Harm reduction, not medical advice. Safety over stigma. Substance testing saves lives.
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1. Call 911 immediately.
2. Give Narcan/naloxone if available. Spray in one nostril or inject in outer thigh.
3. Turn them on their side (recovery position) so they don't choke on vomit.
4. Start rescue breathing if they stop — one breath every 5 seconds.
5. Give a second Narcan dose after 2-3 minutes if no response. Stay until help arrives.
Narcan only reverses opioids. Street fentanyl now commonly contains xylazine or medetomidine (veterinary sedatives) that Narcan does NOT reverse. Give Narcan anyway — it reverses the opioid component. But the person may not wake up fully. Keep breathing for them until paramedics arrive.
You are safe. This feeling is temporary. It will end.
Breathe: In for 4 counts. Hold for 4. Out for 6. Repeat.
Move: Go somewhere quieter, cooler, with less stimulation.
Ground: Touch something cold. Name 5 things you can see. Feel your feet on the floor.
Tell someone: You don't have to do this alone. Ask a friend to sit with you.
If someone has taken MDMA, tramadol, DXM, or SSRIs together and shows these signs — call 911:
Muscle rigidity or twitching (especially legs)
High fever / overheating that won't stop
Rapid heartbeat + agitation + confusion
Clonus (rhythmic jerking of ankles or eyes)
This is a medical emergency. Cool them down while waiting for help.
Stop dancing. Move somewhere cool. Remove extra layers.
Sip water slowly — do not chug. About 1 cup per hour.
If they can't cool down, are confused, or stop sweating — call 911. Hyperthermia kills.
Pour cool (not ice) water on neck, wrists, and armpits.
Emergency: 911
Never Use Alone: 1-800-484-3731
Stays on the line while you use. Calls 911 if you go silent.
Fireside Project: 62-FIRESIDE (623-473-7433)
Psychedelic peer support, daily 11am-11pm PT
SAMHSA: 1-800-662-4357
Free, confidential, 24/7
Crisis Text: Text HOME to 741741
Poison Control: 1-800-222-1222