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Alcohol

Depressant

Ethanol · Booze · Beer · Wine

The oldest known psychoactive substance — evidence of intentional fermentation dates to approximately 7000 BCE in China. The highest-harm substance in any multi-criteria analysis (Nutt 2010: 72/100), reflecting both individual and societal damage. Involved in more drug interaction deaths than any other substance because it potentiates nearly every depressant.

Very high harmHighly addictiveVery narrow safety margin

Caffeine

Stimulant

Coffee · Tea · Energy drinks · Pre-workout

Consumed for over a millennium — coffee cultivation traces to 9th-century Ethiopia, tea to ancient China. The world's most widely consumed psychoactive substance, acting as an adenosine receptor antagonist. Physical dependence develops quickly, with withdrawal headaches beginning 12-24 hours after the last dose.

Low harmMildly addictiveModerate safety margin

Nicotine

Stimulant

Cigarettes · Vape · Tobacco · Snus

Tobacco has been used by indigenous peoples of the Americas for thousands of years in ceremonial and medicinal contexts. Acetylcholine receptor agonist and one of the most addictive substances known — approximately 68% of users eventually develop dependence. The harm score of 26 reflects smoked tobacco specifically; nicotine alone (patches, gum, vaping) is far less harmful than combustion.

High harmExtremely addictiveModerate safety margin

Cannabis

Cannabinoid

Marijuana · Weed · THC · Pot

One of the oldest cultivated plants — evidence of use dates to at least 3000 BCE in Central Asia. Acts on the endocannabinoid system (CB1/CB2 receptors), producing relaxation, altered perception, and appetite stimulation. Alcohol increases THC blood levels by approximately 60%, explaining why the combination hits harder than either alone.

Moderate harmLow addiction potentialNo known lethal dose

Cocaine

Stimulant

Coke · Snow · Blow · Crack

Derived from coca leaves, which have been chewed in the Andes for at least 5,000 years; the alkaloid was first isolated in 1860. Blocks dopamine, serotonin, and norepinephrine reuptake. Combined with alcohol, the liver creates cocaethylene — a unique compound more cardiotoxic than either drug alone.

High harmHighly addictiveVery narrow safety margin

MDMA

Empathogen

Ecstasy · Molly · E · X

3,4-Methylenedioxymethamphetamine — first synthesized at Merck in 1912 as a pharmaceutical intermediate; its psychoactive properties went unnoticed until Alexander Shulgin resynthesized it in 1976. Works by reversing serotonin, dopamine, and norepinephrine transporters, and inactivates the liver enzyme (CYP2D6) that clears it, so redosing produces disproportionately higher blood levels. Serotonin depletion after use causes a characteristic low mood 2-4 days later.

Low harmLow addiction potentialVery narrow safety margin

Amphetamine

Stimulant

Speed · Adderall · Dexedrine · Vyvanse

First synthesized in 1887; marketed as Benzedrine inhalers in the 1930s and used extensively by all sides in World War II. Release dopamine and norepinephrine, with extended-release formulations lasting significantly longer than instant-release. Therapeutic doses are well-studied; cardiovascular risk scales with dose and frequency.

Moderate harmModerately addictiveModerate safety margin

Psilocybin Mushrooms

Psychedelic

Shrooms · Magic Mushrooms · Caps

Used ceremonially in Mesoamerica for at least 2,000 years; the active compound was isolated by Albert Hofmann in 1958. Among the safest psychoactives known — no lethal dose has been established in humans. Whole mushrooms are almost never adulterated, and tea preparation produces a faster onset with shorter effects than eating them.

Low harmNo known lethal dose

LSD

Psychedelic

Acid · Lucy · Tabs · Blotter

Lysergic acid diethylamide — first synthesized by Albert Hofmann at Sandoz Laboratories in 1938; its psychoactive properties were discovered accidentally in 1943. Extremely potent — active in microgram doses, far below what's visible to the eye. Rarely adulterated on blotter; NBOMe compounds are the main substitution risk and are bitter-tasting, unlike LSD.

Low harmNo known lethal dose

Ketamine

Dissociative

K · Special K · Ket · Vitamin K

Synthesized in 1962 at Parke-Davis as a safer alternative to PCP for anesthesia. Blocks NMDA receptors, producing a dose-dependent spectrum from mild dissociation to complete K-hole immersion. Now FDA-approved as esketamine (Spravato) for treatment-resistant depression; tolerance builds quickly and chronic heavy use causes bladder damage.

Moderate harmModerately addictiveVery narrow safety margin

Opioids (Heroin)

Opioid

Heroin · Morphine · H · Smack

Heroin was synthesized in 1874 and marketed by Bayer in 1898 as a non-addictive morphine substitute. Mu-opioid receptor agonist that produces profound pain relief and euphoria. In most US markets, samples sold as heroin now contain primarily fentanyl — only ~2% test as expected heroin.

Very high harmHighly addictiveVery narrow safety margin

Methamphetamine

Stimulant

Meth · Crystal · Ice · Tina

First crystallized by Japanese chemist Akira Ogata in 1919; used extensively by Axis and Allied militaries in WWII under brand names like Pervitin. Produces intense dopamine release that is directly neurotoxic at high doses. Street purity is typically high (~88%), meaning the danger is the drug itself, not adulterants.

High harmExtremely addictiveVery narrow safety margin

Benzodiazepines

Benzodiazepine

Benzos · Xanax · Valium · Klonopin

The first benzodiazepine (chlordiazepoxide/Librium) was discovered accidentally by Leo Sternbach in 1955. GABA-A receptor modulators that are relatively safe alone but extremely dangerous combined with opioids, alcohol, or GHB. Physical dependence develops within 2-4 weeks of daily use, and withdrawal can cause seizures.

Moderate harmHighly addictiveVery narrow safety margin

Fentanyl

Opioid

Fent · Blues · Pressed pills · China White

Synthesized in 1960 by Paul Janssen and originally used exclusively in surgical anesthesia. Approximately 50-100x more potent than morphine, with an active dose measured in micrograms. Now detected as a contaminant in cocaine, methamphetamine, pressed pills, and counterfeit prescriptions across most US drug markets.

Very high harmHighly addictiveVery narrow safety margin

Kratom

Opioid

Mitragynine · Ketum · Biak

Derived from the leaves of Mitragyna speciosa, used for centuries in Southeast Asia by laborers and in traditional medicine. Partial mu-opioid agonist with dose-dependent effects — stimulating at low doses, sedating at high doses. Only 5% of kratom-positive overdose deaths had kratom as the sole substance; fatality risk increases when combined with other depressants.

Moderate harmModerately addictive (with regular use)Very narrow safety margin

DXM

Dissociative

Dextromethorphan · Robo · Robotripping · Skittles

Dextromethorphan — developed in the 1950s as a non-addictive replacement for codeine in cough suppressants. Effects are described in four dose-dependent plateaus, from mild stimulation to full dissociation. Many OTC formulations contain acetaminophen, guaifenesin, or antihistamines that are toxic at recreational DXM doses.

Moderate harmLow addiction potentialVery narrow safety margin

GHB

Depressant

G · Liquid Ecstasy · GBL · 1,4-BD

Gamma-hydroxybutyrate — synthesized in 1960 by French researcher Henri Laborit during research on GABA neurotransmission. One of the steepest dose-response curves of any recreational substance — the difference between a recreational dose and a fatal dose can be less than 2x. Combined with any other depressant, individually survivable doses become lethal.

Moderate harmHighly addictiveVery narrow safety margin

Nitrous Oxide

Dissociative

Laughing Gas · N2O · Whippets · Nangs

Discovered by Joseph Priestley in 1772; recreational laughing gas parties were popular in the early 1800s before its medical applications were recognized. The fastest onset and offset of any recreational substance. Triggers endogenous opioid peptide release in the brainstem, which is why it's synergistically dangerous with exogenous opioids.

Low harmLow-moderate (binge pattern)Wide safety margin

Poppers (Alkyl Nitrites)

Inhalant

Amyl Nitrite · Rush · Jungle Juice · Room Odorizer

Amyl nitrite was first synthesized in 1844 and originally used medically for angina; recreational use became widespread in the 1970s. Inhaled alkyl nitrites that cause brief vasodilation, head rush, and smooth muscle relaxation. Combined with PDE5 inhibitors (Viagra/Cialis), both increase cyclic GMP, causing potentially fatal blood pressure collapse — an absolute pharmacological contraindication.

Low harmNot addictiveWide safety margin

Tramadol

Opioid

Ultram · Tramal

Developed in 1962 by the German pharmaceutical company Grünenthal. An atypical opioid that also inhibits serotonin and norepinephrine reuptake, creating interaction risks that pure opioids don't have. Lowers seizure threshold — seizures occur even at prescribed doses — and is uniquely dangerous with other serotonergic drugs due to serotonin syndrome risk.

Moderate harmModerately addictiveVery narrow safety margin

2C-x (2C-B, 2C-E, 2C-I)

Psychedelic

Nexus · Bees

Synthesized by Alexander Shulgin in 1974 and documented in his book PiHKAL. Unusually steep dose-response curve — 2mg more can dramatically change the experience. Combines mild visual effects with tactile and empathogenic warmth at lower doses, shifting to intense psychedelia above 25mg.

Low harmNot addictiveVery narrow safety margin

DMT

Psychedelic

Dimitri · Spirit Molecule · Ayahuasca

N,N-Dimethyltryptamine — found in hundreds of plant species and used for millennia in Amazonian ayahuasca traditions. The most intense psychedelic experience available — complete reality replacement when smoked. Produced endogenously in the human body in trace amounts, though its natural function is unknown.

Low harmNo known lethal dose

Mescaline

Psychedelic

Peyote · San Pedro · Wachuma

Used by indigenous peoples of the Americas for at least 5,700 years, making it one of the oldest known psychedelics. Notably gentle, grounded character compared to LSD or mushrooms, but one of the longest-lasting psychedelics. Active doses are large (200-400mg), and nausea during onset is nearly universal.

Low harmNo known lethal dose

PCP

Dissociative

Angel Dust · Wet · Sherm · Dust

Phencyclidine — developed as a surgical anesthetic in the 1950s and quickly withdrawn due to severe dissociative and psychotic side effects in patients. Unlike ketamine, PCP activates dopamine systems, contributing to both its addiction potential and psychosis risk. Effects are unpredictable and dose-dependent, ranging from euphoria to violent agitation to complete anesthesia.

Moderate harmModerately addictiveVery narrow safety margin

Methylphenidate

Stimulant

Ritalin · Concerta · MPH · R-ball

First synthesized in 1944 by Leandro Panizzon; marketed as Ritalin in 1954, named after his wife Rita. The most widely prescribed stimulant globally. Unlike amphetamine, which forces monoamine release, methylphenidate blocks reuptake of dopamine and norepinephrine — less euphoric, shorter-acting, and generally lower-risk. Combining with alcohol creates ethylphenidate through the same liver pathway that turns cocaine + alcohol into cocaethylene.

Moderate harmLow-moderate at therapeutic dosesModerate safety margin

Synthetic Cathinones

Stimulant

Bath Salts · Eutylone · Methylone · NNDP

Synthetic cathinones are β-keto analogs of amphetamine, structurally derived from cathinone — a natural stimulant in the khat plant. The first wave hit US emergency rooms in 2010-2011 as 'bath salts,' triggering 6,000 poison control calls in 2011 alone. The dominant compound in the supply changes every 1-3 years as each gets banned and chemists tweak the molecule to create an unscheduled replacement. Usually sold as MDMA/ecstasy, not by their actual names — this is a primary reason why roughly 1 in 4 ecstasy samples contains something other than MDMA.

Nitazenes

Opioid

ISO · Pyro · Benzimidazole opioids · Frankenstein opioids

Originally developed by Ciba-Geigy in the 1950s as morphine alternatives but never approved for medical use due to extreme potency and narrow safety margins. Rediscovered by illicit chemists after China's 2019 fentanyl ban. The first modern variant (isotonitazene, 'ISO') appeared in the US Midwest in 2019 and was linked to at least 40 deaths around Chicago and Milwaukee in seven months. A completely different chemical scaffold from both morphine and fentanyl — a benzimidazole core instead of a morphinan or piperidine ring. At least 26 variants identified by early 2025 across Asia, Europe, North America, Oceania, and South America. China banned the class in July 2025, which may shift production elsewhere.

Tusi / Pink Cocaine

Mixture

Tusibi · Tuci · Tucci · Tussi

Originated in Colombia's nightclub scene in the late 2000s as a way to sell 2C-B. When 2C-B supply dried up, dealers kept the name and pink branding but switched to cheaper, locally available ingredients — typically ketamine, MDMA, and caffeine. The 'tusi' name is a phonetic Spanish rendering of '2C,' and 'pink cocaine' is pure marketing — cocaine is almost never present. Tusi is now its own street-market product category with no consistent formula.

Help
Opioid

Opioids (Heroin)

Heroin · Morphine · H · Smack · Dope

Overview

Heroin was synthesized in 1874 and marketed by Bayer in 1898 as a non-addictive morphine substitute. Mu-opioid receptor agonist that produces profound pain relief and euphoria. In most US markets, samples sold as heroin now contain primarily fentanyl — only ~2% test as expected heroin.

Onset & Duration

Intravenous
🚀 Seconds 3–5 hr100% absorbed
Smoked
🚀 Seconds 3–5 hr~40–60% absorbed
Insufflated (snorted)
🚀 5–15 min 3–6 hr~44% absorbed
Oral
🚀 15–45 min 4–6 hr

Supply & purity

The US heroin supply has been almost entirely replaced by illicitly manufactured fentanyl. Only ~2% of samples test as expected heroin (Maryland RAD data). Xylazine and medetomidine (veterinary sedatives) are now common adulterants that deepen respiratory depression through non-opioid pathways and are not reversed by naloxone. Fentanyl test strips are essentially irrelevant here — the supply IS fentanyl. Assume every dose contains it.

Dosage

Threshold
~5 mg morph eq
Light
5–15 mg
Common
15–30 mg
Strong
30–60 mg
Heavy
60+ mg

Chemistry

MorphinanDiacetylmorphine (pentacyclic morphinan)

The classic morphinan scaffold — five fused rings derived from the opium poppy. Heroin is morphine with two acetyl groups that help it cross the blood-brain barrier faster. DXM shares this exact skeleton but acts completely differently.

Related:FentanylTramadolDXMKratom

How It Works In Your Brain

Opioids (heroin, morphine, oxycodone, etc.) activate mu-opioid receptors - the same receptors your natural endorphins use. The effect is a powerful reduction in pain and a deep feeling of warmth and well-being. They also suppress the brainstem's breathing center, which is how overdoses kill.

Mu-opioid receptors (MOR)Primary

ACTION Activates (agonist)

NORMAL ROLE Your brain's natural pain relief and reward system - endorphins activate these same receptors during intense exercise, orgasm, or injury

WHAT THAT PRODUCES Profound pain relief, euphoria, warmth, emotional insulation. At higher doses: respiratory depression (the brainstem breathing center has mu-opioid receptors, and activating them slows your breathing). This is the mechanism of opioid overdose death

Dopamine system (indirect)Primary

ACTION Mu-opioid activation in the VTA disinhibits dopamine neurons (removes GABA inhibition)

NORMAL ROLE Reward and reinforcement

WHAT THAT PRODUCES Dopamine release in the nucleus accumbens - this is the addiction signal. The indirect mechanism (disinhibition) is different from stimulants (which flood dopamine directly)

Kappa-opioid receptors (KOR)Secondary

ACTION Some opioids weakly activate

NORMAL ROLE Involved in dysphoria, stress response, and some pain modulation

WHAT THAT PRODUCES Some opioids (especially partial agonists) produce a ceiling effect on euphoria and may cause dysphoria at high doses

Glossary
Agonist

Activates the receptor, mimicking the brain's natural signal

Endorphins

Your brain's natural painkillers - chemically similar to opioids. Released during exercise, sex, and injury. Opioid drugs hijack this system.

Dopamine

The 'reward and motivation' signal. Virtually every addictive substance increases dopamine in the reward circuit. It's also essential for movement, focus, and learning.

Lethality

With pharmaceutical opioids of known potency: respiratory depression typically starts at ~2-3x a standard dose. With street heroin — which in most US markets is actually fentanyl — the potency is completely unknown. The effective margin from street supply is essentially unknowable.

30mg of morphine — about two pills — can kill someone who doesn't use regularly.

effective 8 mg IVlethal ~50 mgratio 6:1

Gable

Contraindications

MAOIsDangerous

MAOIs dramatically potentiate opioid effects — particularly serotonergic opioids like tramadol and fentanyl (Boyer & Shannon 2005). Normal doses become lethal. Unpredictable interaction.

GabapentinDangerous

Both depress breathing through different mechanisms — gabapentin reduces CO2 responsiveness while opioids suppress the brainstem breathing center. Opioids also slow the gut, increasing gabapentin absorption. FDA issued a black box warning in 2019. 90% of gabapentin-involved overdose deaths also involved opioids (Gomes et al. 2017).

HIV ARVsUnsafe

Ritonavir inhibits CYP3A4, which metabolizes fentanyl, methadone, and buprenorphine. Blood levels of these opioids increase unpredictably. Fentanyl is most affected — CYP3A4 is its primary clearance pathway. Methadone is less affected because it uses multiple metabolic pathways. Normal opioid doses can become overdose-level with ritonavir on board (Olkkola 1999).

MOUDDangerous

Adding opioids on top of methadone stacks respiratory depression. Street opioids (fentanyl) are especially dangerous because potency is unknown. Methadone tolerance does not fully protect against fentanyl.

CYP InhibitorsUnsafe

Potency Over Time

Stable

Pills remain potent years past expiration — the danger is assuming they're weak

Opioid tablets in solid dosage form are highly stable. The FDA's SLEP program found morphine sulfate among drugs with extension periods of 12-184 months with no failures. Tablets retain potency far beyond printed expiration dates.

Timeline

Opioid tablets retain >90% potency for years past expiration when stored properly.

Harm reduction concern

Someone finds old oxycodone, assumes it must have lost potency by now, and takes extra. But the pills may still be at 85-95% potency. The assumption of degradation leads to intentional overdosing — especially dangerous given the narrow margin between a therapeutic and lethal opioid dose.

What slows degradation

Cool, dry, dark, original packaging.

How Your Body Processes It

Half-lifeheroin: 2–7 min → 6-MAM: 6–25 min → morphine: 2–3 hr

Heroin (diacetylmorphine) is a prodrug that is rapidly deacetylated to 6-MAM, then to morphine. The actual active species is morphine. 6-MAM is the unique marker of heroin use (vs. medical morphine).

Back to baseline3–6 hr
Key metabolites
6-monoacetylmorphine (6-MAM)t½ 6–25 min

Unique heroin marker — presence confirms heroin use (not just morphine/codeine). Very short detection window.

morphinet½ 2–3 hr

Primary active metabolite. What standard opioid panels detect.

Drug testing

Opiates are on all standard drug panels (5/10/12). Heroin-specific confirmation requires detecting 6-MAM, which has a very short window. Poppy seed consumption can cause true positive for morphine/codeine.

Blood6–12 hr (morphine)
Urine1–3 days (morphine), 2–8 hr (6-MAM) (chronic: up to 5 days)
Salivaup to 24 hr
Hairup to 90 days

Withdrawal

Severity
Medical danger
Onset: 8–24 hoursPeak: 36–72 hoursDuration: 4–10 days

Post-acute (PAWS): 6–8 months

Almost never directly fatal. Subjectively extreme but mechanistically different from GABAergic withdrawal.

Physical

• Lacrimation

• Rhinorrhea

• Yawning

• Piloerection

• Diaphoresis

• Myalgia

• Nausea/vomiting

• Diarrhea

• Abdominal cramps

• Mydriasis

• Tachycardia

Psychological

• Dysphoria

• Anxiety

• Irritability

• Insomnia

• Intense drug craving

Mediated by noradrenergic hyperactivity from the locus coeruleus — does not cause seizures or delirium. Deaths are rare and involve severe dehydration, primarily in custodial settings.

Effects

Euphoria ('warm blanket')Total pain reliefDeep sedationWarmthNauseaItching

Biggest risks

YOU STOP BREATHINGAspirationCardiac arrestDeath — #1 cause of drug overdose death

Long-term risks

Severe addiction (often within days)Tolerance escalationVein damage/infections (IV)ConstipationSocial destructionWithdrawal (excruciating but not fatal)

Also called

HeroinMorphineHSmackDopeCodeineHydrocodoneVicodinOxycodoneOxyContinPercocetOxyPercs

Source

Natural & Synthetic

Every number on this page is sourced. Tap any · marker to see the study, confidence level, and methodology.

See an error? corrections@opensubstance.org