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Taking both these drugs should not be harmful. The effects of both drugs are likely to be reduced.

Combining these drugs should not be harmful. However, they will mask each other’s effects, which might increase the risk of overdosing either drug. This combination is also hard on the heart due to each drug’s opposing action (7).

The combination is unlikely to cause any adverse or undesirable reactions beyond those that might ordinarily be expected from taking these drugs individually. Users have reported diminished experiences, thus care should be taken with dosage.

This combination carries a low risk. Aspirin and cannabis are unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

Cannabis and DMT is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

There is no evidence to date showing interactions between paracetamol and 2C-B.

This combination is unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

Taking both these drugs together is likely to cause an effect stronger than taking them individually. If used with care they are unlikely to cause an adverse or undesirable reaction.

We strongly recommend you avoid taking these drugs together, reactions are highly unpredictable and can be fatal. You will likely come to some degree of harm even if you take strong precautions.

Taking the combined oral contraceptive pill and cocaine together is not usually any more harmful than taking them individually. The drugs are not known to interact with each other, each positively or negatively46,47.

Taking both of these drugs together is not usually any more harmful than taking them individually. The drugs are not known to interact with each other, each positively or negatively.

Alcohol and GHB is an unsafe combination. Even in very low doses this rapidly leads to memory loss, severe ataxia and unconsciousness. There is a high risk of vomit aspiration while unconscious.

Be careful when mixing amphetamines and GHB. Stimulants increase respiration rate allowing a higher dose of sedatives. If the stimulant wears off first then the opiate may overcome the patient and cause respiratory arrest.

Avoid benzos if you are taking allergy medicines. benzos and allergy medicines such as Benadryl, Piriton and Clarityn are depressants and both slow down your central nervous system. This can produce heightened side effects such as drowsiness, sedation and poor concentration. In extreme cases, loss of consciousness and may occur.

These two drugs potentiate each other strongly and unpredictably which might lead to memory loss, blackout and respiratory depression.

Using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before mixing drugs.

Effects will be stronger than taking either drug alone, however, it’s unlikely that there will be any adverse health reactions to this combination.

The combination is unlikely to cause any adverse or undesirable reactions beyond those that might ordinarily be expected from taking these drugs individually. Users have reported diminished experiences thus care should be taken with dosage.

There is no evidence to date showing interactions between contraceptive pills and cannabis and generally this combination carries a low risk. However, cannabis will often intensify and alter your mood. If your contraception is causing significant changes in your mood, it is advisable to avoid cannabis as it may intensify mood swings.

This combination carries a low risk. Paracetamol and cannabis are unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

There is no evidence to date showing interactions between paracetamol and LSD. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between allergy medicines and LSD. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between ibuprofen and 2C-B. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

There is no evidence to date showing interactions between ibuprofen and benzos. This combination is unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

Using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before mixing drugs.

The effects of these two drugs are similar and synergistic, therefore mixing MDMA with 2C-B may increase the intensity of the experience.

Combining kratom with such depressants is contraindicated.Depressants have the same general effects as opiates. Therefore, combining them with kratom can cause a synergy effect of severe sedation, which can feel like overdosing. More sedation and respiratory depression can occur as a result. Memory blackouts are also likely to occur.

_Users report that the two herbs go well with each other, however, moderation is important when combining them. Keeping both doses low helps ensuring that you derive the highest possible positive effects without crossing the line to negative side-effects. You should go particularly light on cannabis dosage. Although rarely, some users report mild effects, such as feeling nauseous, sick and uncomfortable. Stronger side effects include anxiety and dizziness._

Be careful when taking paracetamol and cocaine. Paracetamol may increase the harmful effects of cocaine on the liver4.

Taking both these drugs together may produce unpleasant effects such as physical discomfort or overstimulation. High doses put you at risk. If you mix, start low and go slow

_Kratom leaves produce complex opioid-like analgesic effects, which could be potentiated with the use of ibuprofen._

Amphetamines and DMT is not usually a harmful combination but stimulants generally increase anxiety levels and the risk of thought loops which can lead to negative experiences.

Tricyclics (Amitriptyline, Anafranil, Asendin, Aventyl, Elavil, Endep, Norfranil, Norpramin, Pamelor, Sinequan, Surmontil, Tipramine, Tofranil, and Vivactil) is consistently reported as being very bad in combination with LSD. People attempting this combination are unable to communicate with others, they go into a fugue state where they wander away from home and don't know how they got there, and they are generally in a terrible state psychologically. Life-threatening seizures and at least one death have been reported to be triggered by the combination of LSD and tricyclics. If you are prescribed tricyclics for mental health problems, it is not a good idea to try LSD outside of a supervised medical setting, as it might worsen the symptoms.

Effects are additive. The combination is unlikely to cause any adverse or undesirable reactions beyond those that might ordinarily be expected from taking these drugs individually.

This drug can have anxiogenic (anxiety-creating) effects which may create an unpleasant thoughts and discomfort.

Using these drugs together can cause an effect stronger than desired though they aren't likely to cause a serious adverse reaction if used carefully. Additional research should always be done before mixing drugs.

Using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Additional research should always be done before mixing drugs.

This combination is relatively safe and is unlikely to cause any unwanted effects.

Stimulants should not be combined with kratom, as they further increase the level of stimulation provided by the kratom. This results in the development of potentially severe side effects: anxiety, heart palpitations, excessive sweating, and general agitation. More life-threatening side effects that may result include: increased blood pressure. The lowering of the seizure threshold may also be observed.

Cannabis and mushrooms is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

The combination is unlikely to cause any adverse or undesirable reactions beyond those that might ordinarily be expected from taking these drugs individually. Benzos lessen the effects of nitrous oxide due to both drugs acting on common receptors.

This combination carries a low risk. Ibuprofen and cannabis are unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

Cannabis and LSD is not usually a harmful combination, but cannabis has an unexpectedly strong and somewhat unpredictable synergy with psychedelics so beware when mixing these drugs.

These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Be careful when mixing these drugs.

The effects of mixing these two drugs together can be unpredictable.

There is no evidence to date showing interactions between aspirin and benzos. This combination is unlikely to cause an adverse or undesirable reaction when used carefully and within the recommended dose.

There is a low risk when drinking a moderate amount of alcohol when using the recommended dose of aspirin.

Avoid alcohol if you are taking aspirin for a headache. Alcohol is likely to make a headache worse as it causes dehydration.

2C-X and GHB is not usually a harmful combination, it will tend to decrease the effects of both drugs.

_Reactions and side effects are rare, but using these drugs together can cause an effect stronger than taking them individually, and they aren't likely to cause an adverse or undesirable reaction when used carefully. Kratom’s effects are due primarily to its interaction with mu-receptors in the brain, while SSRIs produce their effects by interacting with the serotonin receptors. It is hypothesized that, since both act on receptors that can sometimes be involved with each other in certain processes, an interaction may or may not occur. Interactions include risks such as_ [_serotonin syndrome_](https://www.mdedge.com/ccjm/article/120386/neurology/serotonin-syndrome-preventing-recognizing-and-treating-it)_. Additional research should always be done before mixing drugs._

[**Tramadol**](https://www.drugs.com/tramadol.html) can result in seizures when taken with LSD, as Tromadol lowers the seizure threshold.

There is no evidence to date showing interactions between ibuprofen and modafinil. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

Taking aspirin and cocaine together is not usually any more harmful than taking them individually. Aspirin is sometimes [used](https://www.the-hospitalist.org/hospitalist/article/125897/how-should-patient-cocaine-associated-chest-pain-be-treated) by doctors in response to cocaine associated chest pains51,52.

There is no evidence to date showing interactions between ibuprofen and ketamine. This combination is unlikely to cause an adverse or undesirable reaction when used carefully.

Caffeine and GHB have low risk and decreased synergy. Caffeine will mildly hide the depressant effects of GHB leading to a slightly increased risk of overdose.

There are certain precautions you should take before doing Kratom. The advice below helps you to be physically and mentally prepared before doing it. Furthermore, we want you to be safe, and just in case you have a bad experience or some of the unwanted side effects associated with Kratom, we have also provided information on how to take care of yourself when you are in full swing. Finally, there are those uncomfortable or undesirable effects after the high have worn out, we will provide you with some practical tips on how to have a better calm down and help you to reduce the harm done to your body and brain.

>>> tabs 

# Before 

**Check the source**

Other kratom products are sold as adulterated kratom. This implies they already contain opiates such as morphine, fentanyl or hydrocodone. Opiates such as morphine and fentanyl are powerful, meaning they should never be taken in combination with kratom. You should, therefore, only buy kratom products from a reliable company or sellers. Try to compare the reviews posted online about the product.  
  
**Eat beforehand**

It is usually advised that kratom should be taken on an empty stomach, as being full can increase the risk of feeling nauseous and having a bad trip. You should, however, make sure you have plenty of nutritious food up to 3 hours before taking the drug.

# During 

**Start small**

You should always start with a low dose, especially if you are new to the drug or you are testing a different strand for the first time. You should also accurately weight the drug in order to control how much of it you are taking, especially because of the variety of effects it produces at different doses.  
  
**Drink water**

It is likely that you will get very thirsty during the onset, so try to have water around. You can reduce the risk of nausea by swallowing kratom gradually with small sips of water, however it is tempting to knock it back in one gulp to avoid the bitter taste.  
  
**Trip buddy**

This is especially recommended for users who are not familiarized with the drug, as having a sober friend could help dealing with a bad trip when taking too much.

# After 

**Set yourself a limit**

Try not to consume kratom more than once or twice a week, as this could cause the development of [tolerance](https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance). As with many other drugs, if you use kratom on a daily basis you will eventually need to take increasingly larger doses to obtain the same level of effects. Tolerance is not likely to develop when kratom is taken responsibly.
<<<

Here are the most common effects, not everyone necessarily experiences all of them every time they consume the drug and other effects not listed might be felt. **The likelihood of experiencing negative effects is far greater at high doses.**

At low doses, kratom has stimulant-like effects, similar to those of caffeine. However, when taken in higher doses, kratom has sedative effects.

The effects are (from positive to negative):

**At low doses (1-5g)**

>>> effects 
++   Increased alertness and physical energy
++   Talkativeness
++   Sociable behavior
==   Heightened libido
--   Fast heart rate
<<<

**At high doses (5g+)**

>>> effects 
==   Loss of appetite
==   Dry mouth
==   Sweating
==   Itching
==   Increased urination--   Nausea
--   Dizziness
--   Low blood pressure
--   Loss of muscle coordination
--   Constipation
<<<

**References:** [The Ultimate Guide to Kratom - Experience, Benefits, & Side Effects](https://thethirdwave.co/psychedelics/kratom/); [Current perspectives on the impact of Kratom use](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/)

### How? How Much? When? For how Long?

These are important considerations. The way you consume kratom can vastly impact the experience. The same applies to the dose taken, and even then the effects from a given dose of kratom will vary depending on many factors such as your weight, gender, [metabolism](https://www.pharmacologyeducation.org/pharmacology/drug-metabolism), and [tolerance](https://drugsand.me/en/me/#tolerance) from previous use. Read our section on [dosing](https://drugsand.me/en/me/#dosing) for more information.

### How you take Kratom matters...

From the least to the most harmful way.

**Eating or drinking**

Dried leaves can be chewed, but because the texture is dry and tough, the leaves are commonly crushed into a powder for easier ingestion. Kratom has a strong taste, therefore, the powder is mixed with sweet liquids like fruit juice or milk. Alternatively, Kratom powder can be added to foods like yogurt or applesauce.

The ‘toss and wash’ method is also quite popular. More info on this method can be found [here](http://kratomtimes.com/toss-wash-method/).

**Infused**

Commonly, Kratom is infused in hot water. Many claim that both the euphoric and mood boosting effects of kratom are enhanced with this method in comparison to taking powder. This is because of the rapid digestion and absorption of Kratom alkaloids. However, it is thought that the pain relieving properties of Kratom are reduced.

**Capsules**

Others prefer to take kratom in the form of pills or capsules, much like other supplements. This is a safer option as dosing is more controlled.

**Smoking and snorting**

You should avoid snorting or smoking kratom because both methods increase the speed at which the drug reaches your bloodstream, making it more addictive and thus increasing the risk of overdose and death. These methods may also damage your nose, throat and upper respiratory system. Damage can range from a nosebleed to a respiratory tract infection or even blood clots in the lungs.

More information on the various ways to consume kratom can be found on [The Kratom's user guide](http://www.sagewisdom.org/kratomguide.html).

### Kratom dosage

When it comes to dosing, it is important to note that Kratom has an uncommonly broad range of effects, meaning it acts in different ways depending on how much you take of it.

- 1 to 4 grams can produce subtle, stimulant effects.
- 4 to 6 grams can produce analgesic, stimulant or sedative effects.
- 6 to 8 grams can produce strong analgesic or sedative effects.
- 8 or more grams can produce very strong analgesic and sedative effects, which can be really dangerous and are not recommended.

**Kratom extract (oral dosage)**

- Threshold: 1g
- Light: 1-2g
- Common: 2-4g
- Strong: 2-6g
- Heavy: 5-8g

**Kratom tea (infused)**

- Threshold: 1 g
- Light: 3 g
- Common 5 g
- Strong: 10 g
- Heavy: 11+ g

### When do the effects of Kratom kick in and for how long?

The **START** time below is when you will usually begin to feel the effects of kratom from the time when you first take it. **DURATION** is roughly the length of time you will experience the effects, after which the effects will start to wear off and you might start to feel the comedown effects.

Kratom has a wide range of effects, depending on the dosage. At small doses, it’s a stimulant and at larger doses it acts as a sedative. The stimulatory effects may be shorter than the sedative ones, as the stimulatory effects tend to appear faster and fade earlier.

- **START:** 10-15 minutes
- **DURATION:** 2 - 4 hours
- **PEAK:** 1 - 2 hours
- **AFTER EFFECT:** 3 - 6 hours

**References:** [The Kratom User's Guide](http://www.sagewisdom.org/kratomguide.html); [_www.erowid.org_](https://www.erowid.org/chemicals/mdma/mdma_effects.shtml)

### Dependence, tolerance and withdrawal

Whilst Kratom is not thought to have a strong dependency potential, especially when taken at low doses, when you take something regularly a habitual addiction can form. With a habitual addiction comes an increasing tolerance that demands bigger doses. This is why we recommend that you leave plenty of time between drug-taking experiences - the longer, the better. If you’re struggling with kratom, take a look at [this thread](https://www.reddit.com/r/quittingkratom/).

[Tolerance](https://www.verywellmind.com/medication-tolerance-1124101) can easily be built after prolonged use, causing the need to take more drug to achieve desired effects. This can also cause withdrawal symptoms when stopping intake. These include: runny nose, slight muscle pains.

**Addiction**

The DEA states that [kratom abuse can lead to addiction](https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=84), which can lead to developing psychotic symptoms, such as hallucinations, delusion, and confusion. Not everyone will experience addiction in the same way, however, there are several hallmark symptoms which include:

- Tolerance, dependence, withdrawal
- Secretiveness, stealing, and/or [lying](https://www.verywellmind.com/my-addicted-loved-one-lies-all-the-time-22118)
- Trouble scaling back or stopping drug
- Dropping and losing interest in hobbies, job/school and activities
- Vast amounts of time spent getting, using, and recovering from the drug
- Changes in mood, sleeping patterns, weight, activity levels
- Increased muscle spasms and pain
- Hot flashes, fever, watery eyes, runny nose

Read more about the possible risks of kratom [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402527/)

### Long-term use

Studies of frequent kratom users in Thailand and Malaysia have suggested the existence of long-term side effects associated with the use of high doses of kratom for a prolonged period of time. These include:

- Weight loss
- Insomnia
- Dark spots (hyperpigmentation) on the skin
- Nausea
- Appetite loss
- Frequent urination
- Dry mouth
- Fatigue
- Constipation
- Tremors or shaking
- Seizures
- [Psychosis](https://www.priorygroup.com/mental-health/drug-induced-psychosis)

Read the complete study [_here_](https://www.ncbi.nlm.nih.gov/pubmed/24698080).

Sometimes the drugs we think we are buying turn out to be something very different. Knowing the common substitutes and adulterants that dealers swap or add into the drug is an easy way to protect yourself and your friends.

Commercial versions of kratom are usually combined with other drugs and substances. A good example is krypton, which is sold as a stronger version of kratom. This is a very dangerous substitute because it contains both kratom and an additional opiate compound related to [tramadol](https://www.nhs.uk/medicines/tramadol/). This drug preparation can cause respiratory failure and lead to death.

Another common substitute of kratom is akuamma. Some report it has similar but stronger effects to kratom, those being relaxing, euphoric and relatively long lasting (4-5 hours). Akuamma, however, has a higher potential to cause dependence as withdrawal symptoms are often stronger.

**References:** [Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton.](https://www.ncbi.nlm.nih.gov/pubmed/21513619)

Currently, more research is needed in order to determine kratom’s exact half-life i.e. _the time it takes for the drug’s blood concentration to be reduced by half_. As with many other drug, how long kratom stays in your system will depend on factors such as:

- Strain of kratom
- Frequency of use
- Age
- Genetics
- Body fat
- Water and food intake
- Metabolic rate

However, based on current research, it is thought that the main alkaloid found in kratom, mitragynine, has a half-life of approximately 23-24 hours.

This means that after you take kratom, it takes a whole day to eliminate 50% of the drug from your system.This implies it should take around five days for kratom to be fully cleared your system.

### Does kratom show up in a drug test?

A big reason why some decide to take kratom as opposed to other opioids is because they believe it does not show up in drug tests. While it is true that most standard drug tests such as [SAMHSA-5](https://www.samhsa.gov/workplace/resources/drug-testing) can not detect kratom, there are some [kratom alkaloids](https://www.kratomscience.com/2014/10/08/list-alkaloids-identified-mitragyna-speciosa-kratom/) that can be detected on certain drug tests, such as urine or blood tests.

**Kratom Urine Tests**
Some kratom alkaloids may show up on certain urine tests. While research that indicates how long kratom would be detectable in a user’s urine is limited, there could be trace amounts detected in a urine test for over a week. For someone who doesn’t use kratom often or uses low doses, it probably wouldn't be detectable in their urine after a week.

**Kratom Blood Tests**
A blood test could identify the presence and quantity of Kratom, by showing the concentration levels of the drug. Blood tests can show concentration levels of kratom. In cases of heavy or long-term use, there would likely be metabolites that could show up in blood tests for several days following ingestion, but because blood tests provide a shorter window for substances to be detected, and they’re more invasive, it’s more likely that a urine test would be conducted.

**References:** [The pharmacology and toxicology of kratom: from traditional herb to drug of abuse](https://link.springer.com/article/10.1007/s00414-015-1279-y); [Kratom Drug Test: The Complete Guide in 2019](https://www.budsandblossomsco.com/kratom/kratom-drug-test/)

### Europe

- **UK**: Possession is legal, but possession with intent to supply is illegal. The sale, import, and export of kratom is prohibited under the Psychoactive Substances Act since March 2016.
- **Germany:** Not illegal, but it’s an unapproved medical drug making it illegal to buy, sell, import, or use it.
- **France:** Legal
- **Netherlands:** Legal
- **Spain:** Legal
- **Russia:** Illegal
- **Italy:** Illegal to possess, sell, or import.
- **Ireland:** Schedule 1 illegal drug.

### America

- **USA**: legality varies by state.
  - Alabama - Schedule 1
  - Arkansas - Controlled Substance
  - California - Legal
  - Florida - Legal
  - Illinois - Legal (age restriction)
  - Indiana - Illegal
  - New York - Legal
  - Rhode Island - Illegal
  - Tennessee - Controlled Substance
  - Wisconsin - Illegal
- **Canada:** Selling or possessing kratom is illegal if there is an intention to ingest.
- **Mexico:** legal without restrictions.

### Asia and Australia

- **Australia:** Illegal
- **New Zealand:** Illegal
- **Singapore:** Illegal
- **Hong Kong:**
- **Israel:** Illegal
- **Thailand:** illegal since 1943. In 1979, reclassified as a Type 5 narcotic (the least restrictive and punitive level).

### Africa

- **South Africa:** Legal

**References:** [A Guide to Kratom Legality](https://speciosaguide.com/guide-kratom-legality-kratom-legal/); [Psychoactive Substances Act 2016](http://www.legislation.gov.uk/ukpga/2016/2/contents); [The Legal Status Of Kratom In South Africa](http://purekratom.co.za/kratom-laws-south-africa/)

### Myths

**Kratom is a herbal supplement, so it can't be unsafe.**

Many people believe that since kratom is a herbal remedy, it's safe. It's important to keep in mind that herbal products aren’t reviewed by the U.S. Food and Drug Administration before they hit the market. As a result, there’s no guarantee that a supplement will contain the ingredients listed on the label (or that those ingredients will appear in the indicated amounts). Adulteration and contamination with other drugs, herbs, and substances are possible.

Kratom can take up to 90 minutes to have an effect, be patient and don’t exceed the recommended dosage.

Start small

Alcohol can increase the intended and negative side effects of kratom, making it a potentially lethal combination.

Avoid alcohol

Kratom is a diuretic, so it increases the amount of urine you produce. Make sure you drink plenty of water to avoid negative side effects.

Kratom

{Thang, Krypton, Kakuam, Thom, Ketum}

Harm reduction