people, chewing leaves will give a sufficient experience with less of the risk of overconsumption than smoking might give. Even if you think you would like to have a powerful experience, working your way up through lower doses will reduce the chance of having a more intense trip than you wished for.

Having a sitter

A sober and trusted friend, a ‘trip sitter’, can help look out for you, prevent accidents and may be able to reassure you if you are having an unpleasant or frightening experience. Getting comfortable in a safe place, such as on a carpet with cushions around and dangerous objects removed, reduces the risk of injury.

Is salvia like cannabis?

No. Salvia is sometimes described as or compared with cannabis in the media, for example, being referred to as a legal cannabis alternative because it is a smokeable herb and often not controlled. Most users do not find the drugs similar, and they have different actions on the brain.

Fresh

Psilocybin mushrooms are naturally occurring — they either grow out of the ground or are cultivated from mycelium spores. Different strains of psilocybin mushrooms grow naturally all over the world and some people have been known to forage for them. Picking these mushrooms yourself, however, can be dangerous. There are over 10,000 species of known mushroom, some of which are poisonous to humans. Without knowledge of the different types, species and dangers of various fungi, it can be easy to confuse one mushroom with another and pick one which will leave you comatosed, as opposed to one which will give you a psychedelic trip.

Dried

Mushrooms are composed of around 90% water and so when dried they lose around 90% of their mass. This means that the same dose of magic mushrooms in a dried form will be around 10x lower in weight than a fresh dose.

If the moisture isn’t extracted from mushrooms when they’re picked they can rot fairly quickly, which destroys not only the mushroom itself but also the psilocybin contained within. Eating rotten magic mushrooms is never a good idea — the mould will cause severe stomach issues without any kind of psychedelic experience.

The market for magic mushrooms is illicit and unregulated as psilocybin mushrooms are illegal in almost every country. The danger of purchasing any kind of magic mushrooms (fresh or dried) is that, unless you’re an expert, you will not know exactly which strain you’re purchasing. There are many different types of psilocybe mushrooms and some are stronger than others. Consuming a dose you believe to be a weak strain may bring about unexpected and unpleasant effects if turns out to be a different or a stronger variety.

Powder

Magic mushrooms can also come in powdered form; sold as capsules or as the powder itself. The dangers of purchasing/receiving psilocybin in this form are greater than the fresh or dried variety. It is far easier to add adulterants to powder which greatly increases the dangers of substances of unknown origin, quality and quantity being mixed into what you believe is pure psilocybin powder.

Consuming mushrooms

It is important to recognise that natural products tend to vary in strength even within the same species and across locations. Psilocybin mushrooms are consumed in many ways, fresh or dried, for example, brewed into a tea, put into food, ground-up or just eaten as they are. As mushrooms are almost entirely water, a dose of fresh mushrooms will weigh around 10 times more than the same dose dried. Microdosing psilocybin has become increasingly popular but there is very little research into microdosing at this stage.

Psilocybin and psilocin are known as psychedelic tryptamines and they have very similar molecular structures to a key chemical messenger called serotonin. Serotonin has some very important functions in our brains and digestive systems, including large influences over-regulating our moods, sleep cycles and stress-coping mechanisms.

Due to this similarity in molecular structure, psilocin molecules activate the same receptors in the brain that serotonin activates, particularly at a specific receptor site known as 5HT2A. This particular receptor mediates many different functions in our minds; like mood, imagination, learning and perception.

A large portion of these 5HT2A receptors are located in cells in the cortex; an area of the brain associated with reasoning and rational thought. These cells are also quite long — they span an area of the brain larger than many other cells and therefore have a wider influence over brain activity.

Psilocin sits into these receptors and activates them, thereby producing the characteristic ‘trip’ of a magic mushroom experience, which can include changes in mood, imagination and perception. Recent research has also shown psilocin has an effect on a part of the brain known as the Default Mode Network (DMN).

Our DMN’s are like our brain’s main information highways. They act as consolidation centres while we go about our daily lives, compiling information quietly in the background. They also allow us to ‘time travel’ in our minds, giving us the ability to think back to the past and plan into the future. Some also theorise our DMN’s are home to our individualities; that they house our senses of ‘self’.

Psilocin temporarily disables one or more of the DMN’s ‘connector hubs’. This temporary shutdown of our brain’s main information highway means the brain cannot connect with the different parts of itself like it usually does, and is instead forced to connect in ways it does not usually. This means the brain starts communicating with parts of itself it doesn’t normally ‘talk’ to, which means the brain creates new connections while under the influence of psilocin.

Our understanding of exactly how psilocin affects the brain is not yet complete, and scientific research continues.

Psilocybin mushrooms have potential medical uses in the treatment of mental illnesses and disorders such as depression, anxiety, alcoholism and PTSD, and potential therapeutic uses for things like counselling and even grief.

Numerous studies have been carried out (most notably by David Nutt and Imperial College, London) into the usefulness of psilocybin mushrooms, particularly in the treatment of depression. The findings of these studies show a high correlation between controlled psilocybin experiences and the lessening of depression in subjects, sometimes from as little as one psilocybin experience.

Studies have also shown a correlation between microdosing psilocybin (consuming a dose far smaller than that which would produce psychedelic effects) and the treatment of smaller conditions like migraines and cluster headaches. However, there is very little research into microdosing at this moment in time and many believe the effects to be purely placebo.

Medical administration of psilocybin for the purposes of treatment should only be carried out by registered professionals and you should not attempt medical use of psilocybin yourself.

Research on psilocybin therapy continues — for more detailed information on the medical applications of psilocybin, based on clinical trials, click here.

The main risks of psilocybin are experiencing a ‘bad trip’. A bad trip can encompass various negative experiences but can include feeling incredibly uncomfortable within yourself or your environment, not being able to properly communicate with others, and losing touch with reality, among a whole host of other potential factors.

The most dangerous of these is losing touch with reality somewhere which could have dangerous consequences. It can become almost impossible to think or act ‘normally’ under the influence of psilocybin, and if a person is somewhere which requires their mental faculties to stay safe, for example on a busy street, a crowded area or high-up somewhere, there can be a serious risk to life.

HPPD and ‘flashbacks’

HPPD is a very unusual and poorly understood harmful effect of having taken hallucinogenic drugs. There are few or no good quality formal accounts of psilocybin causing HPPD (LSD is more commonly the cause) but it likely to be possible, and could go unrecognised.

It is most often experienced as re-appearance of some of the effects experienced during the previously occurring hallucinogenic drug experience after some time without the drug. In most cases HPPD follows a traumatic hallucinogenic drug experience (‘bad trip’). In some cases, sufferers may feel detached from normality or the world.

HPPD has been reported occasionally as longer-lasting, though complete or partial recovery usually occurs after weeks or months. Lingering HPPD has been associated mostly with LSD rather than psilocybin, and often involves higher doses and drug combinations. This kind of HPPD may occur in people with underlying psychiatric conditions or genetic vulnerabilities, but the evidence is very incomplete.

Compared to legal drugs like alcohol and nicotine, which can cause considerable physical harm to users (risk of harm to health and body from consuming the substance), psilocybin carries a low risk of physical harm.

Psilocybin is generally considered to have a very low potential for physical harm, but the risks associated with the consumption of the drug are significant if not done responsibly. Psilocybin is widely considered to be of low risk to health by the scientific community, but it still has its associated risks.

The main one of these is that given psilocybin can produce a potent hallucinogenic state, those with prior personal or family histories of psychosis, schizophrenia or psychological disorders should steer clear of psilocybin. This is because a psilocybin experience could exacerbate potential symptoms or bring them to the surface.

Psilocybin should not be mixed with any other illicit drugs, alcohol or nicotine. Drug combinations can be unpredictable, dangerous and potentially even fatal.

Psilocybin should not be mixed with any psychiatric medication or any anti-depressants such as SSRIs or MAOIs. Psilocybin molecules are theorised to affect the same neural receptors as some prescription drugs and they should not be mixed to exclude any potential for adverse drug-drug interactions.

Psilocybin mushrooms seem to have a very low potential for addiction in humans. There have not been any significant cases of people becoming detrimentally addicted to mushrooms.

Psilocybin molecules have not been seen to change the supply of any endogenous neurotransmitters, nor do they affect activation of neural receptors through the use of the brain’s existing supply of neurotransmitters (like cocaine or MDMA do).

Instead, psilocybin molecules seem to mediate their effects through activating 2A serotonin receptors while leaving the brain’s existing supply of serotonin untouched. This prevents the potential for upregulation or downregulation of neurotransmitters, and therefore strongly negates the potential for physical addiction.

The body has a high tolerance for repeated use of psilocybin mushrooms. A user consuming psilocybin one day would have a far diminished effect consuming the same amount the next day. The body’s ability to quickly create a high tolerance for psilocybin means there is a low potential for addiction.

Magic mushrooms have relatively low risks to physical health compared to many other drugs because they are not considered addictive and are rarely used regularly. However, tripping on a psychedelic drug has the potential to produce overwhelming and intensely unpleasant experiences.

The best method of staying safe from psilocybin mushrooms is not to consume them at all, but if a person is going to consume them there are some safety practices which should be followed.

1. Making sure you have the right mushrooms

Psilocybin mushrooms can sometimes look similar to other non-psilocybin mushrooms. Getting psilocybe mushrooms mixed up with other mushrooms can be harmless in the best-case scenario or fatal in the worst-case scenario.

Poisonous varieties of mushrooms do exist in nature and great care must be taken when choosing a type of mushroom to consume. This is especially a danger if a person is picking wild mushrooms without the proper knowledge or guidance.

There are also many different types of psilocybin mushrooms. Some are weaker in effect and some are stronger — even mistaking a strong variety for a weak one can have unintended consequences by making a trip more intense than anticipated.

It is imperative to know what kind of mushroom you are consuming before you consume it. If you are unsure, do not take them or consult a mycologist or someone who is familiar with varieties ad types of mushrooms.

2. Dosage and Measurement

Dosage is extremely important when taking any kind of substance as dosage directly affects the intensity of a trip and/or health risks of a substance.

As psilocybin mushrooms have a very low potential for adverse physical health risks, taking too high of a dose may not do any physiological harm but it will often cause a very intense, unsettling or uncomfortable experience which could leave psychological damage.

The dosage of psilocybin mushrooms differs depending on whether the mushrooms are fresh or dried. As mushrooms are composed of about 90% water, dried varieties will often have a dosage of 10x less than fresh varieties.

For example, if an average dose of fresh psilocybin mushrooms is 20g, the dosage of the same variety of dried mushrooms would be 2g.

Before consuming any psilocybin mushrooms (fresh or dried) it is very important to accurately weigh them to ensure the correct dosage. Accurate gram and milligram scales are widely available and should be used to ensure the dosage is correct.

3. Set and Setting

After ensuring you have the correct type of psilocybin mushroom and accurately measuring the dosage, your set and setting has a strong impact on whether you have a good or bad experience.

Set

Set refers to your mindset. A common effect of the substance is the exaggeration of what you are already feeling. A positive mindset or, at the very least, a neutral mindset is key to the psilocybin experience. If a user is in a highly anxious, fearful or in an otherwise negative state of mind before consuming mushrooms, it is likely these emotions will spill over into the psychedelic experience and cause a bad trip. Conversely, if you are in a positive mood the psilocybin is likely to lift that mood and reflect more of what you are feeling, leading to a happy, insightful and even euphoric experience.

If you are in a bad or negative frame of mind, psilocybin may magnify what you’re feeling, which is an almost surefire way to have a bad trip (if you’re not under the supervision of a professional). Tripping on psilocybin mushrooms when in a negative state of mind may lead to strong feelings of anxiety, discomfort, fear or even terror.

Setting

Setting refers to your environment. Common effects of psilocybin can range from visual distortions and hallucinations to deep-diving into one’s mind or personality. The substance seems to make the brain open to all and any sensory experience during the trip. This means if you are in a loud, crowded, unfamiliar or otherwise uncomfortable environment it is very likely to lead to a bad trip, even if you begin with a positive mindset.

It is very important to ensure your environment is familiar, comfortable and you are with people you trust before embarking on a psilocybin trip. Not doing so will almost certainly lead to a negative experience.

4. Tripsitter

It is an idea to have a trusted, sober person present when on a psilocybin trip. This person, known as a ‘tripsitter,’ can ensure everyone is safe, has a positive experience and can deal with any potentially situations which may arise.

Situations like these can include when a user has a bad experience and doesn’t know what’s real or not — the tripsitter can bring them back to reality and ensure them whatever they’re thinking or experiencing is not real and the drug will eventually wear off. Reassuring comments and gestures are helpful, as is making sure those who are tripping are not feeling anxious or uncomfortable.

An ideal tripsitter would be someone who has also experienced positive psilocybin trips. This means they understand the feeling of the trip and what is needed to effectively tripsit. Psilocybin can make users very sensitive to their own moods and the moods of others. Having a tripsitter who is judgemental or does not agree with consuming psilocybin mushrooms will very much negatively affect the experience of those tripping.

5. Killing the High

Colloquial evidence and user trip-reports suggest the psilocybin high can be cut short or ‘killed’ by consuming sugary foods & drinks like sweets, carbohydrates or fruit juices. It is theorised the sugars break down the psilocin in the blood, speeding up the process of bringing the user back to sobriety/reality quicker.

There is not much scientific evidence to support this theory, but if a user is having a bad trip and/or wants to come down, consuming sugary foods or drinks will not do any harm.

Do Psilocybin Mushrooms cause brain damage?

From the 1960s there was a popular theory that psilocybin mushrooms (and drugs in general, especially hallucinogens) caused permanent brain damage from just one-time consumption.

There is no scientific evidence that this is true, and science does not show one-time or infrequent use of psilocybin mushrooms has any vastly detrimental effects on the brain. In fact, studies have even suggested psilocybin helps create and connect brain cells.

However, there are few studies showing what regular use of psilocybin does to the brain. From this respect, it is best to space trips out (3 months apart, at the least), in order to stay safe but also to maximise the positive outcomes from trips and minimise the building of physical tolerance.

Are fly agaric mushrooms (Amanita muscaria) psilocybin mushrooms?

No. Fly agaric mushrooms (the fairytale toadstools with white spots on red) belong to a different family and should not be confused with psilocybin-containing mushrooms. Rather than psilocybin, the key chemicals associated with the psychoactive effects include ibotenic acid and muscimol. Effects can include twitching, drooling, sweating, dizziness, vomiting and delirium, very unlike the fairly mild physical effects of psilocybin mushrooms. Fly agaric mushrooms do not appear to be a popular recreational drug. In the UK, when the sale of fresh psilocybin mushrooms became controlled, some shops started selling dried fly agaric mushrooms as a non-controlled alternative. However, there is a risk that these types of products might contain a range of added substances, especially when powdered samples are involved. The fly agaric and commercially available products of that nature should not be considered a legal alternative to psilocybin mushrooms as their effects and risks are very different.

Nitrous oxide is a colourless gas that has a slightly sweet smell and taste. It is usually obtained for recreational use from whipped-cream chargers. These are single use, finger-length steel canisters containing 8g of highly pressurised nitrous oxide. The gas is usually discharged into a balloon with a whipped cream dispenser, or a smaller widget called a ‘cracker’. This balloon method seems to be relatively low risk. Other sources of nitrous oxide include full-sized gas cylinders, intended for medical or industrial use. Using these is high risk outside of the intended context.

The exact mode of action of nitrous oxide is still unclear. However, theories have been put forward to explain its actions. There are three main ways that the body is affected by the compound. Firstly, the anti-anxiety effect is produced by the blocking of neurotransmitters by GABA_A receptors. Secondly, it has been suggested that the analgesic effect is due to the stimulation of opioid receptors, resulting in the release of norepinephrine, which inhibits pain signalling throughout the body. Finally, the euphoria felt when the drug is taken is due to the release of dopamine triggered by stimulation of the brain’s reward pathway.

The recreational effects occur at lower concentrations and may be produced by alterations in brain blood flow such as are believed responsible for the recreational effects of another gas, nitric oxide, which is produced from the sniffing of “poppers”.

When someone inhales nitrous oxide, the gas rapidly dissolves into the bloodstream, and reaches the brain within seconds. A rush of dizziness and euphoria is commonly reported, and people often burst into laughter. Sound distortion also occurs.

Hallucinations are possible, from simple moving bright dots to complete detailed dreamscapes, although most users do not experience complex hallucinations. Due to the anaesthetic properties of the gas, coordination and awareness are strongly affected, and users may fall over if they are not sitting or lying down. The effects are short lasting, wearing off within two minutes. Nitrous oxide also reduces anxiety and pain.

Additionally, when purely nitrous oxide is inhaled recreationally, the gas displaces air in the lungs, temporarily preventing much or any oxygen from reaching the blood. This may cause the heart to beat faster, and limbs to feel tingly or heavy.

Nitrous oxide has a long history of medical use, particularly during dental treatment and childbirth. It is used as an anaesthetic, for pain relief, and to relieve anxiety. It is also administered to patients in ambulances and used in emergency departments. In this context, the gas used is typically a 1:1 mixture of oxygen and nitrous oxide.

Using nitrous oxide is relatively low risk, however, it is still very important to be aware of the risks involved, and what you can do to avoid or reduce them.

Oxygen starvation
Inhaling nitrous oxide prevents oxygen from entering the lungs and therefore the bloodstream. This can lead to oxygen starvation which can be fatal when extreme. Some methods of inhaling nitrous oxide can increase the risk of experiencing extreme oxygen starvation. For example, inhaling directly from a canister; inhaling in an enclosed space; placing a bag over one’s head to inhale; filling a room with the gas; or using a medical mask to inhale.

Frostbite
When the gas is released from its highly pressurised container, the gas and metal briefly become very cold (around -40°C). Exposure of tissue to this extreme cold can result in frostbite. Therefore, it is important to take care when opening a canister, and important to not inhale directly from the canister, as this can cause frostbite of internal tissues.

Injury from falling
As inhaling nitrous oxide causes dizziness, it is possible that people may lose balance and fall after inhalation, leading to injury. To prevent this, nitrous oxide should only be inhaled when sitting or lying down.

People with heart conditions or abnormal blood pressure may be at higher risk as the drop in oxygen levels caused by inhaling nitrous oxide raises the heart rate and can cause arrhythmias (skipped heartbeats). This could lead to cardiac arrests in susceptible people.

As with all drugs, mixing nitrous oxide with other substances increases the risks. Therefore, it is not advised to mix nitrous oxide with any other drugs, especially alcohol. It is possible that risks could be greater with stimulants and any other drugs that put pressure on your heart, as effects on blood pressure and heart rate could be unpredictable.

Nitrous oxide can, allegedly, briefly multiply the effects of psychedelics like LSD (acid) and psilocybin (magic mushrooms), or bring the effects back strongly when the drug is wearing off, which could be very frightening if unexpected.

Due to the short-lasting effects of nitrous oxide, people are often tempted to take multiple doses over a short period of time. It is possible for people become psychologically addicted to nitrous oxide and find it difficult to resist taking it every day. Those with existing mental health conditions may be at additional risk of addictive behaviours.

Regular heavy use of the drug can lead to vitamin B12 deficiency. As vitamin B12 is essential for maintaining the nervous system, abuse of nitrous oxide can lead to nerve damage. Symptoms of nerve damage include tingling and numbness in fingers and toes and weakness of the arms and legs. Treatment with high doses of B12 is effective, but some damage can be irreversible. It is likely that less severe vitamin B12 deficiencies caused by nitrous oxide overuse can go undiagnosed, but cause other symptoms, such as depression, forgetfulness, and tiredness.

Using a balloon
Using a balloon, with caution, is the least risky way to use nitrous oxide. Here, the gas is dispensed into a balloon from which a user inhales and exhales repeatedly until they have inhaled enough, or the gas runs out. If oxygen levels in the body drop to the degree where the user is close to losing consciousness, they will be unable to hold the balloon to their lips and will automatically begin to breathe air again. This safety mechanism minimises the risk of death by suffocation. Paying attention to any discomfort and not resisting the urge to breathe normal air will minimise the chances of harm of any kind.

Choosing the right setting
The risks of getting hurt if you fall or lose coordination and awareness when taking nitrous oxide can be minimised by sitting down away from hard edges and other hazards.

Never try to fill a space with the gas
Never attempt to fill a room, car, bag over someone’s head, or any enclosed space with nitrous oxide. This can lead to fatal oxygen starvation.

Like ketamine, methoxetamine is usually acquired as a whitish powder. However, compared to ketamine, a much smaller amount of methoxetamine is required to produce the desired effects, and it is very easy to take too much.

Methoxetamine has also been identified in powders containing other drugs, including mephedrone and cocaine. It has also been found mixed with other drugs in tablets.

Very little is known about methoxetamine. It is a ‘dissociative anaesthetic’, working in similar ways to its close relatives ketamine and PCP. It seems to affect several different receptors in the brain.

Methoxetamine has no known medical uses. However, ketamine has existing medical uses, so drugs in this family are beginning to be investigated by scientists looking for useful properties such as antidepressant effects.

Little is known about methoxetamine so the risks of trying to self-medicate with this drug are likely far to outweigh the chance of benefits.

Our knowledge of the effects is currently based on the unconfirmed reports of users and a handful of case studies from hospital admissions and is therefore unreliable and incomplete. Methoxetamine seems to share similarities with the effects of ketamine, although it seems stronger and much longer lasting than ketamine.

•Smaller doses are reported by some to produce euphoria and fuzzy, floating, cosy feelings.  It seems to make people chatty or relaxed.

•Higher doses can bring increasingly strange feelings of disconnection from normal reality. It becomes increasingly difficult to talk fluently, but thoughts may seem exceptionally meaningful. Alternatively, users report feeling unpleasantly confused. The body may feel clumsy, uncoordinated and detached from the mind. Vision and hearing may become juddering and impaired.

•A high dose can cause a full-blown ‘trip’ or ‘M-hole’ with hallucinatory visions. There may be unpleasant confusion and anxiety, and there have been reports of users getting agitated and even aggressive. Users may become unresponsive to people in the outside world, and physical effectsincreasing the heart rate and blood pressure may be risky. The visions experienced can be very realistic and seem fun, scary or even spiritual, but they are unlikely to be remembered in detail. High doses will seriously impair coordinated movement but some have reported that it is more possible to stagger around (and therefore to injure yourself) on a high dose of methoxetamine than on a high dose of ketamine. According to some users, the long-lasting effects make it more likely that a powerful experience will feel unpleasantly draining.

Reported unpleasant effects include nausea and vomiting, dizziness, headaches afterwards, and difficulty sleeping which can last days. Some users can show signs of impairment for days, or feel slow-witted for hours after any pleasant effects have finished. Low doses probably have a lower risk of serious and lingering unpleasant effects.

A major risk of taking methoxetamine is that there is so little known about the risks of taking methoxetamine.

Some of the problems that have occurred resemble the problems that can be caused by ketamine. Patients admitted to hospital after taking the drug showed raised heart-rates and blood-pressure, and some were experiencing hallucinations and disorientation, agitation, fear and confusion. Based on the very small number of patients reported, the symptoms appear generally more severe than is common with patients who are admitted to hospital after taking ketamine. These acute symptoms are reversible.

What may appear a small quantity may be enough to cause collapse, and even an ambulance ride. Measuring by eye rather than using sensitive scales is very risky. Unpleasant or harmful effects are likely if people take a similar quantity as they are used to taking of ketamine.

Like ketamine, the greatest risk of serious harm or death from methoxetamine may be accidentscaused by the effects of the drug, (especially when combined with other drugs like alcohol) such as road accidents or falls. Anecdotal evidence suggests that it is easier to remain mobile after taking large amounts of methoxetamine compared to large amounts of ketamine. This could increase the risk of injury. This risk can be reduced by preparation of a safe area and the presence of a sober friend.

Aside from the risks of physical harm, the risk of having an unpleasant or even a traumatic experience should be taken seriously. Online user reports of overdoses and bad trips cannot be verified, and it is impossible to know how representative they are of users’ experiences. However, taken as a whole they build up an image of a drug that is capable of causing very frightening and overwhelming experiences, even in experienced drug users. The long duration of the drug’s effects increase the significance of this risk. As with all mind-altering drugs, the chances of a horrible trip are influenced by the ‘set and setting’. Taking methoxetamine when in a low mood, in a stressful unfamiliar place, amongst strangers would be more likely to be disastrous.

There is no relevant evidence about methoxetamine. It is likely that the risks could be similar in many ways to those of ketamine.

It is virtually certain that, like ketamine, methoxetamine will be much more harmful when taken with nervous system depressant drugs like alcohol, heroin or GBL. Combining these drugs powerfully amplifies their negative effects on risky behaviour, consciousness, movement and breathing. One individual needed a tube to keep his airway open so he could breathe after taking the drug with alcohol. Two deaths by drowning that have been linked to methoxetamine also involved alcohol.

The effects of methoxetamine on heart-rate and blood pressure are likely to be exacerbated by stimulant drugs like cocaine and amphetamines, and the risks of disturbing visions and panic may be raised by mixing with cannabis or hallucinogens.

We have no solid evidence. Methoxetamine is related to ketamine, which can be addictive. The reports of users on the internet indicate that some people consider themselves addicted and suffer significant damage to their quality of life from this.

Because it has been around for such a short time, we have no evidence of long-term harms. It was claimed by people selling the drug that methoxetamine is an alternative to ketamine without the risks to the bladder that ketamine has, but there is no evidence for this whatsoever, in fact it appears todamage the bladders of mice.

If, like ketamine, it is addictive, (and unconfirmed user reports online support this), then persistent use could lead to serious effects on people’s quality of life. Addicted ketamine users suffer cravings that disrupt their lives and the drugs can cause negative effects on memory. Regular users can regularly feel a bit befuddled. These mental effects seem to reverse when users quit the drug.

Because so little is known about it, there is an argument that taking methoxetamine is always unacceptably risky. Even so, if you do use the drug, there are ways of reducing the chances of getting harmed.

Be extremely cautious with the dosage

•A line or a pinch measured by eye is probably too much. Digital scales which measure at the 0.001g (1 mg) level may help you prevent errors and can be bought online.

•Users report that methoxetamine can take an hour or so to really kick in. If you add to your dose at this point, the combined effects may be stronger than anticipated.

Avoid mixing it with other drugs, especially alcohol

•It is almost certain that, like ketamine, methoxetamine will be much more harmful when taken with alcohol. Combining these drugs powerfully amplifies their negative effects on risky behaviour, consciousness, movement and breathing. Two deaths by drowning that have been linked to methoxetamine also involved alcohol.

Be prepared

•A reckless decision to take methoxetamine among strangers in a chaotic party is likely to result in an unpleasant experience.

•The chances of having a messy experience can be minimised by staying at home, measuring out doses beforehand, and getting comfy on a bed or sofa with someone sober to chat with who you trust to look after you if needed.

•Leave plenty of time for recovery and sleep before you have anything important to do.

Watch out for the possibility of addiction

It is likely that, like ketamine, tolerance builds up rapidly, so a regular user needs more and more to get the effects they want. The more you use, the higher your risk of suffering cravings and symptoms if you try to stop, and so becoming addicted. If your tolerance is increasing, be especially mindful of the risks of addiction.

Methadone usually comes in liquid form that can be swallowed. It is usually a green liquid although there is a blue liquid that is much more concentrated. Methadone also comes as tablets but this preparation is rarely used.

Methadone is used illicitly, there is a street value for methadone that has been diverted from medicinal use. Most people use it illicitly in the same way as prescribed. As methadone is a powerful opioid drug it is very dangerous for people who are not tolerant to opioid drugs.

Methadone is an opioid drug. It mimics the body’s natural pain-killing chemicals, endorphins. Therefore it can relieve pain, cause drowsiness, can cause mild euphoria, slow breathing, slow the bowels causing constipation, and cause other side effects of opioids.

Yes. It is mostly used as a substitute medication for people addicted to opioids such as heroin. It is occasionally prescribed as a pain-killer.

As an opioid, it mimics the body’s natural pain-killing chemicals, endorphins. Therefore it can relieve pain, cause drowsiness, can cause mild euphoria, slow breathing, slow the bowels causing constipation, and other side effects of opioids. As it takes longer to build up in the body and takes longer to come out of the body it causes much less euphoria than heroin. However, most people report being drowsy, mentally slowed, and often a bit sweaty taking methadone every day.

If someone takes an overdose of an opioid drug they can die quickly. This is usually by respiratory depression (slowing the drive and effectiveness of breathing). Anyone not used to opioid drugs would be much more at risk of this. Methadone is often reported as a contributory cause of death in opioid drug related overdoses. It is particular dangerous if mixed with other drugs such as heroin, alcohol, and benzodiazepines.

The risks of death by overdose increase when many substances are taken together for example alcohol and benzodiazepines which also have effects on breathing (respiration). Methadone decreases control and impairs judgment, making the risk of accidents much higher. This means activities like driving under the influence of methadone are potentially very dangerous. If you are prescribed methadone by your doctor you must inform the DVLA and they have to make a decision whether you are still safe to drive.

The risks of depressed breathing caused by methadone may be increased in people with conditions such as muscle weakness (e.g. myasthenia gravis), sleep apnoea, or lung disease/breathing disorders.

Methadone is dangerous if mixed with alcohol, benzodiazepines or heroin. Taking methadone with depressant drugs increases the risk of depressing breathing. Additionally, the effects of methadone may be masked if taken with a stimulant, which can lead to an overdose if a lot of the drug is taken and then the stimulant wears off. Certain medications (e.g. some antidepressants) may also interact with methadone to increase sedative effects.

One-off or occasional use of methadone is very unlikely to result in the development of depend-ence. However, taking methadone regularly over a sustained period can cause serious physical and psychological addiction. People who become dependent on methadone may become tolerant to the drug’s effects and experience withdrawal symptoms without it. Users may crave the drug and feel unable to cope without it. The longer the drug is taken, the higher and more regular the dose and the stronger the methadone, the higher the risk of dependence.

A period of sustained dependence on any drug can be debilitating and prevent people from working and leading an active life. It may also cause mental and physical harm and opioid withdrawal can be very unpleasant.

Acute withdrawal effects from methadone can be intense, although for many they will be milder than those from heroin. Acute withdrawal effects include shivering, yawning, feeling cold and clammy, goose-bumps on the skin, diarrhoea and vomiting, flu-like symptoms, agitation, anxiety, insomnia and sensitivity to sound/light. Opioid withdrawal symptoms are unpleasant but do not endanger life.

Potential effects of long term methadone use include constipation, tiredness, sedation. People often have problems with their teeth as methadone reduces your natural saliva which protects the teeth against dental caries.

Long-term risks of methadone are low if it is used as prescribed.

How much are you taking? How often?

If taken according to prescription then methadone is very safe.

Are you taking it with anything else? Mixing drugs is risky.

Mixing with benzodiazepines and alcohol is potentially very dangerous. Also if other opioid drugs are used, although initially methadone would usually block the effects, eventually you can over-whelm the methadone and accidentally overdose.

It appears as a white or off-white powder which is primarily either snorted or swallowed. Injection has also been reported. Injection of drugs is associated with higher risks of overdose and other harms like infection.

Mephedrone is a stimulant and its effects are reported to be similar in some ways to cocaine and MDMA. As mephedrone has only been widely used from around 2009 onwards, not much has been established scientifically about the specific effects of the drug.

People who have used mephedrone report stimulant effects such as increased energy, self-confidence and talkativeness. Reported effects also include feelings of empathy/closeness to other people, which is why mephedrone is sometimes said to be like MDMA. However, most users report that mephedrone’s effects are noticeably different to those of MDMA, being more stimulant-like and lacking the full extent of MDMA’s sensual, empathy-promoting properties.

When mephedrone is snorted, it only takes a few minutes for its effects to appear, and the effects generally peak in half an hour or less. When swallowed (usually wrapped in a cigarette paper) its effects can take more than 45 minutes to appear, depending on factors like how much food is in the stomach.

Some people have unwanted side effects of the drug such as: loss of appetite, muscle clenching and tremors, headache, anxiety, elevated blood pressure and chest pain, fast/irregular heartbeat, difficulty urinating, changes in body temperature (hot flushes and sweating) and blue/cold fingers.

People using the drug also report a comedown period after use, which can also be compared to the comedown periods experienced after cocaine, speed or MDMA use. Users have reported that it is very tempting to take more mephedrone again and again to keep the high going and to prevent the comedown. This increases the risks of immediate harm and may increase the risk of becoming addicted. (Much of the information in this section was taken from Schifano et al, 2010).

None known.

There have been deaths associated with or caused by mephedrone use, although not as many as were reported in the media. Usually, deaths involved very high doses, mephedrone use with alcohol and other drugs (including interacting prescription drugs) or pre-existing problems such as heart or liver conditions.

Mephedrone deaths and serious emergencies occur in a similar way to deaths from other strong stimulants. The drug effects can overload the heart, and overheating can cause seizures and organ failure. Fatal accidents have also been associated with the drug.

It should always be treated as a medical emergency if someone collapses having taken mephedrone, suffers seizures, or sudden chest pains.

Other much more common nasty effects, usually associated with moderate or high doses, include feeling unbearably hot, feeling faint or that your heart is racing uncomfortably fast. Some people suffer paranoia, frightening hallucinations, confusion, panic and agitation. If you or a friend gets these symptoms, stay as calm as you can, move if necessary to a more relaxed, cooler environment and try to calm down. Lying down may be helpful, taking slow breaths, (breathing in and out of a paper bag helps with panic). If this doesn’t help, it may be necessary to get medical help. If it does help and you feel totally recovered, it is still sensible not to get back into the party and take more mephedrone.

Some people have binged on mephedrone for several days. Eating, drinking, sleeping and resting are vital. Missing these things makes someone more likely to suffer from any of the potential harms, from the slightly unpleasant effects to seizures, psychosis and death.

As with other stimulants such as speed or cocaine, taking mephedrone if you have a heart problem or high blood-pressure is likely to be riskier.

Mental health should be taken into account, as the chance of panic, paranoia, hallucinations and compulsive bingeing are likely to be increased if you have a disorder that predisposes you to these.

The risks of harm, including death, are likely to be increased by taking the drug whilst being on prescribed medication (especially antidepressants) or particularly taking other stimulant drugs such as amphetamines, MDMA and cocaine.

Not enough is currently known about mephedrone to say how harmful use would be over a long period of time. It is probable that the long term harms of mephedrone would be similar to drugs such as cocaine and MDMA due to their similar effects and structure. There is also some suggestion that mephedrone could be quite addictive, with cravings and low mood unless the drug is taken. However, there has not yet been enough rigorous scientific investigation into mephedrone addiction.

Mephedrone harm reduction advice is partly based on what we know of related drugs like amphetamines and MDMA, as not enough research has been done on mephedrone specifically.

• Taking it with other drugs increases the risks

• Deaths related to mephedrone usually involve large amounts of other stimulants such as cocaine, or depressants such as alcohol.

• You may overheat when taking the drug

• Mephedrone reportedly causes increases in body temperature. If you are dancing also you may overheat and become dehydrated. It is therefore a good idea to take regular breaks from dancing and drink moderate amounts of water.

• Tolerance is a bad sign

• As with most drugs, becoming tolerant to its effects is a sign that your brain chemistry is being changed by the drug, and that you are at high risk of addiction.

Is it actually plant food or bath salts?

Before mephedrone was made illegal, people would sell mephedrone as plant fertilizer, bath salts or as a research chemical. This was a disguise for selling it for use as a recreational drug, to get around the law. Mephedrone cannot be used as plant food/fertilizer or as bath salts.

MDMA is commonly sold as powder, crystals or pills. MDMA powder is simply crushed MDMA crystals. Powder can either be snorted or swallowed, and pills and crystals are swallowed.

There are always associated dangers of consuming MDMA in any form, or indeed consuming any illegal substance. The fact illicit drugs are not regulated means there’s no guarantee you’ll get the drug you think you’re getting, or how much of the actual drug itself you’ll get. You also won’t know how much else of the substance are adulterants or other potentially dangerous compounds.

The ecstasy pills you pick up at a rave may contain only small amounts of MDMA, a huge amount or none at all. Some pills have been found to contain 0% MDMA (like pills made of plaster of Paris) and some have been found to contain close to 100% MDMA content. This lack of standardisation in the amount of the drug in pills poses significant danger to users’ health. MDMA is active in relatively small amounts and has the potential to be life-threatening at high doses, making pills particularly dangerous as you cannot test how much of the substance is in the pill and you could be consuming far more of the drug than is safe.

Pills may contain other stimulants like caffeine, or worse still, have other dangerous compounds in them. One of these particularly dangerous compounds is PMA – a drug similar in structure to MDMA but with far less of the positive effects and far more negative effects at lower doses. PMA has caused a number of deaths since ecstasy rose in popularity in the underground drug scene, and sometimes ecstasy pills contain PMA instead of MDMA. If you are an MDMA user read our PMA harm reduction guide to make sure you are staying safe.

When MDMA is swallowed effects are typically felt anywhere between 20-60 minutes after ingestion and last anywhere between 3-6 hours. It is important not to re-dose if you consume some of the drug and find you don’t feel any effects, even if 2-3 hours pass. Everyone has different levels of tolerance and some anecdotal evidence has suggested it can take upto 3 hours for the effects of MDMA to be felt by some people.

The other important reason not to re-dose if none or very mild effects are felt is that you may have consumed something which you thought was MDMA but isn’t, or the drug was mixed with other drugs. It is very important to test any drug first before consuming it using a reagent test to ensure you stay safe. More detail on this below in heading 5; Before taking MDMA: What are the dangers and can they be avoided?

MDMA spikes the activation level of a natural chemical in the brain called serotonin. The drug does this by grabbing hold of serotonin-transporting proteins and forcing them to flood the brain’s circuits with its existing supply of serotonin. It’s thought to do this at a particular receptor which deals with many functions, among them being imagination, stress-coping, mood and personality.

MDMA’s hijacking of the brain’s serotonin system is thought to be where the drug’s main effects of vastly heightened empathy and euphoria come from. MDMA also spikes adrenaline and dopamine activation in the brain, but in smaller amounts than serotonin. Higher adrenaline levels are responsible for the energetic effects of the drug through increased heart-rate and blood pressure, and higher dopamine levels are thought to be responsible for other pleasurable feelings.

MDMA is also theorised to increase levels of vasopressin and oxytocin; hormones which also have many functions in the body. Vasopressin helps regulates urination and an increase of it in the body translates to a person being less able to urinate. Oxytocin is the chemical most closely associated with love and emotional bonding, and its increase (along with the higher levels of serotonin) make a user feel much more bonded to anyone they interact with while under the influence of MDMA.

MDMA can have many different effects. These vary in type, strength and intensity person-to-person, but typically include the following.

Empathy & Emotional Openness
A vastly heightened sense of empathy and emotional connection with others. Perhaps the principle effect of the drug which most users report feeling. A direct consequence of the heightened levels of serotonin and possibly oxytocin in the brain.

Euphoria & Lifted Mood
Heightened or intense happiness and drastically lifted mood. An all-encompassing sense of well-being is often associated with the experience (as long as correct dosage and harm-reduction practices are followed).

Lowered Aggression
An almost distinct inability to feel anger or aggression, mediated through MDMA’s release of serotonin. Lowered anxiety can also be an associated effect, although some users report higher anxiety (but this tends to be on higher doses).

Increased Energy Levels
Heightened energy, alertness and wakefulness. A consequence of MDMA’s adrenaline release. High doses can turn energetic feelings into restlessness and over-stimulation.

Body temperature changes
Feelings of hot and cold when coming up and often feeling warm or hot in the body during the experience. A consequence of the fact MDMA affects cells in the part of the brain which deals with the body’s internal temperature control. Important to ensure you don’t get too hot – more on this in heading 6 below; When you’ve taken MDMA: What are the dangers and can they be avoided?

Raised Heart rate and blood pressure
A rise in both heart-rate and blood pressure. The rise can be sharp and is directly dependent on the dose taken – higher doses lead to higher increases in both. A consequence of the fact MDMA spikes adrenaline levels whilst also increasing serotonin levels at a receptor which increases vasoconstriction (tightening of blood vessels).

Difficulty Urinating
Users report urinating less whilst on the drug and generally having far less need to urinate, even if they’ve consumed more fluid. A result of the MDMA’s increase of vasopressin levels in the body. Ensure you do not over or under hydrate during the MDMA experience. More on this in heading 6 below; When you’ve taken MDMA: What are the dangers and can they be avoided?

Increased thirst levels
Users can feel thirstier than normal whilst under the influence – a result of the fact MDMA affects the body’s internal balance system (homeostasis). Coupled with the fact urination becomes more difficult, users must ensure they do not consume too much fluid or risk over-hydrated their bodies.

Suppression of appetite
Commonly reported – an almost complete loss of appetite or desire to consume any food.

Muscle clenching
Clenching muscles without realising, particularly the jaw muscles. Thought to be a consequence of adrenaline release. Users should be mindful of how much they jaw-clench, as this can be painful after the drug has worn off.

Perceptual changes
Heightened perception of colour, increased appreciation of music or sounds, blurred vision, mild colour hallucinations in some users.

Anecdotal evidence suggests higher doses of MDMA only increase the energising effects of the drug, not the emotional or euphoric effects. Unpleasant sensations like feeling overly hot, anxious, over-stimulated or confused are more likely to occur on higher doses and are far more likely to overshadow the positive effects users’ feel.

MDMA has significant associated dangers of organs overheating, heart or blood pressure problems, users’ consuming too much fluid and severe mood issues following the experience. More on these in headings 6 and 7, below.

We’ve touched upon points of harm reduction above, and the main points of staying safe before taking MDMA are; ensuring what you have is actually MDMA and ensuring the dosage is correct.

Ensuring what you have is actually MDMA
If you are consuming MDMA in any form — be they pills, powder or crystals — it is essential to test the substance with a reagent test before consuming any of it.

Reagent tests are legal chemicals which offer an easy colour-based test for drugs. Simply and carefully drop a couple of drops of the reagent chemical onto a small amount of what you think is MDMA. If you have powder simply separate some out; if you have crystals, chip a tiny amount off; if you have pills, scrape some off with a knife. The substance will change colour when it reacts with the reagent chemical and you can cross-reference the colour change with the reagent colour chart that comes with the test (or you can search it on the internet). If the colour change corresponds to the correct drug on the chart, you know the substance you have is actually MDMA (in this example). Reagent tests can pick up the presence of dangerous chemicals like PMA/PMMA. This is an easy and inexpensive way to ensure the drug you have is actually what you think it is, and to make sure you aren’t taking something which could kill you. It is essential to test any and all substances before taking them.

Ensuring the dosage is correct
MDMA is active at the milligram level, and a difference of 200-300mg (merely 20-30% of a gram) could mean the difference between a good experience or a trip to the hospital, or death. If you have powder or crystals it is impossible to measure correct dosage just by eye – dosages in this form must always be measured out using an appropriate milligram scale.

If you have pills it is almost impossible to know how much dosage is in each pill. In this case, after testing the pill with a reagent test, start with a small amount (a quarter to a half of a pill) as there is no standardisation of dosages across pills. Some pills have been found to contain 0% MDMA and some close to 100%.

Higher dosages often mean an increase of negative effects like overheating, overstimulation and agitation while bringing no more of the positive effects like euphoria or empathy, whilst increasing chances of negative impacts on the body and a bad comedown.

Overheating
A considerable risk when consuming MDMA is the danger of overheating. MDMA affects the part of the brain that deals with our body’s internal temperature control (the hypothalamus), and it makes it difficult for our brains to regulate our body temperatures. The drug’s tendency to push the body’s temperature higher than the optimum level of 37C is directly dose-dependent, and users will tend to get hotter the more MDMA the consume. On the milder end of the spectrum this can lead to sweating or feeling uncomfortably warm, and on the dangerous end it can lead to organs overheating, posing a serious risk of severe illness or death. Cases have been recorded of users dying from organ failure from overheating as a direct result of consuming too much MDMA.

How to minimise your risk of overheating
First of all, test your MDMA with a reagent test to ensure it isn’t another, more dangerous substance. Secondly, ensure you can measure the dosage correctly with a scale. Do not eyeball or estimate the measurement of a dose; doing so significantly increases your risk of taking too much or overdosing. If you have pills, consume a small amount (a quarter to a half), for there is no way to measure the MDMA content of a pill. The risks of overheating rise sharply when a user is in a hot environment like a sweaty rave or underground nightclub, especially if they’re doing aerobic activity like dancing (for this also raises the body’s temperature). To stay safe as safe as possible, ensure dosage is not too high and to take rests to cool off in a cooler environment.

Drinking too much fluid
As a result of MDMA’s effect on the hypothalamus the body has difficulty regulating how thirsty and hungry it is. Hunger is often not felt at all on an MDMA trip but thirst tends to become stronger. Coupled with the fact the drug constricts blood vessels and releases a hormone which makes urinating much more difficult, there is a risk of overhydration – drinking too much fluid. Overhydration may not sound like a serious problem but it can lead to dilution of blood, which can seriously affect the function of organs. If an MDMA user is dancing in a hot and sweaty environment, not only are risks of overheating higher but risk of overhydration is higher as well, as we tend to consume more fluid with more exercise and the more we sweat.

How to minimise your risk of overhydration
To minimise risk make sure you or anyone else do not take too high of a dose, especially if you are likely to partake in aerobic activity (e.g. dancing) in a hot environment. Be mindful of how much fluid a user is consuming. Everyone has different levels of ideal fluid/water intake, but as a general rule of thumb, one pint of (NON-alcoholic) fluid per 2-3 hours is around what a human would normally consume. Dehydration is also a risk, so users should ensure they drink roughly the correct amount of fluid.

High blood pressure/Heart rate
MDMA has two effects on the body’s heart and blood pressure systems. Firstly, adrenaline released by the drug pushes heart rate higher than normal, and secondly MDMA constricts blood vessels through release of serotonin. The constricting of vessels raises blood pressure, but the fact the heart pumps faster than normal means blood pressure raises even further.

How to stay safe
People with any heart or blood pressure problems should steer clear of MDMA, and any drugs in the stimulant class generally (e.g. cocaine, amphetamines). Drugs like these pose a serious risk of dangerously high blood pressure, heart attack or heart failure. MDMA’s raised blood pressure and heart-rate effects are dose-dependent (the higher the dose the higher the rise in both), and so correct dosage must be ensured to maximise safety. Aerobic activity during an MDMA experience will also raise heart rate, and so users and others around them should be mindful of how much activity they are engaging in.

After an MDMA experience many users report feeling fatigue, anxiety or low mood in the days or sometimes 1-4 weeks to come. At the more extreme end users can experience impaired concentration, insomnia, loss of appetite and even depression.

These effects are commonly associated with lower levels of serotonin in the brain after an MDMA trip. MDMA uses the brain’s existing supply of serotonin to bring about its effects, and once the MDMA has worn off the brain breaks down the serotonin hijacked by the drug. This natural supply of serotonin are one of the things our brains use to regulate our mood, sleep and other things.

Serotonin is a slowly-produced chemical in the brain, and it can take around 1-4 weeks for our brains to replenish their own natural serotonin supply, depending on how much is lost, and therefore this is how long a comedown could last.

The potential severity of a comedown is directly dependent on the dosage taken. Higher dosages use more of the brain’s serotonin supply and therefore the brain has less serotonin afterward to regulate its normal functions (like mood and sleep). Bearing in mind higher doses of MDMA tend to bring more negative effects than positive ones, it is important for a user not to take too large of a dose, or otherwise potentially suffer for weeks after they take the drug.

It can also be beneficial to try to engage in experience-enriching activities during the trip which take advantage of the positive effects offered by the substance. For example, MDMA makes users feel highly empathetic and emotionally-connective during the trip, so activities centred around human connection like deep conversations or cuddling can enrich the experience without needing more of the drug. Since these activities naturally release positive chemicals in our brains anyway (like serotonin and oxytocin, whether you’re sober or not), they naturally increase the high of the drug without the user having to take any more of the drug itself. The same can be said of listening to music or engaging in other activities which the user might enjoy, as long as there is not too much aerobic activity, like dancing, taking place (especially in a hot environment).

The only way to ensure there is no comedown is not to consume MDMA at all, but if a person wishes to minimise their potential comedown from the drug, it is important to first of all ensure the drug you have is actually MDMA (tested with a reagent test), make sure the dose is moderate and not too high, and engage in activities which are naturally positive.

Currently MDMA is an illegal substance across the world – a class A drug in the UK and a schedule 1 substance in the US, meaning it is seen as having no therapeutic or medicinal value, but new and recent studies are challenging this notion.

Studies by David Nutt and Imperial College London have shown MDMA-assisted therapy to have significant potential in treating post-traumatic stress disorder (PTSD) and alcoholism. Various other studies seem to back-up MDMA’s potential for treating PTSD and also its positive use in psychiatry.

MDMA has also been shown to have vastly positive results in couples therapy, with some couples claiming partaking in MDMA-assisted therapy significantly helped them in their relationship and even as individuals.

The reasons for these benefits likely lie in MDMA’s empathy and euphoria effects. Due to the serotonin activation in the brain it seems difficult for users to feel anger, stress or negative emotions while on the drug. This seems to allow people to look at negative situations or past traumas with less anxiety or anger, and instead with empathy and understanding.

At present, MDMA cannot legally be used in psychotherapy but more and more studies are being done which test both MDMA’s positives and drawbacks. The drug itself is not the treatment but rather enables therapy to be more effective. Attempts to self-treat with MDMA could do more harm than good in the absence of a professional therapist trained in MDMA psychotherapy.

Anyone with heart, blood pressure, liver or kidney issues should steer clear of MDMA, along with anyone on any medication which affects serotonin or adrenaline levels (like antidepressants such as SSRIs, SNRIs and MAOIs).

Anyone with existing heart problems or high blood pressure issues is at far increased risk from using MDMA. MDMA raises heart rate (through release of adrenaline) and increases blood pressure (through activation of serotonin). The effects of raised heart rate through tightened blood vessels raises heart rate even further. Consuming MDMA can be potentially quite dangerous if you have these issues.

MDMA could cause problems for those with existing liver issues (as the drug is processed through the liver) and the drug is shown to negatively affect liver-health with repeated use. Those with kidney issues should also avoid the drug because of its effect on the body’s diuretic system.

For those who suffer from depression; MDMA affects the same chemicals in the brain as many anti-depressant medications, so those who are taking or have recently taken these medications (like SSRIs, SNRIs or MAOIs) should avoid MDMA as drug-drug interactions in the brain can be unpredictable and potentially very dangerous. In addition, anyone with serotonin syndrome or who is known to be sensitive to serotonin should not take MDMA.

General fitness should also be taken into account; those with a low levels of fitness may be under greater pressure from the effects of MDMA on the body, and so should avoid the drug or start with smaller doses.

Drug-drug interactions can often be unpredictable and/or dangerous, especially when it comes to unregulated substances, so it is highly advisable not to mix MDMA with any other illicit drugs. If mixed, the substances may interact in strange or unforeseen ways which could be seriously threatening to health or life (many MDMA related deaths have taken place when mixed with other drugs). Alcohol can contribute to dehydrating the body when mixed with MDMA and also dull the drug’s effects, as MDMA is a stimulant and alcohol a depressant. Being under the influence of alcohol or other drugs before taking MDMA can also impair judgement, which could lead to overdosing.

MDMA affects serotonin, adrenaline and dopamine in the brain and body, and therefore it is highly advisable not to consume MDMA if you are on any medication which affects or interacts with these chemicals. SSRI’s (selective serotonin reuptake inhibitors), for example, are common antidepressant medications, as are SNRI’s (selective norepinephrine reuptake inhibitors) and MAOI’s (mono amine oxidase inhibitors). Steer clear of MDMA if you or anyone else is taking these forms of medication or anything else which interacts with the chemicals that MDMA affects (such as herbal supplements which could affect serotonin, like 5HTP).

Do not consume MDMA if you are on any heart or blood pressure medication (or have any heart problems), as MDMA raises both, and interactions with these medications can be unpredictable and dangerous.

MDMA is considered to have low potential for addiction, especially when compared to alcohol, nicotine or heroin, but that does not mean it cannot be addictive at all.

MDMA is unlikely addictive from a chemical standpoint. Chemical addiction occurs when a person continually takes a substance which affects the supply of a particular chemical in their brain, to the point the brain adjusts its own supply in response to the drug-taking. After this point the person must continue taking the drug in order to bring that particular chemical’s supply back to normal levels, hence they must keep drug-taking just to feel normal.

MDMA uses the brain’s existing serotonin supply to bring about its effects and the serotonin used is broken down after the drug wears off. The brain requires a certain level of serotonin to regulate normal functions like mood and sleep, and struggles if the supply is too low. MDMA reduces that natural supply and continued use of the drug reduces it further. The brain cannot replenish its own supply quick enough for chemical addiction to form, since continued and excessive MDMA-use quickly depletes natural serotonin supply.

Whereas MDMA has low potential for being chemically addictive, it has the possibility to be psychologically addictive. The feelings of euphoria, happiness and empathy commonly associated with the experience can make a person want to take MDMA again and again. However, taking the substance more often than once in 2-3 months can have severe implications on brain health and its ability to regulate mood, sleep, concentration and stress-coping abilities. Repeated and long term use has been shown to deteriorate brain health in general.

Taking MDMA too much can build a tolerance and with repeated/often use the substance can ‘lose its magic’. Using it too much will diminish the effects to the point you won’t feel anything anymore from taking MDMA, and instead have vastly negative implications on the health of the brain and the body. Anything more frequent than once in 2-3 months would be considered as too often.

MDMA studies show people with a history of light and occasional use of the drug are far less likely to show mental deficits, compared with studies where people have a history of binging on large amounts of MDMA or regular MDMA use.

There is scientific controversy over the long-term harmful effects of MDMA. Some studies have found links to MDMA use and impairments in memory and impulsivity, but there may be other factors which contribute to this like use of other drugs or lack of sleep. Controlling for such things, one particular study found no significant connection between MDMA use and performance on cognitive tests, although this study has received some criticism.

It is also possible impulsive personality-types could make someone more likely to take MDMA, rather than being caused by drug use. A similar confusion is found with the link between MDMA and depression. Some studies have suggested that MDMA can contribute to depression, though some have found that those with depression may be more likely to later take MDMA.

Whether such effects would last for a long time is also debatable. There is strong evidence from brain imaging studies suggesting that most changes in the brain areas affected by MDMA (serotonergic system) are not long term.

For most people, it is hard to know what to think when considering the possible long term harms of MDMA. It is safest not to take the drug at all, but the above evidence suggests infrequent and mild use may not cause long term detrimental effects in the long term, while at the same time suggesting frequent and heavy use can lead to both psychological and physical negative changes.

Does MDMA put holes in your brain?

MDMA does not put holes in your brain. This myth comes from messages broadcast by anti-drug campaigns in the late 1990s/early 2000s.

Is MDMA (ecstasy) powder purer than ecstasy pills?

Like most illegal drugs, the purity of MDMA changes all the time, so forms that might once have been more reliable cannot be guaranteed to remain so. It is quite easy for drug dealers to mix MDMA powder with any substance that looks like it, so taking MDMA powder does not necessarily mean you are not unknowingly taking other substances mixed with the drug.

Does MDMA (ecstasy) drain your spinal fluid?

No. This myth probably comes from experiments where researchers measured breakdown products of serotonin in the spinal fluid of animals who had taken MDMA. MDMA does not damage your spine.

Does MDMA (ecstasy) cause Parkinson’s disease?

MDMA does not cause Parkinsons. This myth may come from an experiment where researchers accidentally gave methamphetamine (crystal meth) to laboratory monkeys instead of MDMA. There is a horribly toxic chemical with a four-letter acronym, MPTP, which does cause parkinsonism. It has appeared as an unwanted impurity in a heroin-like (opiate) drug called MPPP, causing the people who took the contaminated drug to ‘freeze up’ by destroying dopamine neurons in the brain, just as Parkinson’s disease does. Neither MPTP or MPPP have any relation to MDMA.

Fresh khat looks like hedge trimmings. It is often sold in small bundles wrapped in a banana leaf. It is bought and consumed in places called ‘mafrishes’, and is also sold in some shops. Men may chew it socially in the mafrish, or they take it home. Women are more likely to use in the home only. The bitter leaves are picked off, crushed by the teeth and held in the cheek over an hour or so. In countries where khat is illegal it may instead be dealt secretly like other illegal drugs.

Dry khat leaves are available in some countries. Depending on how they are dried, these can contain much reduced levels of cathinone compared to fresh leaves, and so will probably be less potent.Whilst the tradition of chewing khat leaf has relatively low risks compared to other drugs, risks could be higher with any other form of khat product made to extract or concentrate the drug chemicals. Such a preparation could also be illegal even where khat is legal.

Khat contains cathinone, a stimulant drug closely related to mephedrone and amphetamines. As time passes after picking, the amount of cathinone in the leaf falls as it is coverted to a weaker but similar drug chemical called cathine. Cathinone increases the concentration of dopamine in the brain. Dopamine is a chemical messenger involved in motivating us to do things that feel ‘rewarding’, so this is why taking khat persistently can be addictive to some people. Cathinone also has effects on noradrenalin and serotonin, genrally boosting these too. Noradrenalin is similar to adrenalin, and is involved in the jittery, alert feeling that stimulants produce, as well as the physical effects on blood-pressure, heart rate and energy. Serotonin is involved in mood, so is linked to the happy feeling khat can give.

When the drug wears off, it may take a little while for the brain to rebalance the levels of chemicals that khat has interfered with, which may lead to a ‘comedown’, with approximately the opposite effect of the high. If khat makes a person feel energetic, happy and motivated, they may feel tired, irritable and demotivated afterwards.

Khat gives a feeling of wellbeing and alertness, which may encourage enthusiastic chattiness for a few hours. It can reduce appetite. After the high has gone people can get mood swings, and feel grumpy and irritable. Khat often makes people constipated, and will prevent you sleeping if you have it in the hours before going to bed.

There are no known evidence-based medical uses of khat. However, in the tradtional North-East African cultures where it is popular, it has been used as a medicine to treat depression, gastric ulcers, hunger, obesity, and tiredness.

The risks of khat from experimental or occasional use are low. Reducing the risks of khat is mostly a matter of keeping use to a moderate level or avoiding the drug. Children are likely to be a much greater risk, and therefore khat should not be available to children. It is sensible for pregnant women to avoid it too, because it is linked to lower birthweights. Babies with lower birthweights are more likely to suffer from a broad range of medical problems.

The slow process of chewing khat in the plant form means that the effects come on gently compared to taking something like amphetamine powder, making this a much less risky drug for healthy people. It increases heart-rate, blood-pressure and may make people feel hot, so if the effects are uncomfortable it is best to stop use.

Using khat on a daily or near daily basis can be harmful and has even been associated with deaths(see below).

In countries where khat possession is illegal, users risk persecution, arrest and a criminal record. There have also been cases of people being duped into carrying khat into a country where it is not permitted, resulting in them being convicted of serious drug-smuggling crime they were not aware of committing.

Because of its effects on the heart and blood-pressure, khat is probably riskier for anyone with high blood pressure or heart problems. The added strain could make heart-attacks more likely.

Because of its amphetamine-like mental effects, and the low moods that can occur after the high, khat is riskier to those with mental health problems. Even if you have not suffered mental illness, but are going through a bad time or otherwise do not feel stable and well, it may be a good idea to avoid khat. Some people in the Somali community in Europe suffer symptoms of post-traumatic stress disorder (PTSD) following their experiences of war in Somalia. It is thought that khat is responsible for worsening PTSD and contributing to breakdowns and even psychotic episodes in sufferers.

Khat (presumably long-term excessive use) can cause liver damage, that can be catastrophic, and even fatal. Anyone with existing liver problems could be at greater risk.

Khat is very often combined with tobacco smoking. It is possible that sessions of khat chewing result in smoking more, increasing the chance of the severe harms that smoking causes.

When this stimulant is combined with alcohol, which causes disinhibition, there are credible concerns that the likelihood of drunken violence or risky sexual behaviour might be raised. There is minimal scientific evidence for this. Both alcohol and khat can injure the liver, so in combination the harms could be compounded.

Combining khat with other stimulants like coffee could increase the chance of unpleasant jitteriness or heart palpitations.

Although this is not recorded in the scientific literature, khat could also potentially increase the risk of serious harm like overheating or heart attacks after taking strong stimulants like cocaine and amphetamine.

You should tell your doctor if you are a regular khat user as this could intereact with drugs you may be prescribed. For example, you should not be prescribed MAOI antidepressants, which could prevent your body breaking down the khat drug chemicals causing serious overdose effects.

Khat seems to be addictive to some, but is towards the bottom of the scale in terms of the severity of addiction. The people who suffer harm from khat are almost exclusively very heavy users, who may be addicted to some degree. However, the vast majority of khat users are not driven to use by any addiction.

If using khat is becoming a priority in your life, this is a problem that needs addressing. Firstly, the risks of khat to body and mind are more likely if you use it excessively, and secondly, when drug use becomes a major focus of your days, employment and family can suffer. If you find it hard to limit your use, your doctor could offer advice and assistance.

The topic is controversial, but it seems that physical addiction to khat is closer to addiction to coffeein terms of severity than adiction to amphetamines, leading to some unpleasant but not severe withdrawal symptoms.

Khat does not give the rewarding rush which makes cocaine and other strong stimulants addictive, so unlike those drugs it is very unlikely to ‘hook’ new users after a few doses. However, fresh khat is flown to Europe several times a week, which allows people to develop a daily habit. After persistent use, damaging addictions can develop, especially as it is tempting to avoid the low mood and irritability that often follows a khat high by just chewing more.

Addiction is never a risk that applies equally to all users. Other factors in the lives of users act as gateways to persistent use and then addiction. For example, khat can become overused when it is used as a way of coping with flashbacks to war experiences (PTSD) or coping with other stressors. Unemployment can provide the empty time needed for persistent chewing. Therefore addiction, and khat’s other harms are as much a result of and a contributor to the problems in the lives of users than a cause of the problems.

People addicted to khat can suffer constipation and related gastric problems, and people may not eat properly as khat lowers appetite. The social and economic effects of khat addiction may be more significant, with the possibility that khat chewing could become a barrier to employment. In countries where it is illegal, maintaining an addiction may force users into leading a hidden life, dealing with a criminal network.

Khat withdrawal is relatively mild. Low moods, irritability and cravings can be difficult to deal with.Weird nightmares can occur. There may be physical symptoms like slight trembling.

Long-term khat use can cause severe injury to the liver, which can result in death, or the need for liver transplantation. There is no published evidence yet which determines the level of use necessary to cause these very serious effects. In one case where a transplant was needed, it was noted that the patient and his family had not realised that khat was a drug and could possibly be the cause, allowing his health to deteriorate for three more months until the probable cause was discovered.

The drug chemicals in khat are similar in action to chemicals like amphetamines that can have severe psychiatric consequences. However, the chemicals in khat are very slowly released by chewing leaves, which reduces the risk of all harms. Persistent use of khat has been linked to mental health problems, both mild and serious, but there is disagreement over whether the risk is large and indiscriminate, or small and avoidable.

It seems that people who use the drug on a daily basis may become short-tempered. Khat, like most mind-altering substances, can be destabilising to people with pre-existing mental health issues, and such problems are also likely to contribute to using khat too much, for example as an escape from PTSD symptoms. Taking stimulants excessively, especially when normal patterns of sleeping and eating are disrupted, can lead to a breakdown of mental health.

Unless you have underlying health problems, using khat in moderation has a relatively low risk of harm. Khat use is not entirely safe, and most users could improve their health and wellbeing, or reduce the risks of harm, by using less or quitting entirely.

If you do wish to use khat despite the risks, try to avoid chewing one bunch after another and avoid using two days in a row to keep the risks down. If you miss out on eating and sleeping because of khat you may become more vulnerable to mental health problems. Try to wash khat, it is conceivable that pesticide contamination could be responsible for some harm.

Consider your reasons for using khat. If you are taking khat for a particular purpose, for example to escape thinking about your problems, to kill time, to alleviate feelings of depression, or to work without sleep, you could find yourself becoming dangerously reliant on it. If you can take it or leave it, but enjoy it socially once in a while, you probably have a healthier relationship with it.

Excessive use could cause very serious harm or even death. If you use khat regularly and have health problems, consider the possibilty that khat could be involved and remember to tell your doctor that you use it.

The harms of khat, like those of many other drugs, are often overstated in the media.Within cultures which use khat, it may be considered to be a special food rather than a ‘drug’, much like coffee and beer are often seen as drinks, not drugs, by their users. This can cause harmful miscommunication with doctors who may ask khat users whether they take any ‘drugs’ and be told “no”.

There are risks of dangerous misunderstandings regarding legal status, which differs from country to country. There have been cases of people being persuaded to carry a suitcase of khat into another country. The courier may believe or be told that this is a legal way to make some money, and then be prosecuted for drug trafficking.

Ketamine is a white/transparent when pure, and often sold as a powder of tiny crystals. It is often crushed into a fine powder so it can be snorted up the nose. Occasionally the powder can be other colours, such as off-white or brown.

Ketamine also sometimes comes in pills. These could contain other drugs, which increases the risk of a bad reaction. It has even been sold as or confused with ecstasy pills.

Some people get ketamine in liquid form (or dissolve it) and inject it for a faster, stronger effect. Injecting drugs is more dangerous for many reasons. For example, it is easier to take too much and can cause injuries and infections such as HIV (sharing needles).

Ketamine is a dissociative anaesthetic. When used medically, it is given in high doses that blocks pain signals and makes people unconscious. The lower doses used recreationally produce very different effects, sometimes including hallucinations, which are not well understood. There are similarities between the strange states of mind caused temporarily by ketamine and the experiences of people suffering from schizophrenia.

Ketamine is an essential medical and veterinary drug used for anaesthesia and pain relief under a wide range of circumstances. Ketamine is much less likely than other anaesthetics to depress the heart and respiration, so it is the anaesthetic agent of choice in low income countries and in environmental/conflict disasters where there are few trained medical personnel, anaesthetic machines or consistent sources of electricity. In the western world ketamine is the most commonly used veterinary anaesthetic, particularly in horses and the more unusual species. In developed countries ketamine is less commonly used for routine anaesthesia in people as it may cause hallucinations during recovery; more conventional anaesthetics are preferred where trained anaesthetists and appropriate equipment are readily available to monitor the patient and support respiration.

Ketamine is a potent pain killer and is particularly useful for children undergoing agonizing procedures such as treatment of burns. It is now also an important treatment for chronic pain.

New therapeutic uses for ketamine have more recently been identified, including treatment of depression and refractory status epilepticus. A single low dose of ketamine can rapidly lift depression, although the effect does not last long-term. It is thought to work by causing new connections (synapses) to be made in the brain. This is a promising lead for the development of new treatments because conventional antidepressants take some time to work. Self-treating using ketamine puts the user at risk of the harmful effects of ketamine, and it has not yet been established through large-scale trials that the benefits outweigh the risks.

Ketamine produces very different effects depending on whether someone takes a little or a lot. It is a strong drug and it is easy to take more than intended. It is therefore better for inexperienced users to start with a small dose first before they consider trying to get the effects of a larger dose.

Low to moderate doses

Ketamine can give sensations of lightness (like walking on the moon), dizziness, and euphoria. It makes people’s thoughts flow randomly; ideas can seem special and important, or pleasantly or unpleasantly muddled. Things may begin to look and sound different or somehow unreal. There is always a higher risk of accidents whilst using ketamine. Taking any depressant drug, such as alcohol, can very easily and quickly make the effects much stronger and riskier.

Higher doses

The more ketamine that is taken, the harder it is to stand up and move about. Quite large quantities lead to exceptionally odd feelings such as separation between the mind and the physical body, which some find pleasurable and others find distressing. Unpleasant side-effects like nausea and vomiting can occur. Ketamine can produce delusional thoughts much like those associated with schizophrenia. Very large quantities lead to users losing touch with their identity and surroundings altogether, which is called k-holing. People k-holing may be unresponsive, although inside their mind they may be experiencing vivid hallucinations. Users can have notions and hallucinations which can feel very real, and can be anything from wonderful conversations with angels, to being convinced they are dying. The risks of accidents, overdoses and anxiety described below are increasingly significant at higher doses.

People can die after taking ketamine. People who die or end up in hospital almost always have combined ketamine with other drugs, particularly alcohol. Taking ketamine with stimulants (such as cocaine and ecstasy) may overload your heart. Taking it with depressants (such as alcohol, GBL or heroin) may make you become unconscious quickly and unexpectedly, and can stop your breathing or allow you suffocate on your own vomit.

Ketamine works in several ways to make you particularly vulnerable to accidental injury and death; even smaller amounts will decrease your ability to make sensible decisions or recognize dangers (like roads). Larger amounts have anaesthetic effects; people have died by lying outside on a cold night without awareness of the cold, and by falling unconscious in the bath and drowning.

Tripping on ketamine can be an utterly overwhelming experience, especially if the user does not expect its powerful effects. Users can freak out whilst taking it and sometimes end up being rushed to hospital. Such anxiety attacks produce a dangerously racing heart and palpitations as well as extreme agitation. This can be a seriously traumatic experience, even if it doesn’t cause physical harm.

People with schizophrenia, or who have ever suffered a psychotic episode, should avoid ketamine. The drug has been demonstrated to bring back symptoms of psychosis, and these could persist beyond the period when the drug is in the body.

Drugs which radically affect consciousness are more likely to cause panic and fear in people who suffer anxiety, whether this has been diagnosed as a disorder or not.

Ketamine increases heart-rate and blood pressure. These effects are usually quite minor, but could be dangerous for people with related health problems or who combine it with other drugs.

When people die after taking ketamine, they have usually combined it with another substance.

Taking with depressants (such as alcohol, GBL , benzodiazepines such as valium, or opiates such as heroin) may make you become unconscious quickly and unexpectedly, and can stop your breathing or allow you suffocate on your own vomit.

Taking ketamine with stimulants (such as cocaine and ecstasy) may overload your heart. The chance of agitation and anxiety is also increased. Stimulants may keep you moving when the effects of ketamine would otherwise have immobilised you, increasing the chance of accidental injury.

Whilst many people use ketamine on occasion without feeling cravings, some people get addicted to ketamine use and may use it daily. People can struggle and fail to be able to stop using ketamine. Tolerance builds up, so users need much more ketamine to get the effects they like. Signs of tolerance should be considered an early warning sign of addiction and harmful use.

People addicted to ketamine can suffer strong cravings, anxiety and misery, and even shaking and sweating when they try to go without. Such withdrawal symptoms are not dangerous and eventually pass.

Addictive regular use of ketamine can cause serious mental and physical harm.

Mental impairment

Taking ketamine regularly seems to affect the mind, particularly memory.  The effects are not serious enough to count as a mental disorder, but regular users may feel that they’re not nearly as sharp as they should be. This could be very bad for work, education and relationships. These harmful effects seem to fade when people give up the drug.

Urinary system damage

People who use ketamine more than a couple of times a week are at high risk of damaging their kidneys and especially their bladder. Once the damage is done, the organs do not always recover. The bladder condition, called ketamine-induced ulcerative cystitis, starts with the need to urinate very often, and leads to painful urination. Sufferers may be prone to wetting themselves and can  have blood in their urine. A few young people have had to have their damaged bladder removed, which leaves men unable to get a natural erection and both genders unable to urinate naturally for life. This disease can even encourage more ketamine use, or prevent users quitting, as ketamine temporarily eases the pain.

Ketamine cramps

Regular users get severe abdominal pain often called k-cramps. Their cause is unknown but they seem distinct from the bladder damage.

There are always risks to using ketamine. However, if you do take drugs, you can make simple choices to improve the chances of a good experience, rather than a regretted, harmful or even fatal one. Here are some things to consider.

How much are you taking and how often?

Taking bigger amounts, and taking it frequently, means higher risks. The most severe harms, including permanent bladder damage, affect people who take ketamine regularly.

First time users should be especially cautious with dose. Some users plan and measure out how much they intend to take, and only have that amount accessible. Otherwise, it can be tempting to keep taking more whilst you are less capable of making sensible decisions.  It’s important to keep track of whether you or your friends are taking increasingly large amounts, or using ketamine increasingly often, as this can be a sign of an addiction developing.

Are you taking anything else?  Mixing drugs is much riskier. 

Drug effects are unpredictable, but mixing drugs makes the effects on your body and mind even harder to control. Deaths after ketamine use usually involve mixing it with other drugs. Ketamine plus a sedating drug like alcohol can stop you breathing.

How appropriate is your setting and state of mind? 

If you are anxious, or feeling down, the drug may exaggerate these feelings and give you a terrible experience. Additionally if you are in a stressful, unfamiliar environment with strangers, the risk of having a bad time, or experiencing physical harm, is increased.