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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.

[^1]: Palamar, J. J., Acosta, P., & Cleland, C. M. (2019). Planned and Unplanned Drug Use during a Night out at an Electronic Dance Music Party. *Substance use & misuse*, *54*(6), 885--893. <https://doi.org/10.1080/10826084.2018.1529186>

[^2]: Mustonen, A., Niemelä, S., Nordström, T., Murray, G., Mäki, P., Jääskeläinen, E., & Miettunen, J. (2018).[ Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis](https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/adolescent-cannabis-use-baseline-prodromal-symptoms-and-the-risk-of-psychosis/D5CAA12A5F424146DABB9C6A6AB4CB56). *The British Journal of Psychiatry,* *212*(4), 227-233. doi:10.1192/bjp.2017.52

[^3]: Sessa B, Higbed L and Nutt D (2019) A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy. Front. Psychiatry 10:138. doi: 10.3389/fpsyt.2019.00138

### How do recreational drugs work?

Understanding how the feelings and effects of drugs happen requires a bit of understanding of how brains work. Our brains are made up of cells known as neurons. Neurons communicate through the release of chemicals known as neurotransmitters. A neurotransmitter is released by one neuron at a junction called the synapse and either inhibits or excites the neuron on the other side through proteins known as receptors.

*Most* drugs mentioned on this site act to change how a family of neurotransmitters called monoamines act in the brain. This includes serotonin, noradrenaline and dopamine, which you may have heard of. There are some exceptions to this, such as ketamine, nicotine or alcohol.

When you take a drug, it enters your brain and influences how these neurotransmitters work, changing its properties and altering how your neurons act. This can be great! It's the basis of what you're feeling when you take the drug. It can also be bad and damage your neurons with long lasting effects, such as neuron death. If you'd like to know more about this process, check out this [website](https://thedea.org/mdma-risks-science-and-statistics-technical-faq/how-does-mdma-molly-ecstasy-work/) - it's aimed at MDMA but the mechanisms explained highlight how drugs work.

Once the drug is cleared from your body and brain, you'll be dealing with the after effects, known as a comedown.

### A note on drug-assisted therapy

You may have seen in the news that some drugs, such as ketamine and MDMA have been used recently to help with existing mental health problems[^3]. The use of them in this way is different to using drugs recreationally. It is done in a controlled setting, with a trained clinician working with you.

### How to get help?

Speak to a medical professional if you or someone you know may need help.

Before any experience with recreational drugs, there are three main things you should think about to help prepare yourself and look after your health: preparation, set and setting. These three areas will have different relevance for different types of drugs, though they are all important to consider beforehand. For instance, with psychedelics, mindset might take the forefront. Or with empathogens (e.g. MDMA), setting can be very important for a positive experience. Most people take drugs in the spur of the moment[^1], so it's worth getting clued up in advance. Set and setting are good things to think about every now and then anyway, so if you take a few minutes to reflect on how you feel and who you're with you'll get used to the idea.

### Preparation

Try to prepare for any experience - we know it's not always possible but your future self will be very grateful, plus it'll help settle any anxiety or apprehension you might be feeling. Buy a set of [testing kits](https://dosetest.com/r/15/) to have on hand, get any supplements that may help you afterwards and [check](https://www.drugsand.me/tools/interactions) if the drug interferes with anything else you are taking.

We've adapted Rollsafe's great [MDMA list](https://rollsafe.org/mdma/#safer-and-more-enjoyable-usage-checklist) into our own HeadSafe checklist. Nothing on the list is mandatory, but each item you tick on the list increases your chances of a good experience.

#### HeadSafe checklist

1. I’ve given myself enough time to recover since I’ve last taken a recreational drug
2. I’ve had a look through the [benefit-harm management guide](https://www.drugsand.me/en/) to be as safe as possible
3. I know what I’m taking, how much I’m taking and how I’m taking it
4. I know where I’m going and who with and they’re both safe and positive
5. I know what to do during the event to keep myself safe, including drinking enough water
6. I’m aware that some drugs may bring emotional issues to the surface and have some techniques ready to help if I’m struggling
7. I know what to look out for in my friends if they’re struggling and how to help them out
8. I know why I’m taking them, even if it is only for fun
9. I’m prepared for the comedown and know some coping mechanisms like [mindfulness](https://www.drugsand.me/blog/how-to-cure-a-comedown)

### Mindset

Before you choose to take drugs it's a good idea to take a minute to reflect on your "set". Set, or mindset, refers to your own personality, traits and mental state. It can be separated into two categories: long range/distant mindset and immediate mindset.

Your long range/distant mindset is the underlying traits that all humans have, such as your desires, fears, long term goals and anxieties. So, if you're generally quite anxious, you should learn about which drugs are likely to increase this feeling, and how to cope with it. Luckily you're in the right place!

The immediate mindset is your mental state going into the experience. This might be how you feel on the day - anxious, excited, but also, particularly for psychedelics, how open you are feeling on the day to potentially intense experiences. Think how you are feeling and the day that you've had. Are you feeling exhausted from a long day of work? Maybe it's not a great time to take stimulants that will keep you up.

There's much more to mindset, but this is just a brief overview. Remember the key points from the checklist above:

- I know why I’m taking them, even if it is just for fun. Is it to have a good time? Because your friends are taking it? These are perfectly reasonable reasons (if not from a legal standpoint). However, if it’s for a deeper reason, or you set your expectations too high, this can impact you going in and have an impact on your mental health.
- I’m aware that some drugs may bring emotional issues to the surface. It's important to know this might happen to you or a friend and it is not something to be afraid of. Read on below for some tips on how to cope if it happens.

### Setting

Setting encompasses the physical environment you'll be in - whether that's a club, a house or the forest - but also the social environment, i.e. who you'll be with. Setting can have a huge impact on your experience and how you feel afterwards, but everyone is different. For example, some people might find using psychedelics in a club environment overwhelming, but others wouldn't have it any other way.

That being said, if you're alone in a club on psychedelics, it's not quite the same as being with all your closest friends. And heavy metal might not have the same effect on you as psytrance!

Have a look at our checklist again for some quick things to think about:

- I’ve got a safe, positive environment to take it. Is the venue one that aims to keep it’s attendees safe and secure?
- If I'm taking them with friends and I know what to look out for if they’re struggling. Are you planning to go with good friends who you trust?

### Tips & Tricks

>>> tabs
# Prepare
Psychedelics
-   Have some water with you.
-   Have a pen and paper handy in case you wish to draw or jot down notes.
-   You may want a trip sitter to keep you safe during the use.

Stimulants
-   Separate your doses and decide when you'll take them.
-   Grind up the drug that you are taking.
    Make sure you've eaten.

Sedatives
-   Separate your doses and decide when you'll take them.}

# Mindset

Psychedelics
-   Make sure your intentions are clear and you're in the right mental space for the trip.

Stimulants
-   Make sure your intentions are clear and you're in the right mental space.

Sedatives
-   Avoid using sedatives to numb anger or sadness, this can lead to bad experiences too.

# Setting

Psychedelics
-   Is your chosen environment a place with people you trust and are comfortable with?

Stimulants
-   Is the environment a positive, safe one with space to rest and cool down?

Sedatives
-   Make sure your environment is safe with people you trust.
-   Once you have take them, you may stumble or fall easily.
<<<

### You're there - lying in a field, at a friend's house or in a club...

First things first, start low and go slow. The worst thing you can do is take too much. Less is more! Always remember that you can take more if you need to, but you cannot un-take what you have already taken.

Secondly, look out for your mates and fellow party-goers. Remember smoking and chill out areas exist for a reason - if it's all a bit much, it can do a world of good to pop outside or have a sit down for a few minutes. If it goes south, don't leave friends unattended and never be scared to ask for help from stewards, medics or security. If you see someone else struggling, an "are you okay?" never goes amiss!

Lastly, remember to have fun and enjoy the experience. If it's an appropriate setting, don't be scared to have activities - from massages to meditation and drawing, there's lots of ways to enjoy the event.

### Looking after yourself:

1. Remember the effect of the drug and the feelings in that moment are only temporary - especially for psychedelics - the feeling will eventually end.
2. If you’re panicking, take notice and focus on slowing breathing down to calm down
3. Keep an open mind to the feelings you feel even if the experience was not what you expected

#### Grounding

Grounding is a term used to describe taking notice of the time and place around you. It's very common to hear it used in terms of mindfulness, where they are used to help you stay in the moment and feel connected to the world around you.

This technique can help to have a way to bring yourself back down if it's getting a bit too much. Some people find having an object that is relevant to them can be helpful, others find going for a sit down or fresh air can be helpful.

It can also help to appreciate what you are feeling and how you are feeling. You can feel great having taken something and it is good to acknowledge that and appreciate it in the moment. Breathing exercises might be one of the easiests ways to do this in the moment. Inhale for 3, hold for 3, and exhale or 3. Repeat this until you're at 8 or [check this guide out](https://www.bigbreathathome.com/breathing-technique-8-triangular-breathing/) for more information.

### Looking after your friends

At some stage, you may be with someone having an unpleasant experience, regardless of the type of drug they take or their previous experience of using it. The most important thing is to make sure this person is physically okay. If you're ever worried, seek medical help.

Here are some tips for helping people having an unpleasant experience, adapted from the [MAPS and Zendo Project](https://www.globaldrugsurvey.com/past-findings/gds2017-launch/understanding-and-working-with-difficult-psychedelic-experiences/):

1.  Create a safe space: Be grounded and compassionate. Approach with kindness and openness, creating an environment of acceptance and compassion. Let the person know that they are in a safe place and that their experience is welcome.
2. Sitting and not guiding: Words can often confuse or get in the way. Use them sparingly unless the individual is desiring to engage in a dialogue about their process. Rather than analyze their experience, listen with an open mind and heart.
3.  Talk through, not down: Help the individual turn toward their experience rather than away from it. Trust that whatever is showing up for them is something that they are being invited to learn about. Never dismiss or invalidate someone's perceived reality.
4. Acknowledging the difference between difficult and bad: Difficult life experiences can be some of the most valuable learning opportunities. Strength, resilience, surrender, and deep wisdom are often forged in the fires lit in our darkest times.

#### Active listening

Active listening means listening to someone with compassion and kindness, in a neutral and non-judgmental way. You want to understand the person and their struggle. Active listening isn't guiding them through what they're experiencing, just be there and listen!

You can reflect back what they say to let them know you are hearing and understanding them, or use words like "uh-huh" or "mmm" at relevant places in the conversation. Non-verbal communication is also important, use nods to acknowledge them and keep an open body language.

Make the person know that they can share thoughts and emotions if they want to but that there's no expectations. Be patient and don't worry if there are silences - you're there to sit with them. Active listening is a powerful tool used in business, schools and health. To learn more about it, here is a[ helpful starting point](https://www.youtube.com/watch?v=s3MCJZ7OGRk&feature=youtu.be).

Coming back down to normal life can be off putting. Each substance has a different type of come-down and you can check out what these often are in our [drug pages](https://www.dugsand.me/drugs). These are diverse effects and can vary person to person. In the immediate aftermath of the event, what can you do to help your mental health?

These comedown effects are perhaps most pronounced with MDMA and psychedelics. Though many guides are available for supplements that may help with comedowns, it's important to remember two key things: sleep and eat well. No easy task after a night out.

This is really key for two reasons:

-   Common feelings of anxiety, paranoia and even hallucinations are also symptoms of sleep deprivation and can exacerbate any comedown from drugs.
-   If you've been on a night out, you've probably not eaten for over 12 hours - you'll need a top up!

What else can you do to help you through the next week or so? Well - keep up social contact if you feel up to it. Hang out with those you've been out with. Get outside in the fresh air. Make sure you return to your routine as much as you can. And, apparently [dogs can help too!](https://www.vice.com/en_uk/article/7xxnyg/i-spent-a-month-testing-comedown-cures-safe-sesh)

### Comedowns

Comedowns, or hangovers, are just how you feel in the days following taking drugs or alcohol. You can think about comedowns in three stages. The first is the reaction your body has after an exhausting -- both mentally and physically - night or day beforehand. This is normal, and should be fine once you've rested, eaten and slept.

The second is the one that comes around because of the direct impact on your brain. Earlier we described how neurotransmitters are released from one neuron onto another. The feelings you feel immediately afterward may just be a result of this action.

However, the last is the impact this may have long term. Over time, these temporary changes can build up. If you take ecstasy on a regular basis, you may be releasing and depleting your serotonin before it has a chance to fully replenish itself. This means you will be operating on lower-than-normal serotonin levels most of the time, and this can [lead to depression](http://www.bmj.com/content/350/bmj.h1771) or worsen depressive symptoms.

Sometimes this long term effect may manifest where there is no or little immediate comedown. Cannabis may only have mild or short term comedowns, but heavy and consistent use over time may exacerbate underlying mental health problems, especially if you're under 18[^2].

It can be quite difficult to tease out each element of the comedown and how your use is impacting you.

#### Can I avoid it? What helps them?

Sadly there is not an easy way to get around comedowns. The best way to avoid comedowns and long term side effects is to spread out and reduce use.

There are online guides, such as those on [TripSafe](https://tripsafe.org/psychedelic-supplements/) and [Rollsafe](https://rollsafe.org/mdma-supplements/), that provide supplement lists. These could help reduce the negative impacts of some drugs. The theory behind these is to offset a negative part of the drug, such as taking 5-HT (aka Serotonin) to replace it after it's depletion. There is not anything more than anecdotal evidence for these though!

### Between doses

You've had a fantastic experience and the first thing you want to do is to dive back in. Wait! You can do yourself serious damage by using drugs regularly. Give yourself time to recover.

We've got some suggestions to help bring you back up to tip top shape:

-   Share - some experiences can bring up thoughts that might challenge you. Feel free to discuss these with those you trust, especially if they have shared that experience or similar with you. Reminiscing about a night out can also be good!
-   Recover - Processing the experience can take time. Mindfulness exercises and yoga can help ground you and provide resilience, helping your mental health in life and onwards.
-   Exercise - don't forget the physical. Get moving and get outside!
-   Eat well - making sure you're eating healthily can help you recover and to improve your own mental health.
Consider your 'normal' - what do you normally do to look after your emotional wellbeing? There are many tools and apps around that can help you think about this such as the [Wheel of Wellbeing](http://www.wheelofwellbeing.org/).

Take care of yourself and your friends

Preparation, mindset, setting - think about them before you take any drug recreationally, even if quickly.

Before

Keep a close eye on your friends and think about yourself too. Enjoy yourself, and if you have a bad time, remember it won’t last forever.

During

Take it easy for a bit; sleep, eat and relax. Space out your experiences to give your body and mind time to return to normal.

Mental Health

{Take care of yourself and your friends}

In the know

How do recreational drugs work?

A note on drug-assisted therapy

How to get help?

References