Harm Reduction · Too High Toolkit
Too High Toolkit
Evidence-rated interventions for difficult experiences — cannabis, psychedelics, MDMA, stimulants, dissociatives, depressants, and opioids. Select what you took and start there.
What did you take?
Slow down. Read this. We'll figure it out.
You don't have to know exactly what you took to get help. The most dangerous symptoms look similar across substances. Start here.
Call 911 right now if any of these are happening
These are the universal signs of a medical emergency, regardless of what was taken:
- Not breathing, breathing very slowly, or breathing irregularly (fewer than 8 breaths a minute, long pauses, gurgling, snoring sounds in someone who can't be woken)
- Blue or gray lips, fingertips, or face
- Unresponsive — won't wake up, won't respond to their name being shouted, won't react to a firm rub on the breastbone with your knuckles
- Seizure lasting more than a couple of minutes, or repeated seizures
- Chest pain, crushing chest pressure, pain radiating to the left arm or jaw
- Body temperature feels dangerously hot to the touch (hot, dry skin, confusion, collapse)
- Severe self-harm risk or active attempts
- Repeated vomiting plus inability to stay conscious (risk of choking)
If you're unsure, call. Good Samaritan laws protect callers in most US states. Tell the dispatcher what you know — "I'm not sure what they took" is a complete answer. Stay on the line.
If they're breathing and conscious
Buy yourself time to figure it out
Most difficult experiences are not medical emergencies. If the person is breathing normally, conscious, and not in the 911 list above, these interventions help across almost every substance:
Slow, deep breathing activates the parasympathetic nervous system. It lowers heart rate, blood pressure, and panic — and it works regardless of what substance is in play.
If they're conscious but very impaired, get them on their side — never their back. If they vomit while on their back, they can choke. The recovery position keeps the airway open.
If their skin feels hot, they're sweating heavily, or they collapsed in a warm room or after activity, body temperature could be dangerous. Hyperthermia is the deadliest stimulant/MDMA symptom. Cool them down while you assess.
If the person is unresponsive or breathing very slowly and you can't rule out opioids, give naloxone (Narcan). The drug supply is contaminated with fentanyl across categories — counterfeit pills, cocaine, meth, stimulants of every kind. When in doubt, give naloxone. It's well-tolerated in people without opioids in their system, and it can save their life if opioids are present.
Nausea and vomiting are common across mushrooms, ayahuasca, edibles, MDMA, opioids, and alcohol. Vomiting itself isn't a 911 situation — but vomiting while unconscious or barely conscious is, because of choking risk.
If barely conscious or fading: Roll them onto their left side immediately. Never let someone vomit while flat on their back. Call 911 if they can't stay awake between heaves.
Fireside is staffed by people trained for exactly this — someone scared, alone, not sure what they took. Call or text. They will stay with you. You don't need a diagnosis to call.
Can you narrow it down?
Pick the closest category for more specific help
If you can guess at the category — even roughly — the tabs above this section have substance-specific guidance. Here's a quick translator:
- Edible, gummy, brownie, weed, pot: Cannabis tab
- Mushrooms, shrooms, acid, tabs, LSD, DMT, ayahuasca, tea, mescaline, peyote, San Pedro: Psychedelics tab
- Molly, ecstasy, E, X, MDMA, "rolls": MDMA tab
- Coke, cocaine, crack, meth, speed, Adderall, line, bump: Stimulants tab
- K, ketamine, special K, PCP, DXM, cough syrup, robo, nitrous, whippets: Dissociatives tab
- Alcohol, drinks, Xanax, Valium, benzos, bars, GHB, G: Depressants tab
- Pills you got from someone (especially "oxy," "Percs," "blues," M30s), heroin, fentanyl, kratom, dope: Opioids tab
Honest note: The illicit drug supply is contaminated. Pills sold as one thing are frequently pressed with fentanyl. Cocaine and meth supplies contain fentanyl in many regions. If there's any chance the substance was a pressed pill or street powder, treat the Opioids tab as a parallel reference even if you think it was something else.
Tim's Take
"I don't know what I took" is one of the most common reasons people end up reading this page at 2am. You are not stupid for being here. You are not in trouble for being here. What you took came from somewhere outside your control, and what's in it is genuinely unknowable in the modern supply. The 911 list above is the most important thing on this page. If none of those signs are present, the second most important thing is: get someone with you, breathe slow, get on your side, and call Fireside. The fact that you found this page means you're already doing the work. Stay with it.
This is temporary. It will pass.
No one has ever died from consuming too much cannabis. What you're experiencing will end — that's not a platitude, it's pharmacological fact.
Interventions
What actually helps — rated by evidence
Not all of these are equal. Some have solid research behind them. Some are anecdotal but widely reported. The ratings reflect what the evidence actually says.
CBD is a negative allosteric modulator of CB1 receptors — it blunts THC's effects by competing for the same binding sites. This is the most pharmacologically sound intervention on this list.
Controlled breathing activates the parasympathetic nervous system — the physiological opposite of the anxiety response. Works regardless of cause.
Cannabis experiences are highly environment-dependent. Changing your physical environment is one of the most reliable interventions available.
Cannabis causes dry mouth and mild dehydration. Dehydration amplifies almost all negative symptoms and is an easy variable to remove.
Beta-caryophyllene, a terpene in black pepper, binds to CB2 receptors and may modulate anxiety. Scientific evidence is thin but it's low-risk and widely reported.
Limonene in lemon peel has anxiolytic properties in preliminary research. Evidence is early but low-risk.
When to call 911
Cannabis itself is not a respiratory depressant and no one has died from cannabis alone. But call 911 if: someone is unresponsive, having a seizure, showing signs of a heart attack (chest pain, pressure, pain in left arm/jaw, shortness of breath, sweating), experiencing severe psychosis or self-harm risk, or you suspect what they took was contaminated with another substance (synthetic cannabinoids, fentanyl, unknown chemicals). For people with cardiovascular conditions, cannabis can trigger acute cardiac events. Good Samaritan laws protect callers in most states.
Tim's Take
First thing I tell anyone who calls me in that state: you are not dying. Nobody has ever died from too much cannabis. What you're feeling is temporary — it has a ceiling and it will pass. The move is simple: water, a safe horizontal surface, and something familiar and low-stakes in the background. Don't fight it. Don't try to logic your way out of it. Just ride it. If someone you care about is in this situation, stay calm, stay with them, and keep reminding them it ends. That's the whole toolkit.
You took a substance. It will wear off.
Psilocybin: 4–6 hours. LSD: 10–12 hours. DMT: 15–30 minutes. Mescaline: 8–12 hours. The experience has a duration. You will return to baseline.
Duration Reference
Interventions
What actually helps
Most difficult psychedelic experiences are psychological, not medical emergencies. The interventions that work are almost entirely about reducing resistance and creating safety.
Fighting a psychedelic experience consistently makes it worse. Clinical research and harm reduction consensus both support stopping resistance and moving with the experience rather than against it — it is the approach most associated with better outcomes.
A pounding or racing heart during a psychedelic experience is a known and expected effect. Classical psychedelics produce a mild sympathomimetic response — your heart rate goes up. In an otherwise healthy person without cardiovascular disease, this is not a medical emergency. It will pass as the experience wears off.
When it IS a 911 call: Crushing chest pain or pressure, pain radiating to the left arm or jaw, severe shortness of breath at rest, or any known cardiovascular condition with severe symptoms. These are different from anxiety-driven tachycardia.
Feeling like you've lost your sense of self, like reality isn't real, like you're watching yourself from outside — these experiences are called depersonalization and derealization. At higher doses, they can become full ego dissolution. All of it is a known and temporary effect of psychedelics. It is not psychosis. It is not permanent. It ends with the experience.
What to say to yourself: "I took a substance. This feeling is the substance. It ends when it ends." You don't have to understand it. You don't have to solve it. You just have to wait.
A calm, sober, trusted person is the most reliable harm reduction tool for a difficult psychedelic experience. Their job is simple: be present, stay calm, reassure without redirecting the experience.
Psychedelic experiences are acutely sensitive to environment. A change of scenery — even moving to another room — can meaningfully shift a difficult experience.
Breathwork activates the parasympathetic nervous system and is one of the few interventions that works across all substances and all anxiety causes.
Benzodiazepines (diazepam, lorazepam) are the pharmacological standard for managing acute psychedelic distress. They work by enhancing GABA — which directly counteracts the overactivation driving the distress. They don't end the experience but significantly reduce its intensity. This is what's used in clinical settings.
Cannabis is commonly reached for during a difficult psychedelic experience but frequently amplifies rather than reduces distress. THC can significantly intensify psychedelic effects and anxiety, especially at higher doses or in already-difficult experiences. This isn't universal — some people use cannabis intentionally with psychedelics and find it helpful — but if you're already in distress, adding THC is a gamble.
The Fireside Project is a peer support line specifically designed for people having difficult psychedelic experiences. Trained responders, available 24/7, free and confidential. This is the resource this toolkit is built around — use it.
When to call 911
Most difficult psychedelic experiences are not medical emergencies. Call 911 if: someone is unresponsive or unconscious, experiencing prolonged seizure activity, showing signs of self-harm or danger to others, or if the substance taken was unknown and symptoms are severe. When you call, tell them what was taken — this helps them respond appropriately and most areas have Good Samaritan protections.
Tim's Take
The hardest thing to accept in a difficult psychedelic experience is that there's no exit door. You can't outthink it, you can't outrun it. The only way through is through. What I've seen work, consistently, is a trusted person who stays calm, a safe physical space, and the decision to stop fighting. That decision — to let it happen — is usually the turning point. The Fireside Project exists because sometimes you need a human voice to help you make that decision. Call them.
Stay cool. Sip slowly. Sit down.
MDMA's serious risks are physical, not psychological. Temperature regulation and hydration are the priorities — but overdrinking water is also dangerous. Sip, don't chug. About a cup per hour if you're active, less if you're resting.
Duration Reference
Interventions
What actually helps
Hyperthermia — dangerously elevated body temperature — is the primary cause of MDMA-related deaths. MDMA disrupts the body's ability to regulate temperature, especially during physical activity in warm environments. Dancing in a hot venue is the highest-risk scenario.
MDMA causes the body to retain water and reduces sodium excretion. Drinking too much plain water can cause hyponatremia — dangerously low blood sodium — which has killed people. This is a real risk, not a minor footnote.
Physical exertion dramatically increases the risk of hyperthermia. Taking regular breaks from dancing, sitting down, and moving to cooler spaces are simple and effective risk reducers.
Jaw clenching is one of the most common MDMA side effects. Magnesium glycinate is widely used in harm reduction communities and has plausible mechanism. Alpha-lipoic acid is also commonly mentioned. Neither has strong clinical evidence but both are low-risk.
The days following MDMA use — sometimes called "suicide Tuesday" — involve serotonin depletion that can cause significant low mood, anxiety, and fatigue. This is predictable and temporary.
When to call 911
Call 911 if someone is: extremely hot and confused (hyperthermia), having a seizure, unresponsive, developing a severe headache with confusion after drinking a lot of water (hyponatremia), or showing irregular heartbeat or chest pain. Tell emergency responders what was taken.
Tim's Take
MDMA deaths are preventable. Almost all of them involve heat, dehydration, or overhydration — things that are entirely manageable with information. The harm reduction message here isn't "don't do it" — it's "the risks are specific and known, so address them specifically." Rest. Electrolytes. Temperature. In that order. The comedown is real and it's serotonin math — plan for it, don't be surprised by it, and don't use more MDMA to fix it.
Stop. Sit down. Cool off.
Stimulant emergencies are physical — heart rate, blood pressure, temperature. If you're feeling chest pain or irregular heartbeat, that is a 911 situation. No exceptions.
Interventions
What actually helps
Cocaine, methamphetamine, and high-dose stimulants all carry cardiovascular and thermoregulatory risk. The interventions are physical, not psychological.
Hyperthermia is a primary risk with stimulant overdose. Moving to a cool environment removes a dangerous compounding factor immediately.
Physical activity under stimulant load increases heart rate, blood pressure, and body temperature simultaneously. Rest directly reduces cardiovascular stress.
Stimulants cause sweating and appetite suppression, leading to dehydration and electrolyte loss. Replacing both is important — water alone isn't enough if you've been sweating.
This includes caffeine, energy drinks, pre-workout, and tobacco. Any additional stimulant load compounds cardiovascular strain. Even cigarettes raise heart rate and blood pressure.
Common with cocaine and meth. Chewing gum provides an outlet and reduces pressure on teeth. Magnesium is anecdotally reported to help.
When to call 911 — no exceptions
Chest pain or pressure, irregular heartbeat or palpitations that won't stop, severe headache with vision changes (stroke risk), seizure, or loss of consciousness. Cocaine specifically causes coronary vasospasm — even in young, healthy people with no prior cardiac history. This is not an "it probably won't happen to me" situation. Call 911 and tell them what was taken.
Tim's Take
Stimulant harm reduction is about the physical body, not the mind. The anxiety and paranoia are real but they're not the danger — the danger is your cardiovascular system running hot for too long. The move is always the same: stop, sit, cool off, no more stimulants. If your chest hurts or your heart feels wrong, that's not anxiety. Call 911.
Get horizontal. Don't move. Wait.
Dissociatives impair coordination and judgment severely. The primary risk is physical injury from moving around in a dissociated state. The experience has a short duration. Stay still and let it pass.
Duration Reference
Interventions
What actually helps
Dissociation severely impairs balance, coordination, and spatial awareness. Falls are the most common source of injury. Getting low and staying there eliminates that risk.
Dissociative experiences have a compulsive quality that makes redosing feel appealing. The k-hole is deeper when you add more ketamine to an existing dose. Duration stacks. Wait until you're fully baseline before any additional use.
Most dissociatives — especially ketamine and nitrous — have short durations. Time is the primary intervention. Knowing the duration helps.
Ketamine combined with alcohol, benzodiazepines, or opioids produces additive CNS depression that can suppress breathing. This is one of the most dangerous combinations in harm reduction. If someone has mixed ketamine with depressants and becomes unresponsive — call 911 immediately.
DXM inhibits serotonin reuptake in addition to its NMDA antagonism. Combined with SSRIs, SNRIs, or MAOIs, this can cause serotonin syndrome — a potentially life-threatening condition involving agitation, hyperthermia, rapid heart rate, and muscle rigidity.
When to call 911
Call 911 if someone is unresponsive or can't be woken, if breathing becomes slow or irregular (especially if mixed with alcohol or opioids), if there's a fall with possible injury, or if you see signs of serotonin syndrome in a DXM user on SSRIs. Tell responders what was taken.
Tim's Take
Dissociatives are the substances where physical setting matters most. The experience itself is usually manageable — the danger is underestimating how much your body isn't cooperating with your intentions. Get horizontal before the peak. Don't mix with alcohol. Don't redose because you think it's wearing off. DXM in particular is longer and weirder than people expect — and if you're on an SSRI, it shouldn't be on your list at all.
Don't let them sleep alone.
Unlike cannabis or psychedelics, depressant overdose can stop breathing. This is the one category where the harm reduction message is: know the line, and know that letting someone "sleep it off" alone is how people die.
Interventions
What actually helps
Alcohol, benzodiazepines, and GHB all depress the central nervous system. The dangers are respiratory depression, aspiration (choking on vomit), and — with benzos and alcohol — potentially fatal withdrawal in dependent users.
Aspiration — choking on vomit while unconscious — is a leading cause of alcohol-related death. The recovery position keeps the airway open and prevents this.
Someone who is significantly intoxicated on depressants can shift from "sleeping it off" to respiratory depression without warning. Someone needs to stay with them and check breathing regularly.
Depressants are not additive — they're synergistic. Alcohol + benzodiazepines is significantly more dangerous than either alone. Alcohol + GHB is one of the most dangerous combinations in harm reduction: GHB has an extremely narrow therapeutic window and alcohol dramatically lowers the overdose threshold. A dose of GHB that's fine on its own can be incapacitating or fatal combined with alcohol.
Cyanosis — blue or purple discoloration of the lips, fingernails, or skin — indicates oxygen deprivation. It's a visible sign that someone is not getting enough oxygen and requires immediate intervention.
Naloxone (Narcan) reverses opioid overdose by blocking opioid receptors. It has no effect on alcohol, benzodiazepine, or GHB overdose. If someone is overdosing on depressants only, naloxone will not help. Call 911.
Unlike almost every other substance, cold-turkey withdrawal from alcohol and benzodiazepines can be fatal in physically dependent users. Seizures, delirium tremens (alcohol), and cardiovascular instability are real risks. This is not a "too high" situation — but if someone dependent on alcohol or benzos suddenly stops using and begins to show confusion, tremors, or seizures, this is a medical emergency.
When to call 911
Won't wake up or respond to a sternal rub (firm rubbing of your knuckles on the breastbone — if they don't react, that's a 911 sign), slow or irregular breathing (under 8 breaths per minute), blue lips or fingertips, vomiting while unconscious, or seizure activity. Good Samaritan laws protect you in most states — call without hesitation.
Tim's Take
Depressants are where the stakes are highest and the harm reduction is simplest: don't leave people alone. The recovery position is one of the most important things anyone can know — it takes thirty seconds to learn and it has saved lives. Alcohol is normalized to the point where we forget it's a CNS depressant that can stop your breathing. GHB has a window so narrow that a dose that works fine becomes dangerous with two drinks. Know what you're combining before you combine it.
Naloxone. Recovery position. Call 911.
In that order. An opioid overdose is a medical emergency. Every second matters. If someone is unresponsive and you suspect opioids — don't wait, don't check your phone, do these three things.
Interventions
What actually helps
Opioid overdose is different from every other substance on this page. It's not primarily about discomfort — it's about breathing. Respiratory depression is how opioid overdose kills. The window for intervention is short.
Naloxone is an opioid antagonist that rapidly reverses opioid overdose by blocking opioid receptors. It is available over the counter in most US states under brand names Narcan (nasal spray) and Kloxxado. It works within 2–5 minutes.
If the person is breathing but unresponsive, place them in the recovery position while waiting for naloxone to work or for 911 to arrive. This prevents aspiration if they vomit.
Even if naloxone works, call 911. Naloxone wears off. The underlying opioid may still be active. The person needs medical monitoring. Many people hesitate to call because of fear of legal consequences — most US states have Good Samaritan laws that provide immunity to people who call 911 for an overdose in good faith.
The Never Use Alone hotline exists for exactly this: if you're using opioids alone, call them first and stay on the line. If you stop responding, they call 911 with your location.
Fentanyl is in the drug supply at unprecedented levels — not just heroin and counterfeit pills, but cocaine, meth, and pressed tablets of every kind. Fentanyl test strips detect its presence in a sample. A negative test reduces risk. A positive test means: use less, use slowly, have naloxone ready, don't use alone.
Several widely circulated interventions don't work and waste critical time. Stimulants do not reverse opioid overdose — injecting someone with cocaine or meth to "wake them up" is dangerous and ineffective. Cold water or ice baths do not reverse opioid overdose. Walking it off does not work. Only naloxone reverses opioid overdose. Everything else is time you don't have.
Signs of opioid overdose
Unresponsive or won't wake up · Slow, shallow, or stopped breathing · Gurgling or snoring sounds (death rattle) · Blue or purple lips and fingertips (cyanosis) · Pinpoint pupils · Limp body. If you see these: naloxone, recovery position, 911. In that order. All three.
Tim's Take
Fentanyl changed everything. It's in the supply in ways that nobody reliably detects without test strips, and a dose that looks identical to what worked last week can be ten times stronger. The harm reduction math is simple: carry naloxone, use test strips, never use alone. The Good Samaritan laws exist because people were dying while their friends debated whether to call 911. Call. Every time. No exceptions.
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