Call for help

Tell the dispatcher what they took, how much, when, and what you are seeing now. Being honest gets a better response - dispatching an ambulance is not a police matter in most places, and many countries have Good Samaritan laws protecting the caller.

Check your local number before you need it. Peer-support lines exist too - for example Fireside Project in the US supports people in psychedelic crisis - but they are not a substitute for emergency services when breathing or consciousness is affected.

Opioid overdose

• Slow, shallow or stopped breathing; blue or grey lips and fingertips.
• Unresponsive to shouting or shaking; loud snoring or gurgling that will not stop.
• Pinpoint pupils.

Do this:

• Call emergency services and say "suspected opioid overdose".
• Give naloxone - nasal spray or injection. It cannot harm someone who has not taken opioids.
• Put them in the recovery position (on their side, mouth down) and stay with them.
• If they are not breathing, start rescue breathing. Naloxone wears off before many opioids do - a second dose may be needed.
• Do not make them walk, do not give them coffee, do not leave them alone, do not put them in a bath or shower.

Overheating and stimulant emergencies

• Hot skin, no sweating, confusion, agitation, racing heart, muscle cramps, seizure.

Do this:

• Move to a cool place, remove excess clothing, fan them, apply cool wet cloths to neck, armpits and groin.
• Small sips of water or an electrolyte drink if they are alert enough to swallow. Do not force fluids.
• Call emergency services if they are confused, fitting, or their temperature will not come down.
• Do not restrain them. Keep them from hurting themselves and keep other people back.

Depressants: alcohol, GHB, benzodiazepines

• Breathing slower than one breath every 4-5 seconds, blue lips, unrousable, snoring that will not stop.

• Recovery position and stay with them. Never leave someone who is vomiting and drowsy alone.
• Check breathing every few minutes. If it is slowing, call emergency services.
• Never 'sleep it off' alone, and never mix in more depressants to settle someone down.
• GHB in particular can look like deep sleep and then stop being sleep. Treat any unrousable GHB user as an emergency.

Bad trip or severe anxiety

• Move them somewhere quieter, dimmer and calmer. Reduce stimulation: music, lights, crowds, phones.
• Speak in short, calm, concrete sentences. Remind them: this is a drug, it will end, they are safe, you are staying.
• Do not argue with their experience, do not restrain them, and do not take them to hospital unless they are a danger to themselves or physically unwell.
• Ask what they need: water, a blanket, to sit, to walk, to be left alone for a minute.
• Do not give them another drug to 'fix' it, and never cannabis - it makes a difficult psychedelic experience worse.

Serotonin syndrome

Caused by combining serotonergic drugs (MDMA, SSRIs, MAOIs, tramadol, DXM, lithium, 5-HTP). Watch for: agitation or confusion, sweating, shivering, muscle rigidity or twitching, fast heartbeat, fever, and diarrhoea. It can progress within hours.

Test before you use

• Reagent tests identify a substance group, not purity or strength.
• Fentanyl and nitazene test strips catch some - not all - contamination. Every batch needs its own test.
• Quantitative lab testing (drug-checking services) is the only way to know actual content and dose.
• Never use a reagent test as a green light to take more.