Mixing two or more drugs at the same time can make the effects riskier and less predictable.
This includes alcohol, prescription medication, and illegal drugs. Different combinations of drugs carry different risks.
If you plan on mixing drugs, it is a good idea to do your research first to understand what the risks are. The Tripsit interactions checker is a great tool to use for many different drugs, as well as WebMD’s drug interaction tool for medications.
Mixing depressants
Depressants are a wide range of drugs, including alcohol, opioids, benzos and GHB/GBL. Depressants slow down your body functions, including your breathing. Mixing depressants together can cause your breathing to become very slow or stop. This is called respiratory depression and is very dangerous.
Combining depressants also puts you at greater risk of losing consciousness and choking on your vomit. If you are with someone who becomes unresponsive after taking depressants, lie them on their side in the recovery position and call 111 for an ambulance.
It is recommended to avoid mixing depressant drugs together to avoid this risk. If you do mix, have a sober buddy around who can get you help if things start to go wrong. It is also a good idea to have naloxone if you are using opioids.
Mixing serotonergic drugs (serotonin syndrome)
Serotonergic drugs work on the serotonin system in the body, and include drugs like: MDMA, MAOIs, SSRIs/SNRIs (medicines used to treat depression and anxiety), tramadol, fentanyl, amphetamines and DXM.
Mixing serotonergic drugs together can cause serotonin syndrome. While rare, serotonin syndrome is very dangerous and can be fatal.
Signs of serotonin syndrome include: agitation, confusion, fevers, tremors, difficulty controlling muscles, headache, shivering seizures, loss of consciousness and hallucinations.
If you experience these symptoms after taking drugs it is important to get medical attention as soon as possible.
It is best to avoid combining serotonergic drugs. However, if you do combine them consider taking lower doses of each and spacing your doses out as much as possible.
Mixing stimulants
Stimulant drugs speed up your body functions. This group of drugs includes amphetamines, MDMA, synthetic cathinones, methylphenidate (Ritalin) and cocaine. Mixing stimulants together can put extra strain on your body, which can cause a variety of effects. This is referred to as ‘overamping’. In more serious cases this can cause seizures, psychosis, severe agitation, heart attacks, strokes and hyperthermia (severe overheating).
If you are mixing stimulants, it is recommended to take lower doses of each drug and space out your doses as much as possible. It is also important to remember that drinks containing caffeine will also add strain on your body, so it is best to avoid these if mixing stimulant drugs.
Mixing depressants and stimulants
Mixing depressant and stimulant drugs together (e.g. cocaine and ketamine, or MDMA and alcohol) can also have risks. These drugs do not ‘cancel each other out’. Mixing them can make the effects you experience less pleasant and less predictable, even if you feel like the effects of each drug are dulled. This can sometimes be dangerous as people can take more drugs to feel stronger effects and not realize how much they have taken. When one drug wears off, the effects of the other drug can be stronger than you expected. This can increase your risk of overdose and your risk of experiencing a more intense comedown.
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.