Much work has been done to help partygoers with informing themselves about drug combinations. There are many free online resources available, like Tripsit’s drug combination chart, which you can print and take with you. This kind of chart gets updated regularly to reflect new drugs and new discoveries, so it is a good idea to take a look from time to time. The risk level of each combination is indicated, from low-risk combinations that create synergetic effects like candy-flipping, to ones that pose real danger, like mixing ketamine with alcohol. (Ketamine and alcohol can be a dangerous combination because they both slow breathing, which could lead to respiratory depression, leading to low oxygen, unconsciousness, or even death. In addition, the combo can potentially result in blackouts, choking on vomit, severe confusion, and accidents and injuries due to profoundly impaired coordination and judgment.)
Websites like Trimbos Institute’s DRUGSinfo let you choose two substances to see how they react when combined. While the variety of so-called recreational drugs is smaller than on the chart, the site provides useful information about mixing drugs with prescribed medications, from antidepressants and anti-psychotics, to meds for asthma and diabetes, antibiotics, and anticonception pills.
Common mistakes which people make are not taking all substances into account and not considering all the effects an interaction might have. As we mostly use the word “drug” for illegal substances, people pay less attention to possible interactions between drugs and legal substances they consume, such as prescribed medications, alcohol, caffeine, and sugar. This is one of the biggest misconceptions leading to harm, as some medications and supposedly softer substances are involved in some of the riskiest combinations.
The painkiller Tramadol, for example, is considered unsafe to mix with psychedelics: it creates a dangerous combination with almost any other substance on the chart. An average partygoer who takes a psychedelic at a party goes to the bar a couple of times to the bar to get a drink. They may also smoke a joint or two during the evening. While this is not what we have in mind when we talk about polysubstance use, this person has consumed a minimum of three psychoactive substances: a psychedelic, alcohol, and weed. Their drink may have contained another substance, such as a stimulant, and if their joint contained tobacco, we are already at five different substances. When they consider taking another drug, counting it as the second, checking how it would combine with the psychedelic is not enough – they are facing possible interactions between all of those substances. Note that the combination chart and most other resources only relate to interactions between two substances at a time. The more you add to the mix, the more unpredictable your personalized cocktail becomes.
Another issue to take into account is indirect consequences. Let us take the example of alcohol and caffeine. The stimulating effect of caffeine was traditionally used to counteract the tiredness, dizziness, and slowness caused by alcohol. In the old days, people would even be served a cup of coffee in order to drive back home from the bar after a night’s drinking. While there are some immediate physical effects to the mix, like heightened blood pressure and heart rate, the real danger of this combination is revealed when zooming out of pure chemical effects to look at the bigger picture. While the coffee makes you feel less drunk, it does not eliminate the effects of the alcohol, and this is precisely what makes this combination so dangerous. The same goes for alcohol and other legal stimulants like cola and energy drinks, combinations which often come together in one glass.
Studies have shown that people who mix energy drinks and alcohol are more likely to engage in risky behaviour like driving or getting in a car with a drunken driver than people who consume only alcohol. Moreover, those who mix the two have a significantly higher chance of being taken advantage of sexually and also experience more binge drinking in the long run. Paradoxically, our attempts to subdue the effects of a drug using another can aggravate the situation even more.
Drinking can also be risky when combined with an illegal stimulant like cocaine. Here we see a similar story to that of alcohol and caffeine. Many people who are drinking heavily may eventually start doing bumps or lines of coke to ‘sober up’. Again, there’s the feeling of being less drunk; yet the effects of alcohol remain. What’s worse is that this feeling of sobering up can encourage someone to then drink more than they would if they didn’t do any cocaine, to regain the feeling of drunkenness. We also know that combining alcohol with cocaine results in the production of an even more harmful substance in the body: cocaethylene. This is chemically similar to cocaine, but with a significantly higher risk of cardiotoxicity: it increases the risks of heart attack, arrhythmia, and sudden death.
Another such example is smoking weed in order to relax when a psychedelic experience becomes too overwhelming. Depending on the set and setting, weed can intensify the psychedelic experience even more and enhance anxiety and rumination.
So, rather than dividing substances into general categories, make yourself a simple rule: if it goes into your body, you want to know what it is, what it does, and how it combines with other substances. Everything counts: whether you eat, drink, or smoke it, whether you take it daily or occasionally, and whether it’s recreational or prescribed by a doctor. Always check beforehand, and if you have a specific medical condition, double-check!
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