Drug safety

Drugs may be swallowed in the form of powder, crystals, pills or in gel caps. Some people also mix drugs into a liquid and drink them or place them under their tongue and wait for them to dissolve (called sublingual). Powdered drugs can also be used orally by rubbing them on your gums. People sometimes swallow powder or crystal drugs wrapped in paper or plastic (called parachuting).

You may want to consider doing these things if you decide to take drugs orally:

• Wait for at least 1 hour before re-dosing. Taking drugs orally delivers them to your body slower, and it can mean you do not feel the effects right away. While you may want to use more soon after your first dose because of this, it is safer to wait to reduce your risk of overdose.
• Check your dose. Just because taking a drug orally delivers it to your body more slowly, it does not mean you should take more at the start. It is a safer choice to start slow and see how you are affected. It is also good to do your research on oral dosing amounts on places like tripsit.
• Think about diluting your drug in a drink and sipping it slowly. This can help you to control the effects and gives you more opportunity to stop.

Snorting is when someone inhales drugs through their nose. Using drugs this way means the effects will come on quickly and may wear off fast. Faster methods of using drugs can also make them more addictive. You might find you crave them more if you are snorting the drug instead of swallowing it.

You may want to consider doing these things if you decide to snort drugs:

• Use smaller amounts. Because snorting drugs delivers them to your body faster, there can be an increased risk of unpleasant experiences and overdose, especially if you take a large amount.
• Take long breaks between use and rinse your nostrils with saline after use. Read our article on how to do a sinus rinse. Snorting drugs regularly can also damage your nose by causing holes in the tissue. This can lead to loss of smell, nose bleeds and problems breathing and swallowing. If you snort drugs often, it can affect your vision and hearing and cause brain or spine infections.
• Avoid snorting prescription pills (such as benzos or opioids). These have fillers and binders that are dangerous to snort.
• Use a clean surface and a new straw or snorting utensil every time. This can help to avoid infection. Don’t share these tools with others.
• Stop if your nose starts bleeding. This can be a sign that there is damage to your nasal passage, so it is best to stop to avoid doing further damage.

People can inject drugs into muscles (intramuscular or IM) or into veins (intravenous or IV). Using drugs this way means the effects will come on quickly and may wear off fast These faster methods of using drugs can also make them more addictive.

You may want to consider doing these things if you decide to inject drugs:

• Use smaller amounts. Because injecting drugs delivers them to your body much faster, there can be an increased risk of unpleasant experiences and overdose.
• Visit a local needle exchange. They can show you proper injecting techniques and provide you with information. Learning how to inject in a safer way can reduce your risk of damaging yourself. Find your local needle exchange. 
• Use new needles and injecting equipment on a clean surface every time. Using new equipment every time you use (including clean, filtered water) will help to reduce your risk of infections and skin damage around the injection site. Make sure you do not share needles or other injecting equipment with others as this can lead to the transmission of diseases such as HIV or hepatitis C. Where possible, dispose of your used needles in a sharps bin.
• Keep your injection site clean. Use alcohol pads or wipes to clean the area before you inject, and clean your hands thoroughly before using. Use a gentler cleaner after you have injected like a wipe to clean off the area and keep it dry.
• Don’t overuse the same injection site, and stop if you experience redness or soreness in your injecting site. If you use the same area regularly, this can cause damage to the tissue in that area and increase your risk of infection. If your injection site is red or sore, it may be a sign that there is damage to this area, so it is best to stop using in this area to avoid doing further damage.
• Consider having naloxone if you inject opioid drugs. Enquire with your local needle exchange or Opioid Substitution Treatment service about naloxone – a drug that can reverse the effects of an opioid overdose. This is especially important for opioids that are injected as this method can carry a higher risk of overdose.
• Know the signs of infection at an injection site. Your injection site may be a little tender or red right after injecting- but lasting soreness or other symptoms can indicate a more serious problem. If your injection site becomes quite sore, swollen, red and inflamed, contains pus, has a foul odour, has ulceration (sore with hard edges), blistering or changing in colour (especially if becoming dark or blue/black) you should seek advice from a healthcare professional. If you are experiencing any of the changes above and also have signs of a fever or flu-like symptoms you should seek urgent medical care or visit an Emergency Department. 

Drugs can be smoked by being rolled in cigarette paper, being put into a pipe, bong or vape or placing the drug on aluminum foil and inhaling the vapour. Some people think it is safer to smoke drugs with a bong or waterpipe rather than a joint, but research shows that they carry very similar risks. Smoking drugs (especially if you are doing it regularly) can cause lots of other health problems such as lung damage, cancers and mouth diseases. If you do choose to smoke drugs, try taking longer breaks in between using to reduce the long-term side-effects.

You may want to consider doing these things if you decide to smoke drugs:

• Use smaller amounts. Because smoking drugs delivers them to your body quickly, there can be an increased risk of unpleasant experiences and overdose. Try starting with smaller amounts of the drug and see how you feel before you use more.
• Avoid mixing with tobacco. Rolling cigarettes with drugs such as cannabis or synthetic cannabis with tobacco can result in more harm to your body and lungs. Tobacco is also an addictive substance because it contains nicotine, and this can make it difficult to stop using or cause cravings to use more.
• Use a mouthpiece to stop burns. If you are using a pipe, a mouthpiece is very helpful to stop damage to your mouth and lip. You can also hold the flame beside the stem, not directly on it, to prevent burns.
• If you are using a glass pipe, make sure it is shatterproof. Glass pipes that are not shatterproof can break when heated and cause cuts and burns – Pyrex or shatterproof pipes are best. Pipes made of other materials like pop cans, copper or plastic can release toxic fumes when they burn, which can damage your lungs. Brass screens are also safer to use than steel wool, and they are best when rolled up tightly and pushed into the stem with a chopstick.
• Avoid sharing smoking equipment. Germs can be spread from passing around cigarettes, bongs and other smoking equipment. As smoking drugs can sometimes cause cuts, burns and sores on your mouth, this means that blood can get on things like pipes when you share them and increase your risk of contracting blood-borne and other diseases.

Inhaling substances releases them into your bloodstream quickly as they travel from the cell walls of your lungs into your blood. These effects can sometimes wear off quickly after using. Many volatile substances that are inhaled come in liquid form that is quickly turned into a strong-smelling gas.

You may want to do these things if you are considering inhaling drugs or other volatile substances:

• Use smaller amounts. Drugs are delivered to your bloodstream quickly when you inhale them, and this can lead to quick onset of effects. There can be an increased risk of unpleasant experiences and overdose. Many volatile substances are toxic and can have unpredictable effects. It can be hard to know how your body will react to inhaling them. Try starting with smaller amounts of the drug and see how you feel before you use more.
• Avoid inhaling in small, closed spaces or in areas with danger around. Inhaling substances in closed spaces can further reduce the amount of oxygen. This can increase your chance of losing consciousness when you use. Inhaling volatile substances anywhere carries a risk of losing consciousness, so make sure you are not somewhere with immediate dangers like by a highway with lots of cars. It is safer to inhale drugs with someone who is not using so they can get you help if things go wrong.
• Inhale from a smaller vessel to better control the amount you inhale. Inhaling substances from vessels like bottles with a small mouth allows for better control over how much is inhaled at once. Vessels with big openings like large containers or plastic bags release lots of the substance at once, which can increase your chance of overdose or unpleasant effects.
• Avoid being near flame sources, like cigarettes. Most volatile substances are very flammable and can cause serious burns if you are using near a fire source. It is important not to smoke or be around other smokers while you are using them or be around any other flame.
• Be careful when using pressurised cans of volatile substances. These can cause burns and damage to your skin if the substances come out of the container quickly. If you do receive a burn from a volatile substance, run it under room temperature water then apply an antiseptic gel and keep the area clean. Seek medical treatment if the burn is severe.

Inserting drugs into your rectum (called ‘boofing’ or ‘shelving’) or vagina is another way people use drugs. As the vagina is a sensitive area, putting any substances in it can result in dryness, pH balance issues, infections and bleeding. There is also no evidence that it increases the euphoria or onset of drugs. Similarly, the anus is also a sensitive region, and shelving or boofing can cause tearing and infection.

You may want to consider doing these things if you decide to insert drugs into your vagina or rectum:

• Use smaller amounts. Taking drugs anally can deliver them to your bloodstream in a similar time to that of snorting. There can be an increased risk of unpleasant experiences and overdose. Try starting with smaller amounts of the drug and see how you feel before you use more.
• Think about safer sex. Drugs get into body through the blood vessels in the rectum or vagina, which means they are under strain and can be more easily damaged. Inserting some drugs into your vagina can make the area numb. If you are having sex after taking drugs vaginally, you might not feel pain or soreness while having sex, which can lead to damage.
• Dissolve your drug in water before inserting it. There is not enough fluid in your rectum or vagina for solids to dissolve. Mixing your drugs with water before you insert them reduces the potential for damage to these areas.
• Insert with care. Inserting drugs into your rectum or vagina can cause tearing, burning and infection. Use lube when you are inserting the drug, and insert it with a clean tool such as a new syringe (without the needle) to release it into your vagina or rectum. Do this in a clean area, and do not share insertion tools with others.
• Rinse with saline afterwards (douching). Use douche or a clean vessel such as a turkey baster, drink bottle or empty syringe (without the needle) to insert saline (salt and water) solution into your vagina or rectum. This will help to clean the area and get rid of any residual drugs.

Using around others, especially if there is someone sober with you, is a safer choice than using alone. If something goes wrong, like an overdose, you will have people around who can get you help.

If you are using around other people, it is good that they know what drug you are using and how much. That way, if something happens, they can let medical staff know. Being around others also means that, if you have a not-so-pleasant trip or high, they may be able to help calm you down or bring you to a safer space.

If you are using around people you don’t know or trust or people you feel may put you in danger, this can make for an unpleasant experience. Make sure the people you are taking drugs around are people you feel comfortable and familiar with.

If you are using alone, ask a friend or someone you trust to check in with you to make sure you are OK.

Where you use drugs can be just as important as who you use them with. In fact, there have been many cases of overdose where a person has used the same amount of drugs they usually do but in a different location than they usually do. This is called a ‘context’ effect and happens because our bodies adapt to environments we are in a lot. When you are planning on using, think about whether you have used in this environment often. If it is not a familiar place, consider starting with a lower dose than usual.

It is also good to think about your safety when you are choosing where to use. Alcohol and other drugs impact our ability to make judgements and can make us less aware of what is going on around us. If you are somewhere public, like a bar, event or outside, this lack of awareness could mean that you aren’t able to notice if things aren’t right. This might be falling victim to criminal violence, sexual assault or drugging (‘being roofied’), making poor choices or doing reckless acts.

You also could lose track of your friends, not have a way home or end up somewhere you don’t want to be. This doesn’t mean that you can’t find ways to use drugs in these places in a safer way. If you are using somewhere that is not at home or at a place you feel safe in, make a plan for yourself, let others know where you will be and what you are doing and set limits and boundaries.

Serotonin syndrome is reasonably rare, but can be dangerous or fatal. It happens when someone takes two or more drugs that affect serotonin in the brain (also known as serotonergic drugs). Serotonin syndrome can cause:

• Agitation
• Delirium
• Confusion
• Hallucinations
• Fevers
• Tremors
• Kidney failure
• Seizures
• Comas

Many drugs are serotonergic. This includes:

• MDMA
• Many tryptamine drugs
• SSRIs and MAOIs (often used as antidepressants)
• Many opioids (tramadol, fentanyl)
• Amphetamines
• DXM
• Cocaine
• Tricyclic antidepressants 

If you are using more than one drug (including medications), it is important to check whether the combination can cause serotonin syndrome. If you are not sure, you can do you research by visiting tripsit's drug interaction page. If you do plan on taking two or more serotonergic drugs in the same day, it is best to space out your doses as far apart as possible to reduce your chances of developing serotonin syndrome. 

Depressant drugs are drugs that slow down your body and brain. This includes:

• Opioids
• Benzodiazepines
• Ketamine
• Alcohol
• Cannabis
• GHB/GBL
• Gabapentinoids
• Other sedatives and hypnotic drugs

Taking any of these drugs at the same time increases your risk of unpleasant effects. A dangerous effect you could experience is respiratory depression. This is when your breathing slows down significantly which can cause a build up of carbon dioxide in your body, stopping it from getting the oxygen it needs to function (hypoxia), which can result in death.

Many depressant drugs can make it difficult to move (ataxia), cause drowsiness, and make you vomit. Combining depressants also puts you at a higher risk of choking on your vomit as you may not be able to move yourself into a safe position. 

There are myths that say if you mix a stimulant (like cocaine) with a depressant (like alcohol) the effects will cancel out.

If you take a stimulant and depressant together you may feel like they dull the effects of one another, however this is not what is happening in your body. What actually happens is that the stimulant and depressant are working in different ways in your body. One may wear off quicker than the other and leave you with unpleasant effects or as they both wear off you will experience the combined comedown symptoms of both. This can put a lot of strain on your body.

When you mix these two types of drugs it also becomes harder to dose appropriately, as the effects can be changed or masked. There are also some depressant and stimulant combinations that are particularly dangerous (such as cocaine and heroin). Taking these two drugs together (known as 'speedballing') can put strain on your heart which can cause you to have a heart attack or stop breathing.

If you are planning on taking a stimulant and depressant together, it is important to do your research to understand the risks, and leave as much time as possible between taking each drug.

Some people talk about using drugs like benzodiazepines to 'kill' a bad trip from hallucinogenic drugs like LSD or psilocybin mushrooms. If you choose to do this, it is important that you understand what you are taking and what the effects might be.

Many benzodiazepines sold illegally in New Zealand are mixed with other more dangerous novel benzodiazepines (such as flualprazolam). These drugs can be dangerous, especially if used in large doses or in combination with other drugs.

Drugs that you may use to kill a trip can also have unpleasant effects and can sometimes make you feel worse. It is important to do your research before you choose to take them. If you are experiencing a bad trip, think about how you can make yourself feel better. For example, visiting the paramedics if you are at an event, using calming techniques such as mindfulness, or going into a quiet space and practicing deep breathing. 

It is important to make sure that you research the effects and know what to expect. As you are coming down off of a drug, there can be different amounts of it still in your system, which means you may end up unintentionally mixing them together (see the points above).

Some drugs that people use to ease a comedown, can have their own comedown as well, which can lead to an even more unpleasant experience. You may also find that you become reliant on a certain drug every time you experience a comedown. In this case, if you are not able to get ahold of the drug, you could feel much worse and find the effects harder to deal with.

There are lots of other things you can do to reduce the effects of a comedown, such as resting, exercising, taking supplements and doing rewarding activities. If you do choose to use another drug to ease comedown symptoms, make sure that you are leaving lots of time between when you took the first drug and when you take the new one. It is also a good idea to not use a drug to help you comedown every time. This can help you be less reliant on the drug. 

Stimulant drugs speed up your brain and body functions, which can sometimes lead to dangerous or unpleasant effects, such as:

• A very fast heartrate
• Tremors
• Seizures
• Psychosis
• Agitation
• Fever
• Loss of consciousness

When you mix two stimulants together (such as cocaine and amphetamines), body functions like heartbeat, temperature and breathing become harder to regulate at a normal level. This also increases your risk of experiencing a heart attack.

It also means that it is harder to dose the drugs you are using, as it can be difficult to tell which drug is causing a particular effect. This can even be the case with legal stimulants like caffeine and creatine as well.  If you are mixing stimulants, it's best to start with a lower dose of both and see how you feel. It is also a good idea to wait as long as possible between taking the first and second drug. 

Put off using for a little while when you wake up. Using early in the day can make it hard to get anything else done and can make it difficult to feel the effects of drugs you take later in the day (meaning you may take more).

If you are using and planning on having sex, make sure that you have a plan in place to protect yourself. Have condoms and lube available and use them, and talk with your sexual partner about things like what consent might look like when you are using and what boundaries you have.

Ensuring that your sexual partner and you give an enthusiastic ‘yes’ to sex is essential, and if you or the other person is too high or intoxicated to consent enthusiastically, stop the sexual encounter.

Sleeping can be difficult when you are using regularly, especially if the drugs you take are stimulants or uppers (like meth). For these drugs, take a break if you are using for more than 24 hours, and don’t take more after 3pm so that you can sleep that evening. Avoid using other drugs or medicines (prescription or over the counter) to help you sleep, as this only gets you into a more difficult pattern to break.

If you are using depressant or downer drugs, try not to rely on them to sleep, as this can become a hard pattern to break and can make withdrawal more unpleasant. You can try using a natural supplement like melatonin to sleep better, but be careful not to take it with other drugs.

Depending on what drug you use, there are ways to be safer with how you use. Use new needles and injecting equipment, use a shatterproof pipe and clean the inside often, clean and replace vaping coils regularly, use single-use or cleanable straws for snorting and use clean hands whenever you are using drugs.

Just because you are using drugs doesn’t mean that you shouldn’t take the time for self-care. If anything, it is even more important when you are using as your body is in recovery mode after use. Take a multivitamin every day, and make sure it is one that has ingredients that don’t react with the drug you are using.

Have some antiseptic cream from a pharmacy on hand, especially if you are an IV user or if you scratch yourself when using. If you are taking an upper that makes you grind your teeth, consider chewing some gum so you don’t hurt your lips or mouth.

Lots of drugs, but especially meth, can have bad effects on your teeth. Try to have toothpaste, a toothbrush and mouthwash in a place that is easy to get to. If your mouth is dry, gargle with salt water to help kill the bacteria.

Practise simple hygiene when you are actively using such as showering, washing your face and hair and changing into clean clothes. This self-care can help you to feel more normal and keep viruses, bacterial and fungal infections away.

Once you have thought about what you want your use of alcohol or other drugs to look like, make some rules for yourself to help you stay on track. Some examples of rules might be: “I only want to use when I am with other people” or “I only want to use on the weekend”.

Write them down or save them on your phone or even tell someone else who can help keep you accountable. Having rules in place can help stop use from creeping up and helps to give you, not the drug, control over your life.

Covid-19 is still in our communities and can make some people seriously ill. It's a good idea to keep taking measures to stop the spread of Covid-19: 

• Stay at home if you're unwell. 
• Get tested regularly. Some drugs may give you a sore throat or a cough, making it harder for you to notice Covid-19 symptoms. 
• Don't share needles, pipes or other equipment. You can get new needles and syringes from a Needle Exchange near you.  
• Wash your hands and clean surfaces and equipment before using. Each person should use their own sterile equipment, such as needles and straws for snorting.  
• Puff puff but don't pass. It's best not to share ciggies, joints or vapes to reduce risk of spreading Covid-19.

How much you weigh, your height, your metabolism and your amount of body fat or muscle can influence how your body responds to different doses of different drugs. Generally, the smaller you are, the smaller the dose you need to feel the effects (the exception for this is with tolerance - see below).

For example, if a taller, heavier person with more body muscle and a shorter, lighter person with a fast metabolism both drink four alcoholic drinks or take 100mg of MDMA, the taller person may feel less drunk or high than the shorter person. This is because your BMI or body mass index (your height and weight) can affect how much alcohol is in your blood and how quickly you feel the effects. This isn’t just for alcohol – many guides to taking other drugs talk about taking your BMI into consideration.

Because of this, try not to base what you take on the people around you who may be larger or smaller than you or have a different tolerance. Start with a smaller amount and see how your body reacts.

You can look up the dosing for different drugs on tripsit. 

It’s good to have a meal before you use alcohol or other drugs. For some drugs, this can help reduce unpleasant effects. If high on drugs like methamphetamine or LSD, you may not want to eat or may forget to eat for a long time.

Similarly, make sure that you drink water regularly when you are using alcohol and other drugs, especially if you are in the sun or in hot, sweaty environments. Dehydration can be dangerous and can also make the comedown or hangover much worse.

Sometimes, MDMA can make some people drink too much water. In these cases, it is good to carry a bottle of water so you know exactly how much to drink to stay hydrated.

Mixing drugs together (including with alcohol), called ‘polydrug use’, can lead to more unpleasant and unpredictable effects. It is important to know that it can be just as risky to mix alcohol and other drugs with medicines (prescription or over the counter) and even some supplements.

For example, combining benzodiazepines and GHB/GBL can increase the risk of overdose. Mixing MDMA with other substances that affect the level of serotonin in your brain (such as large amounts of 5-HTP, a supplement, or some anti-anxiety medications) can cause serotonin syndrome. This can be dangerous and can lead to fevers, seizures and even death in extreme cases. See more information on how to avoid bad experiences on MDMA.

You can also have unpleasant and unpredictable effects from mixing depressants (downers) with stimulants (uppers), such as MDMA with tramadol. Doing this does not mean these two drugs cancel each other out. The upper can mask or hide the effects of the downer, meaning you may take more than your body can handle and increase your risk of unpleasant effects or overdose. It also means you will experience comedown symptoms from both drugs at the same time, which can make you feel much worse.

Have a look at tripsit to see which drugs taken together carry the highest risks. 

Regardless of your body size, you can develop tolerance to a drug if you use it often. However, this does not mean that your body gets rid of the drug any faster. People develop a tolerance to psychedelic drugs like LSD or psilocybin mushrooms quite quickly, while other drugs take longer. It is important to make sure that you don’t just base what you are using on people around you as they may have a very high tolerance.

It is good to remember that where you are and who you are with can affect your tolerance. If you use with the same people or are in the same place often, your body can develop a ‘context tolerance’ – this means that you can take more of the drug in that environment. If you take the same amount of that drug in a new place or with new people, you may feel the effects much differently and have an increased risk of overdose.

Check out tripsit for some examples of doses for different drugs.

How someone feels emotionally and mentally before they use alcohol and other drugs can influence their experience. For example, psychedelic drugs can alter your perception of yourself and can increase emotions, so if you are feeling low or anxious, these drugs can make these feelings worse.