Combinations - Drug combos & safety: what should be avoided ?

[genaro]

It appears to me that many people seem to know next to nothing about how to mix drugs in a safe way, so...


Drug combos, some advice:

next time you wanna try a combo, make researches about the pharmacology of each substance, here are questions you must ask yourself:


Is it a depressant (alcohol, kava, sedatives, trankilizers, anxiolitics, analgesics, anaesthesics, benzos, sedative antihistamines, opiates, heroine, ketamine, pcp, dxm, ghb & gbl, ether, lsa, anything that might make you feel drowsy/sleepy/sedated)

Does it induce low heart beat, slowing down the heart (many depressants can do so such as K, heroin..)

Does it produce hypotension (for instance dimenhydrinate, sinicuichi...)
Note that hypotensive substance can lead to periferal vasoconstriction.

Is it a stimulant (cocaine, XTC, amphet, meth, phenethylamines, ephedra & ephedrine, pseudoephedrine, herbal XTC)

Does it produce hypertension and/or accelerated heart beat (amphets, meth, XTC and phenethylamines, coke, datura & tropanes, fly agaric, ephedra & ephedrine, pseudoephedrine, herbal XTC, and a few tryptamines RCs such as 5-meo-dmt)

Does it produce vasoconstriction (pseudoephedrine, ephedra & ephedrine -and therefore some herbal XTC mixes-, LSAs, ergot alkaloids, dimenhydrinate, coke, adrenaline)

Does it produce overheating (many phenethylamines such as 2Cs do so, dxm, amphets, XTC, datura & tropanes, fly agaric)

Is it an MAOI (moclobemide, harmala, caapi, harmine & harmaline)




then the rule is:

mixing alcohol (or alcohol like substances) with depressants is very dangerous (for instance ghb + a single beer have been known to put people in coma)

mixing alcohol with IMAOs is very dangerous

mixing MAOIs with stimulants, vasoconstrictors, substances accelerating or significantly slowing down heart beat or hypertensive/hypotensive substances is very dangerous

mixing MAOIs with depressants is very dangerous

mixing aspirin with high doses of stimulants (or substances producing hypertension, hypotension, fast heart beat or vasoconstriction) can be really dangerous. For this reason if you've been taking stimulants (amphets, coke) and you have a headache much better take acetaminophen (aka paracetamol) rather than aspirin to stop it.

mixing substances that produce the same effect is dangerous (for instance depressant+depressant or stimulant+stimulant or overheating substance+overheating substance or substance slowing down the heart+substance slowing down the heart) as the mentionned effect might be multiplicated exponentially (especially with depressants)
For instance many overdoses at raves have been known to be caused by mixing ketamine+alcohol or ketamine+heroin (= mixing two depressants and low heart beat inducing substances), leading to respiratory depression, coma and possibly death.

mixing substances that have an opposite effect, meaning stimulant+depressant, can also be dangerous in a different way: the effects will cancel themselves, leading you to redose because you don't feel much effect, which could easily end up in an overdose from multiple excessive redosing.

Also mixing depressant with stimulant should be avoided, it can be extremely unpleasant: you body might start doing sudden "up & downs", meaning continuous nervous swinging from rush of energy & tension to depressive phases (weakness/slow motion/drowsy) which can be psychologically difficult but can also be hard on your heart and therefore possibly dangerous: if too much of each was taken, you heart will go "fast-slow-fast-slow" which can cause serious problems in the most extreme cases.

Also important, keep in mind that vomiting in one's lungs is a common cause of fatal overdose, generally this is caused by mixing drugs with lots of alcohol: the individual fall deeply unconscious, laying on his back or his stomach, then vomit, and suffocate in his own vomit (by breathing it while still comatose).
That's why people that are found unconscious (from drugs) should be turned on their side in 'safety position':
http://www.medecine-et-sante.com/gim...animation5.jpg
if you try it you will notice that such positioning prevents the unconscious individual from turning on his stomach or on his back, so if he does vomit while unconscious, this would happen as he's laying on his side so he shouldn't suffocate from vomit in his respiratory tract.

As said, mixing substances that might induce unconsciousness (dxm, opiates, K, dmt, 5-meo-dmt..) with substances that can cause vomiting (opiates, alcohol) can be dangerous as one might vomit in his lungs while unconscious and die from suffocation (if there's no trip sitter/friends to watch over him while he's unconscious)

DXM should not be mixed with stimulants, amphets, meth, phenethylamines, ephedrine, alcohol, depressants, MAOIs, substances producing overheating, vasoconstrictors, substances accelerating or significantly slowing down heart beat or hypertensive/hypotensive substances. Be careful as some DXM containing medecines contain other active ingredients that can be extremely dangerous with dxm when taken in high dose (such as acetaminophen, Chlorpheniramine Maleate, pseudoephedrine or aspirin), that's why one should always use dxm-only medecines with no other active ingredient in it.


At last, some guy told me that giving oxygen (the rescue team do so) to someone near-coma from drugs can be dangerous, I don't know wheter or not this is true...this would need medical confirmation from a doctor that knows specifically about treating different drugs ODs (in case of overdose from mixing alcohol with either K, XTC, opiates or ampets, is there any risk if oxygen is given?).


To conclude, if you ever choose to try a potentially dangerous combo, start with very low dosages of each compound and do not redose (and increase dosage quite progressively from one attempt to another) and get a sitter. Also think about drinking (water) regularly to avoid dehydratation (which is also a common cause of OD from drug mixes)
Note that some dangerous combos should be absolutely avoided (ex: alcohol+ghb) while some might be ok as long that you stick to low doses (ex: stimulant+stimulant).
If you have any doubts about how risky a combo is, just ask!

Reputation Comments on this post:

	good post
	Good, informative and useful post
	Very useful and informative post, could prevent an OD.

[Jatelka]

Does SWIG have a source for their statement that "giving oxygen to a semi-unconcious individual having an od can be very dangerous"? The only situation that she can think of is if an individual has Chronic Obstructive Airways Disease and relies on their hypoxic drive to trigger breathing (unlikely in the majority of illicit drug users). In such a situation giving high flow O2 abolishes the hypoxia and causes accumulation of CO2 and respiratory failure.

Which drugs is SWIG thinking of here?

[genaro]

no I have no source beside people talks for this one, but it's obvious as oxygen will make you quite relaxed, so giving some to someone near-coma might well put him into some deep coma he might possibly not ever wake up from (in many case of non-lethal OD people say they felt that falling asleep was the thing to avoid if they wanted to live so they fighted it to stay awake). That's all.

[Jatelka]

Originally Posted by genaro

no I have no source beside people talks for this one, but it's obvious as oxygen will make you quite relaxed, so giving some to someone near-coma might well put him into some deep coma he might possibly not ever wake up from (in many case of non-lethal OD people say they felt that falling asleep was the thing to avoid if they wanted to live so they fighted it to stay awake). That's all.

Oxygen does NOT cause relaxation in terms of sedation (wanting to fall asleep). It also does NOT cause relaxation of skeletal muscle (loss of protection of airway). Therefore O2 is NOT going to deepen coma UNLESS an individual requires chronic hypoxia to drive their breathing (as this results in CO2 retention).

SWIJ can see SWIG's logic, but their information is incorrect.

Peace X

Oxygen + Cigarette: Definitely to be avoided

[bewilderment]

One should also take into account which neurotransmitters and receptors are being affected and how they are being affected i.e. are they agonists, antagonists, reuptake inhibitors or what. Then one should do research to find out how they react with each other or if that information is not available then find drugs which use similar mechanisms of action of the drugs being mixed combine together. If they are prescription meds then it's easy enough to just do a quick search on Rx interactions...these calculators can be easily found on the net. Also do search on erowid to see how people reacted to the combination and if you're at all unsure of a combination and how it will react then ask on the forum! Don't take people's word for it, but it will give you a jumping off point on what kind of research to do. If still in doubt, don't mix!

[Forthesevenlakes]

swim is with bewilderment's sage advice here. learn how each drug works, what their interactions and contraindictions are. these can be easily obtained online on any search engine by looking for, say, "substance z contraindictions". erowid's experience vaults also contain a wealth of info on the combination, and see how people enjoyed them, and what negative effects they experienced. if possible try to figure out what mg/kg were taken so that swiy doesnt end up taking a dose that would only be considered "low level" in someone who is 400 lbs. start low and work your way up as well...because you can always dose up, but you can never dose back down.

[genaro]

well when you get quite a lot hyperventilated (just play didgeridoo) you just feel like about to fall on the floor, so even if it's not sedative I'm not sure this would be safe while ODing. Any blood/circulation issue with oxygen?

[Jatelka]

The dizzyness/weakness issue with hyperventilating isn't the excess 02 it's the fact that you're blowing off CO2. This increases the bloods ph (because C02 dissolves in water to form acid). When the blood ph rises above a very narrow normal range (greater than ph 7.45) you have a situation called respiratory alkalosis. As well as weakness/dizzyness this also results in tingling/numbness aound the mouth and in the fingers/toes (which is why you get those symptoms during panic attacks).

In drug OD one of the major problems is decreased respiratory rate (plus relaxation of muscle which leads to inability to protect the airway). In that situation you're getting less O2 into the blood stream because your breathing isn't efficient/deep/frequent enough. In that situation you have to get the extra O2 in somehow. By giving high flow O2 first responders increase the amount of O2 delivered which can buy time until the mechanics of breathing are sorted.

Of course high flow O2 can be dangerous in itself. If given over more than 48 hours at greater than 60% (ie: ventilated patients on ITU) or so it can be irritant and can lead to the development of Acute Respiratory Distress Syndrome.

Not sure what SWIG means on the "any blood/circulation issues with oxygen" front?

Reputation Comments on this post:

good info

[nanobrain]

properly used 02 is very safe - and the only thing that aborts a Cluster Headache with certainty within minutes, short of a shotgun to the head.

applied, the O2 for this purpose, is at a high flow rate, 12-15 l/m. i've been on O2 for a couple years now, no signs of any concern. and the knowledge that i can stop a Cluster is priceless.

[mr_trance]

can pills and coke? / pills and speed be mixed? and if so is it good/?

[IHrtHalucingens]

What kind of pills? Im assuming you mean ecstacy, it that case its not too smart to combine them with coke or speed or any other type of CNS stimulant.

[mr_trance]

how about coke and speed? thanks

[IHrtHalucingens]

Again they are both CNS stimulants and are no good for ya. Just stick with one or the other or mix with weed or something. Chances are if you have no past history of heart problems you will most likely survive the combo but why take that risk? Be smart, enjoy your stimulants individually.

[ziphren]

One thing you forgot to mention about DXM and ecstasy.. don't mix them with SSRI's.. you can get serotonin syndrome and possibly die.

[toe]

Originally Posted by ziphren

One thing you forgot to mention about DXM and ecstasy.. don't mix them with SSRI's.. you can get serotonin syndrome and possibly die.

A million monkeys at a million typewriters over the course of a million years have produced statements like a thousand times and while SWIT sorts of understands the logic behind the idea, she's never seen any actual evidence to back this up. She understands why people- especially those who have no personal experience with the combo- might argue that a combo of MDMA & SSRI might trigger a seizure instead of simply nullifying the action of the MDMA. Admittedly she's a little less clear on the logic behind the argument against DXM, but can buy that the combo might be a little more prone to kindling of convulsions as SSRI-medicated monkeys trip out just fine on DXM, albeit perhaps on somewhat higher-than-expected dosages. Of course, it's well known that tramadol and SSRIs can interact and cause an SS seizure. Toe is not a chemist, toe is not a chemist.

Lithium & LSD will cause a seizure. Honestly, much like the MAOI's, screwing around with almost anything while on lithium seems a bit iffy.

And, and. . . cocaine does not work while one has topiramate in the system.

Waste should be avoided.

[nanobrain]

^all this was mentioned by the O.P.

avoid 5HTP and B6 vits. infact, avoid 5HTP. avoid DMT and piracetam. avoid parlodel and modafinil. avoid paracetamol / panadol and alcohol, whatever the dose. unless you have a thorough understanding, i will repeat, do not mess with MAOIs

[ramacharaka]

why he should avoid 5Htp?

[darawk]

Originally Posted by nanobrain

^all this was mentioned by the O.P.

avoid 5HTP and B6 vits. infact, avoid 5HTP. avoid DMT and piracetam. avoid parlodel and modafinil. avoid paracetamol / panadol and alcohol, whatever the dose. unless you have a thorough understanding, i will repeat, do not mess with MAOIs

Hmm..I get most of the ones you've mentioned, but why parlodel and modafinil? I ask because SWIM once ingested those two substances concurrently and had a bad experience. Nothing life threatening, he just didn't like how he thought the modafinil was making him feel. But maybe his modafinil deserves another try sans parlodel?

[Micklemouse]

Originally Posted by nanobrain

^all this was mentioned by the O.P.

avoid 5HTP and B6 vits. infact, avoid 5HTP. avoid DMT and piracetam. avoid parlodel and modafinil. avoid paracetamol / panadol and alcohol, whatever the dose. unless you have a thorough understanding, i will repeat, do not mess with MAOIs

The 5htp & b vitamin debate would appear to be 10 year old pure conjecture with nothing to back it up (see 5-HTP for depression) - if someone can come up with sourced theory (other than Dr Harris's diatribe)I'd be happy to read it. Some people have reported nausea & headache from 5htp alone, & of course it is potentially very dangerous to mix 2 or more serotonergic agents - 5htp + MDMA/amfetamines/phenethylamines/SSRI's & other depressants, etc is not a recommended combination (look up Serotonin Syndrome - there are some good articles in the File Archive)

[keats]

Great post, though frankly the content could be boiled down to: Don't mix a stimulant/depressant with any other stimulant/depressant. Don't get me wrong, SWIM has many times and will continue to, and that rule of thumb varies greatly in severity and so on. But when you really read what the OP's post is saying it's basically that there's no good way to combine a CNS stimulant/depressant with another CNS stimulant/depressant without endangering yourself, which is true. A couple specific drug combos SWIM wonders if SWIY has any info on:

MDMA and Oxycodone? How bad would this combo be physically and has anyone ever tried this or another MDMA/opiate combo? SWIM has a lot of experience with both drugs and has always been tempted to try a mix, say 75mg mdma and 20mg oxy?

SWIM has always mixed recommended doses of benadryl and dxm with opiates for potentiation and itch, is this dangerous? SWIM's never experienced any problems before and has the understanding this is a pretty common practice. Is taking these two meds in the doses recommended on the packages with oxycodone a bad idea?

Anyway good thread, to add a little personal advice: Mixing alcohol with almost any other CNS depressant is a really stupid idea. Closest SWIM ever got to ODing was oxy/alcohol and then an accidental dose of xanax later (SWIM knew how much xanax he could mix with his oxycodone dose but forgot he'd drank), and was up all night barely breathing. So is alcohol and coke, or alcohol and...pretty much anything that isn't weed or a hallucinogen. I can also testify to the foolishness of mixing stimulants, SWIM had a friend OD from aderall and coke, and another OD from esctasy and coke, don't do it.

[smokeymcbongwater]

how about alcohol and adderal?

[svenghali]

Adderall masks a lot of the strength of the alcohol, so as SWIY drinks more and realized he's not nearly intoxicated, he continues drinking- and once he comes down, he's a drunken mess. Care should be taken on that mixture, that's all.

[smokeymcbongwater]

alright, so besides the chance of drinking too much, its not bad for your body, like your heart or anything

[Nagognog2]

Alcohol and amphetamines are bad for your heart. This combination has been linked to heart-disease. Remember - alcohol acts as a stimulant first, then as a depressant. It's a rather paradoxical drug.

[tayo]

Originally Posted by Nagognog2

Alcohol and amphetamines are bad for your heart. This combination has been linked to heart-disease. Remember - alcohol acts as a stimulant first, then as a depressant. It's a rather paradoxical drug.

either of the two, alcohol, or amphetamines alone can be linked to stress induced cardiac damage. thought that should be noted as well