Alpha Guide- Substance Abuse Reference Guide
Comprehensive Substance Reference &
Harm Reduction Guide
Clean Rebuilt Edition - September 2026
IMPORTANT: This guide is for recognition, harm-reduction, and emergency-reference purposes. Appearance alone cannot reliably identify a substance. Counterfeit pills, powders, vapes, edibles, and street mixtures may contain unexpected drugs. Do not taste, smell closely, burn, or handle an unknown substance to identify it. If poisoning is possible, contact Poison Control (U.S. 1-800-222-1222) or 911 for severe symptoms.
Emergency Response - Start Here
1. Check responsiveness and breathing: If the person is unresponsive, has abnormal or slow or absent breathing, turns blue or gray, has a seizure, severe chest pain, dangerous overheating, or cannot be kept safe, call 911.
2. Give naloxone when opioid exposure is possible: Use naloxone if available. If normal breathing does not return after about 2-3 minutes, give another dose according to product directions. Naloxone will not reverse non-opioid sedation, but it can treat an opioid component.
3. Support breathing: Open the airway. Give rescue breaths and/or CPR according to your training and dispatcher instructions. Use an AED if available and indicated.
4. Recovery position: If unconscious but breathing adequately, place the person on their side to reduce choking risk.
5. Seizure and overheating safety: Protect the head, clear nearby hazards, do not put anything in the mouth, and do not forcibly restrain. For dangerous overheating, move to a cooler environment and begin active cooling while EMS is responding.
6. Stay with the person: Monitor breathing and responsiveness until emergency personnel arrive. Keep containers, pill bottles, packages, or photos available for responders when safe to do so.
7. Avoid harmful actions: Do not assume someone can "sleep it off" if they are difficult to wake, breathing abnormally, or turning blue or gray. Do not put an unconscious person in a cold shower or bath, force food or liquids into an unconscious or seizing person, induce vomiting unless instructed by Poison Control, or put objects or fingers in the mouth of someone having a seizure.
Unknown Substance or Unknown Pill
Never identify an unknown drug solely by color, logo, shape, odor, packaging, or street name. Counterfeit tablets can closely resemble legitimate medication.
If a prescription pill looks different than expected, check the imprint and contact the dispensing pharmacy or Poison Control rather than relying on appearance alone.
If the substance is unknown and symptoms are developing, focus on the person's condition - breathing, consciousness, seizures, chest pain, temperature, and behavior - rather than trying to determine the exact drug first.
For non-emergency poison exposures in the United States, Poison Control is available at 1-800-222-1222. Severe symptoms require 911.
1. Opioids & Synthetic Opioids
2. Central Nervous System Stimulants
3. Depressants, Sedatives & Related Agents
4. Cannabis & THC Products
5. Hallucinogens & Psychedelics
6. Dissociatives
7. Entactogens & Novel Tryptamines / Research Chemicals
8. Performance and Image Enhancing Drugs (PIEDs)
9. Synthetic Cannabinoids & Inhalants
10. Nicotine & Caffeine
11. Common Medication Poisonings & Specific Antidotes
12. Drug Testing, Adulterants & Harm Reduction Supplies
Fentanyl Test Strips: Used to test powders, pills, and liquids for the presence of fentanyl before consumption.
Xylazine Test Strips: Used to detect the presence of animal tranquilizer adulterants in illicit drug supplies.
Color Reagent Testing Kits: Chemical reagents (such as Marquis, Mecke, and Simon's tests) react with substances to help identify adulterants or check expected compounds (e.g., checking MDMA or cathinones).
13. Polysubstance Use, Interactions & Contamination
14. Emergency First Aid Quick Reference
15. What NOT To Do
Do not assume someone can "sleep it off" when difficult to wake, breathing abnormally, or turning blue/gray.
Do not put an unconscious person in a cold shower or bath.
Do not force food, coffee, water, or other liquids into an unconscious or seizing person.
Do not induce vomiting unless specifically instructed by Poison Control.
Do not put objects or fingers in the mouth of someone having a seizure.
Do not rely on appearance, street name, taste, or packaging to prove a drug's identity.
16. Global Harm Reduction, Drug Checking & Addiction Support Resources
NEXT Distro (USA Mail-Based): nextdistro.org - Free mail-based naloxone and fentanyl test strips.
OK I'm Ready (Regional USA): okimready.org/overdose/free-kits - Free naloxone kits.
Georgia Overdose Prevention (Georgia): georgiaoverdoseprevention.org/request-naloxone-kit/ - Request a naloxone kit.
NASEN (Locator): nasen.org - Find local syringe services and public health programs.
Harm Reduction Coalition: harmreduction.org/issues/syringe-services/ - Syringe access resources.
DanceSafe: dancesafe.org - Fentanyl test strips and safer-use tools.
Harm Reduction International (Global): hri.global - Global advocacy and network directory.
Correlation - European Harm Reduction Network: correlation-net.org - European safer-use resources.
International Network of People who Use Drugs (INPUD): inpud.net - Global peer-led health network.
Availability, eligibility, mailing rules, and legal status vary by country and region. Where fentanyl test strips are not routinely available, professional drug-checking services may provide broader substance analysis.
Find A Helpline - Substance Use (Worldwide): https://findahelpline.com/topics/substance-use - Country-by-country directory of free and confidential substance-use helplines.
World Hotlines (Worldwide): https://worldhotlines.org/ - International directory of crisis, mental-health, and substance-use support resources.
European Union Drugs Agency - Drug Checking (Europe): https://www.euda.europa.eu/topics/drug-checking_en - European information hub for drug-checking services and harm-reduction systems.
Energy Control (Spain / International): https://energycontrol.org/servicio-de-analisis/ - Drug-checking and substance-analysis services, including an international analysis option.
National Harm Reduction Coalition (USA): https://harmreduction.org/resource-center/harm-reduction-near-you/ - National harm-reduction locator and information for naloxone, syringe services, and safer-use programs.
SOAR Initiative (USA): https://thesoarinitiative.org/ - State-by-state access information for free drug test strips, naloxone, and drug-supply alerts.
SAMHSA National Helpline / FindTreatment.gov (USA): https://www.samhsa.gov/find-help/helplines/national-helpline - Free confidential 24/7 treatment referral and information; 1-800-662-4357.
Indian Health Service - Drug Checking Equipment (USA): https://www.ihs.gov/opioids/harmreduction/drugcheckingequipment/ - Fentanyl and xylazine test-strip guidance and Tribal/IHS harm-reduction resources.
Vancouver Coastal Health - Drug Checking (Canada): https://www.vch.ca/en/service/drug-checking - Free anonymous drug checking, fentanyl-test-strip access, and related overdose-prevention services.
Toward the Heart (British Columbia, Canada): https://towardtheheart.com/ - Naloxone locator, drug alerts, and harm-reduction resources.
Health Canada - Opioid Harm Reduction Initiatives (Canada): https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/government-initiatives-related-opioids.html - Federal directory and information on opioid harm reduction and drug-checking initiatives.
WEDINOS / Public Health Wales (United Kingdom): https://wedinos.wales/sample-testing/ - Anonymous drug sample testing and published drug-checking results.
The Loop (United Kingdom): https://www.wearetheloop.org/drug-testing - Drug checking, alerts, harm-reduction information, and public/festival services where available.
Jellinek / DIMS Drug Testing Service (Netherlands): https://www.jellinek.nl/en/alcohol-drugs-behavior/drug-testing-service/ - Anonymous drug testing through the Dutch DIMS drug-checking network.
checkit! (Austria): https://checkit.wien/en/drug-checking/ - Drug checking, alerts, counseling, and harm-reduction information.
Saferparty Zurich (Switzerland): https://www.saferparty.ch/ - Drug checking, alerts, and safer-use information.
CanTEST (Canberra, Australia): https://cantest.com.au/ - Free and confidential community drug checking and health support.
KnowYourStuffNZ (New Zealand / Aotearoa): https://knowyourstuff.nz/ - Free and confidential drug checking at clinics and events.
New Zealand Ministry of Health - Drug Checking: https://www.health.govt.nz/regulation-legislation/drug-checking - Official information and list of licensed drug-checking service providers.
Important: A negative fentanyl test-strip result does not prove a substance is safe. Drug contents can vary within a pill, powder, or bag, and test strips cannot detect every hazardous contaminant. When available, professional drug checking can provide additional information.
17. Emergency Poison Control Contacts Worldwide
United States: Poison Control Hotline - 1-800-222-1222 (24/7) / Emergency: 911
Australia: National Poisons Information Centre - 13 11 26
Belgium: Antipoison Centre / Antigifcentrum - 070 245 245
Germany: Berlin: (030) 19 240 | Munich: (089) 19 240 | Bonn: (0228) 19 240
Luxembourg: 8002 5500
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Fentanyl | Fine/chunky white, off-white, beige, or light-brown powder; counterfeit tablets; patches/lozenges. Snorted, smoked, injected, swallowed. Pinpoint pupils, heavy sedation, nodding, slurred speech. | Constipation, nausea/vomiting, itching, dry mouth, dizziness, slowed breathing, reduced bowel motility. | Overdose: Unresponsiveness; very slow/stopped breathing; gurgling/snoring; blue/gray skin/lips; limp body. Response: 911, naloxone, breathing support/CPR, recovery position. Repeat naloxone if needed. |
| Heroin | White, tan, brown powder or dark sticky tar. Snorted, smoked, injected. Pinpoint pupils, nodding, itching, drowsiness. | Constipation, nausea/vomiting, itching/flushing, dry mouth, slowed breathing; injection infections and vein damage. | Overdose: Respiratory depression, unconsciousness, blue/gray skin, choking/gurgling. Response: 911, naloxone, breathing support, recovery position. |
| Oxycodone / Hydrocodone | Prescription tablets/capsules; imprints. Usually swallowed. Drowsiness, pinpoint pupils, slowed speech. | Constipation, nausea/vomiting, itching, dizziness, dry mouth, sweating, slowed breathing. | Overdose: Unresponsiveness, slow/stopped breathing, clammy/blue/gray skin. Response: 911, naloxone, breathing support. |
| Morphine / Methadone | Tablets, oral liquids, injectables. Oral/injected. Sedation, pinpoint pupils, slowed breathing. | Constipation, nausea, sweating, itching, dizziness, sedation; methadone can cause QT prolongation (heart rhythm). | Overdose: Profound sedation, severe respiratory depression, coma. Prolonged effects. Response: 911, naloxone, airway/breathing support; continued monitoring. |
| Buprenorphine / Suboxone | Sublingual films/tablets, injections/implants. Drowsiness, small pupils, slowed reactions. | Constipation, nausea, headache, sweating, dizziness, sleepiness; slowed breathing rises with other sedatives. | Overdose: Marked sedation/respiratory depression with alcohol/benzos/opioids. Response: 911, naloxone, breathing support. |
| Codeine | Prescription tablets/capsules/cough liquids. Oral. Sleepiness, small pupils, nausea. | Constipation, nausea/vomiting, itching, dizziness, sleepiness, slowed breathing. | Overdose: Respiratory depression, unconsciousness, choking. Response: 911, naloxone, breathing support. |
| Tramadol | Prescription tablets/capsules. Oral. Drowsiness, dizziness, nausea, possible agitation. | Nausea, constipation, dizziness, sweating, headache; lowers seizure threshold, contributes to serotonin toxicity. | Overdose: Seizures, respiratory depression, altered consciousness. Response: 911 for seizures/abnormal breathing, naloxone for opioid component, EMS evaluation. |
| Hydromorphone / Oxymorphone | Potent prescription tablets/injectables. Oral or injected. Sedation, pinpoint pupils, slowed breathing. | Constipation, nausea/vomiting, itching, dizziness, profound drowsiness. | Overdose: Rapid respiratory depression, coma, cyanosis. Response: 911, naloxone, airway/breathing support. |
| Nitazenes / Emerging Synthetic Opioids | Powders or counterfeit pills; non-distinctive. Variable routes. Opioid signs: pinpoint pupils, sedation, stopped breathing. | Marked sedation, nausea/vomiting, pinpoint pupils, slowed breathing, low oxygen; highly unpredictable potency. | Overdose: Profound and prolonged respiratory depression. Response: 911, immediate naloxone, breathing support, repeat naloxone as needed. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Methamphetamine | Clear/jagged crystals or coarse white powder. Smoked, snorted, injected, swallowed. Dilated pupils, intense energy, rapid speech, sweating, jaw clenching. | Rapid heart rate, high blood pressure, sweating, dry mouth, tremor, appetite loss, insomnia, overheating. | Overdose: Chest pain, dangerous blood pressure, arrhythmia, seizure, stroke, hyperthermia, extreme paranoia. Response: 911 for severe symptoms, reduce stimulation, cool if overheated, avoid forceful restraint. |
| Cocaine / Crack | Cocaine: fine white powder. Crack: hard off-white/tan rocks. Snorted, smoked, injected. Dilated pupils, talkativeness, restlessness. | Rapid heart rate, high blood pressure, sweating, dilated pupils, tremor, nasal/lung irritation. | Overdose: Chest pain, heart attack, stroke, seizures, severe agitation, dangerous overheating. Response: 911 for chest pain, seizures, collapse, or overheating. Keep calm and cool. |
| Amphetamine / Adderall | Prescription tablets/capsules with imprints. Oral. Increased alertness, rapid speech, dilated pupils. | Reduced appetite, dry mouth, high heart rate/BP, sweating, tremor, insomnia, jaw tension. | Overdose: Very high heart rate/BP, chest pain, hyperthermia, seizure, psychosis. Response: 911 for severe cardiovascular/neurological symptoms. Calm, cool environment. |
| Lisdexamfetamine / Vyvanse | Prescription capsules/chewable tablets. Oral. Increased wakefulness, decreased appetite, faster pulse. | Reduced appetite, dry mouth, increased heart rate, sweating, headache, stomach upset, insomnia. | Overdose: Severe agitation, high BP/heart rate, hyperthermia, arrhythmia, seizure. Response: 911 for severe symptoms, reduce stimulation. |
| Methylphenidate / Ritalin | Prescription tablets/capsules. Oral. Alertness, reduced appetite, talkativeness. | Reduced appetite, stomach pain, headache, increased heart rate/BP, sweating, tremor, insomnia. | Overdose: Chest pain, arrhythmia, severe hypertension, hallucinations, seizures. Response: 911 for severe symptoms, calm setting. |
| Synthetic Cathinones / Bath Salts | Fine white, ivory, tan powders/crystals. Swallowed, snorted, injected, smoked. Marked agitation, paranoia, rapid heart rate. | Fast heart rate, high BP, sweating, dilated pupils, jaw clenching, tremor, dehydration, overheating. | Overdose: Excited delirium state, dangerous hyperthermia, seizures, heart attack. Response: 911, prioritize safety, reduce stimulation, cool if overheated. |
| Tusi / Pink Cocaine | Brightly colored pink powder; variable composition. Usually snorted or swallowed. Mixed stimulant/psychedelic/sedative effects. | Fast heart rate, high BP, sweating, nausea, dizziness, jaw clenching, coordination issues. | Overdose: Agitation, sedation, vomiting, high BP, seizures, respiratory depression. Response: Treat symptoms, 911 for severe symptoms, naloxone if opioid exposure possible. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Benzodiazepines (Xanax, Valium) | Prescription tablets / bars. Usually oral. Slurred speech, poor coordination, confusion, relaxation. | Drowsiness, dizziness, muscle weakness, poor coordination, slowed reflexes, blurred vision. | Overdose: Deep unconsciousness, dangerous breathing depression (worse with opioids/alcohol), aspiration risk. Response: 911 for severe sedation/abnormal breathing. Recovery position. Naloxone if opioid co-exposure. |
| Alcohol | Beer, wine, spirits. Oral. Slurred speech, poor balance, impaired judgment. | Flushing, nausea/vomiting, dehydration, headache, poor coordination, impaired temperature regulation. | Overdose: Unconsciousness, slow/irregular breathing, repeated vomiting, blue/pale skin, seizures. Response: 911 for unconsciousness/abnormal breathing. Recovery position, keep warm. |
| GHB / GBL | Clear, colorless liquid or powder. Usually swallowed. Euphoria, disinhibition, rapidly increasing drowsiness. | Drowsiness, dizziness, nausea/vomiting, sweating, slowed heart rate/breathing, reduced muscle tone. | Overdose: Sudden coma, severe respiratory depression, seizures, slow heart rate. Response: 911, airway monitoring, recovery position. Do not leave alone. |
| Xylazine ("Tranq") | White/brown powder mixed with illicit opioids. Snorted, smoked, injected. Profound sedation, slow breathing. | Profound sedation, slowed breathing, low BP, slow heart rate; repeated exposure causes severe skin wounds/ulcers. | Overdose: Severe CNS depression, low BP, prolonged sedation. Response: 911, breathing support. Give naloxone for opioid component (naloxone does not reverse xylazine). |
| Barbiturates | Prescription/veterinary tablets/capsules. Oral or injected. Drowsiness, slurred speech, confusion. | Drowsiness, dizziness, poor coordination, slowed breathing, low BP, nausea, weakness. | Overdose: Coma, low BP, severe respiratory depression, hypothermia. Response: 911, airway/breathing support, recovery position. |
| Z-drugs (Zolpidem / Ambien) | Prescription tablets. Oral. Marked sleepiness, confusion, unusual behavior or amnesia. | Drowsiness, dizziness, headache, impaired coordination, nausea, unusual sleep behaviors. | Overdose: Profound sedation, falls/injury, breathing depression with alcohol/opioids. Response: 911 for unresponsiveness/abno rmal breathing. Recovery position. |
| Gabapentin / Pregabalin | Prescription capsules/tablets/liquid. Oral. Dizziness, sleepiness, poor coordination, blurred vision. | Dizziness, sleepiness, blurred vision, swelling of hands/feet, weight gain; breathing risk rises with opioids. | Overdose: Severe sedation or respiratory depression with CNS depressants. Response: Call 911 for abnormal breathing or severe sedation. |
| Muscle Relaxants (Baclofen, Cyclobenzaprine) | Prescription tablets/capsules. Oral. Drowsiness, dizziness, weakness, confusion. | Drowsiness, weakness, dry mouth, blurred vision, nausea, low BP, abnormal heart rhythm. | Overdose: Coma, respiratory depression, arrhythmia, seizure, severe weakness. Response: Contact Poison Control for excess dose; 911 for severe symptoms/seizures. |
| Clonidine | Tablets or transdermal patches. Oral/transdermal. Sleepiness, dizziness, slow heart rate, low BP. | Sleepiness, dry mouth, dizziness, slow heart rate, low BP, constipation. | Overdose: Marked bradycardia, hypotension, pinpoint pupils, severe sedation, breathing depression. Response: Call Poison Control promptly; 911 for severe symptoms. |
| Phenibut | White powder or capsules. Oral. Sedation, dizziness, impaired coordination, paradoxical agitation. | Drowsiness, dizziness, nausea, poor coordination; heavy use leads to dependence and severe withdrawal. | Overdose: Severe sedation, delirium, breathing depression. Response: Poison Control for exposure; 911 for severe agitation, seizures, or unresponsiveness. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Cannabis Flower / Marijuana | Dried green/brown plant material. Smoked or vaporized. Red eyes, altered time perception, impaired coordination, increased appetite, anxiety/euphoria. | Red/dry eyes, dry mouth, increased heart rate, dizziness, impaired coordination. | Overdose: Extreme confusion, panic, paranoia, hallucinations, fast heart rate, severe vomiting. Response: Calm environment. Poison Control for concern; 911 for severe confusion, seizures, or breathing problems. |
| THC Concentrates (Wax, Shatter, Oils) | Sticky waxes, amber sheets, oils. Vaporized or dabbed. Intense intoxication, anxiety, tachycardia. | Dry mouth, red eyes, increased heart rate, dizziness, coughing/airway irritation, nausea. | Overdose: Severe panic, hallucinations, vomiting, loss of consciousness. Response: Calm setting, monitor. Poison Control or 911 for severe/worsening symptoms. |
| THC Vape Cartridges | Small cartridges or disposables. Inhaled aerosol. Rapid intoxication, coughing, dizziness, anxiety. | Dry mouth, red eyes, dizziness, increased heart rate, cough, throat irritation. | Overdose: Severe intoxication, chest pain or shortness of breath (possible lung injury/EVALI). Response: Stop exposure, fresh air. 911 for severe breathing difficulty, chest pain, collapse. |
| THC Edibles / Beverages | Gummies, baked goods, drinks. Oral. Delayed and prolonged effects; impaired coordination, anxiety. | Dry mouth, red eyes, dizziness, increased heart rate, impaired coordination, nausea. | Overdose: Extreme confusion, panic, hallucinations, severe vomiting, inability to walk. Response: Do not induce vomiting. Poison Control for excessive ingestion; 911 for severe symptoms. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| LSD (Acid) | Blotter paper, tiny tablets, liquid drops. Oral/sublingual. Dilated pupils, altered visual/auditory perception, synesthesia. | Dilated pupils, increased heart rate/BP, sweating, tremor, nausea, sleeplessness. | Overdose: Severe panic, dangerous confusion, psychosis-like behavior, accidental injury. Response: Quiet, low-stimulation environment, reassurance. 911 for seizures, violent behavior, or psychosis. |
| Psilocybin Mushrooms | Dried/fresh mushrooms, chocolates, capsules. Oral. Altered perception of time, dilated pupils, nausea. | Nausea, stomach discomfort, yawning, dizziness, dilated pupils, increased heart rate/BP. | Overdose: Severe panic, risky behavior, vomiting; toxic misidentified mushrooms can be fatal. Response: Calm, safe setting. Poison Control for uncertain identification; 911 for severe reaction. |
| DMT / Ayahuasca | White/yellow/orange powder or dark plant brew. Smoked, vaporized, or oral. Rapid intense hallucinations, detachment. | Rapid heart rate, increased BP, dilated pupils, nausea/vomiting. | Overdose: Severe agitation/panic, high heart rate/BP, vomiting, dangerous interactions. Response: Protect from injury, calm environment; 911 for severe cardiovascular symptoms or seizures. |
| Mescaline / Peyote | Plant buttons, dried powder, capsules. Oral. Visual changes, altered perception, nausea, dilated pupils. | Nausea/vomiting, increased heart rate/BP, sweating, dilated pupils, headache, dizziness. | Overdose: Severe agitation/confusion, persistent vomiting, cardiovascular stress. Response: Calm environment, Poison Control for exposure; 911 for severe symptoms. |
| 2C-B | Tablets, capsules, powder. Oral or snorted. Stimulation plus psychedelic sensory changes, dilated pupils, anxiety. | Nausea, increased heart rate/BP, dilated pupils, sweating, tremor, jaw tension. | Overdose: Severe agitation, panic, hypertension, hyperthermia, seizures. Response: Reduce stimulation, cool if overheated, 911 for severe symptoms. |
| NBOMe Compounds | Blotter paper or powder (often sold as LSD). Buccal or sublingual. Intense hallucinations, agitation, vasoconstriction. | Fast heart rate, high BP, vasoconstriction, sweating, tremor, nausea, overheating, seizures. | Overdose: Seizures, hyperthermia, severe hypertension, arrhythmia, dangerous agitation. Response: Medical emergency. Call 911, begin cooling if overheated, and reduce stimulation. |
| Salvia divinorum | Dried leaves, extracts. Smoked or chewed. Rapid dissociation or hallucinations, impaired coordination. | Dizziness, impaired coordination, sweating, nausea, altered body sensation. | Overdose: Accidental injury, extreme panic, unsafe behavior. Response: Keep away from hazards, calm reassurance; 911 if injured or unresponsive. |
| Amanita muscaria | Red/yellow mushroom caps with white spots, gummies, extracts. Oral. Drowsiness, confusion, agitation. | Nausea/vomiting, abdominal pain, sweating/salivation, dizziness, poor coordination, muscle jerks. | Overdose: Delirium, seizures, marked sedation, coma. Response: Poison Control promptly. 911 for severe sedation, seizures, or breathing problems. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Ketamine | Fine white powder, crystals, medical solution. Snorted, injected, oral. Nystagmus, numbness, slurred speech, dissociation. | Nausea/vomiting, dizziness, numbness, increased heart rate/BP, poor coordination; bladder damage with chronic use. | Overdose: Deep unresponsiveness, vomiting/aspiration, severe confusion, respiratory depression. Response: Protect the airway and protect the person from falls. 911 for unresponsiveness or breathing problems. |
| PCP (Phencyclidine) | White/yellow powder, liquid, dipped cigarettes. Smoked, snorted, swallowed, injected. Nystagmus, rigid muscles, blank stare, agitation. | High BP, increased heart rate, nystagmus, muscle rigidity, sweating, numbness, poor coordination. | Overdose: Seizures, dangerous hypertension, severe agitation, catatonia, psychosis, hyperthermia. Response: 911. Avoid confrontation, reduce stimulation, ensure safety. |
| DXM (Dextromethorphan) | OTC cough syrups, gels, tablets. Oral. Slurred speech, euphoria, double vision, dissociation. | Nausea/vomiting, dizziness, sweating, increased heart rate/BP, blurred vision. | Overdose: Severe confusion, vomiting, rapid heart rate, respiratory depression, serotonin syndrome. Response: Poison Control for excess; 911 for severe tachycardia, seizures, or breathing trouble. |
| Nitrous Oxide | Metal chargers, tanks, balloons. Inhaled. Brief euphoria, lightheadedness, distorted perception. | Dizziness, tingling/numbness, headache, nausea; heavy use causes B12 nerve damage. | Overdose: Hypoxia, asphyxia, loss of consciousness, falls/injury. Response: Move to fresh air. 911 if unconscious or breathing abnormally. |
| Designer Dissociatives (3-MeO-PCP, 2-FDCK, DCK) | Powders or liquids. Variable routes. Dissociation, confusion, agitation, nystagmus. | Fast heart rate, high BP, numbness, poor coordination, nystagmus, nausea. | Overdose: Severe agitation, psychosis, high BP, seizures, coma. Response: 911 for severe symptoms. Low-stimulation environment, protect from injury. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| MDMA (Ecstasy / Molly) | Pressed tablets with logos, crystals, capsules. Usually oral. Euphoria, empathy, sensory intensity, jaw clenching. | Jaw clenching, sweating, increased heart rate/BP, nausea, muscle cramps, dehydration, overheating. | Overdose: Hyperthermia, dehydration, hyponatremia, seizures, serotonin syndrome, collapse. Response: 911 for overheating/seizures. Move to cool area, active cooling. Do not force excess water. |
| Novel Tryptamines (e.g., 4-AcO-DMT) | Powders or capsules. Oral or vaporized. Psychedelic sensory shifts, altered perception, euphoria. | Nausea, dizziness, increased heart rate/BP, sweating, tremor. | Overdose: Severe panic, confusion, cardiovascular stress, acute anxiety. Response: Calm environment, reassurance; 911 for severe physiological distress. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Anabolic-Androgenic Steroids | Injectable oils, oral tablets. Used for muscle growth. Mood shifts, increased aggression, hormonal changes. | Acne, hair loss, liver strain, lipid profile disruption, blood pressure elevation, testicular atrophy. | Overdose / Toxicity: Severe cardiovascular strain, heart attack, stroke, severe psychiatric disturbance, liver failure. Response: Medical evaluation for severe cardiovascular or psychiatric symptoms; 911 for cardiac emergencies. |
| Clenbuterol | Tablets or liquids. Oral. Bronchodilation, stimulant effects, jitteriness, rapid heart rate. | Tremor, palpitations, anxiety, sweating, muscle cramps, high blood pressure. | Overdose: Dangerous tachycardia, severe hypokalemia (low potassium), cardiac arrhythmias, myocardial ischemia. Response: 911 for severe chest pain, extreme heart rate, or collapse. Poison Control for excess dose. |
| DNP (2,4-Dinitrophenol) | Yellow powder, capsules. Oral. Extreme metabolic uncoupling and rapid weight loss; highly toxic. | Sweating, warmth, dehydration, rapid breathing, yellow discoloration of fluids. | Overdose / Toxicity: Fatal hyperthermia (dangerously high body temperature), dehydration, multiple organ failure, cardiovascular collapse. Response: Medical emergency. Call 911 immediately. Active cooling, do not wait for symptoms to worsen. |
| Growth Hormone Secretagogues (e.g., MK-677) | Powders or capsules. Oral. Increased appetite, water retention, fatigue, lethargy. | Edema, joint pain, decreased insulin sensitivity, elevated blood glucose. | Overdose / Toxicity: Severe water retention, acute hyperglycemia, numbness/tingling. Response: Poison Control for guidance; medical evaluation for severe metabolic symptoms. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Synthetic Cannabinoids (K2 / Spice) | Sprayed plant material, papers, liquids, vapes. Smoked, vaped, ingested. Anxiety, confusion, paranoia. | Fast heart rate, high BP, nausea/vomiting, sweating, tremor, chest discomfort. | Overdose: Seizures, severe agitation/psychosis, kidney injury, arrhythmia, collapse. Response: 911 for severe symptoms. Calm environment, avoid unnecessary physical restraint. |
| Inhalants (Solvents, Aerosols, Glues, Dusters) | Aerosol cans (difluoroethane dusters), glue, paint thinner, gasoline. Inhaled/huffed. Dizziness, slurred speech. | Headache, nausea, chemical irritation of eyes/airways, irregular heartbeat. | Overdose: Sudden cardiac arrest ("sniffing death"), asphyxia, seizures, coma, trauma from falls. Response: Call 911. Move to fresh air without exposing yourself to fumes. CPR/AED if indicated. |
| Volatile Anesthetics (Ether, Chloroform) | Liquid solvents. Inhaled. Rapid central nervous system depression, anesthesia, dizziness. | Dizziness, respiratory irritation, nausea, unconsciousness, severe skin irritation. | Overdose: Respiratory arrest, profound hypotension, cardiac arrest, asphyxiation. Response: 911 immediately, move to fresh air, provide artificial respiration if not breathing. |
| Nitrites ("Poppers") | Small volatile liquid bottles. Inhaled. Flushing, headache, dizziness, rapid heart rate. | Headache, flushing, dizziness, low BP, nausea; impairs oxygen delivery (methemoglobinemia). | Overdose: Dangerously low BP, fainting, methemoglobinemia (blue/gray color). Response: Fresh air, sit/lie down safely. 911 for blue/gray skin, breathing trouble, or chest pain. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Tobacco & Vapes / E-Liquids | Cigarettes, cigars, chew, vapes, nicotine pouches/gum. Smoked, oral, vaped. Stimulation, fast heart rate. | Increased heart rate/BP, nausea/dizziness in new users, throat irritation, cough. | Overdose: Severe vomiting, sweating, tremor, seizures, arrhythmias, weakness, breathing failure. Response: Remove exposure, wash skin if liquid contact. Poison Control for poisoning; 911 for seizures, collapse, breathing problems. |
| Caffeine (Beverages, Pills, Powder) | Coffee, energy drinks, tablets, pure powder. Oral. Alertness, jitteriness, anxiety, tremor, insomnia. | Jitters, tremor, increased heart rate, urination, stomach reflux, headache. | Overdose: Marked palpitations, vomiting, severe agitation, dangerous arrhythmias, seizures, death. Response: Stop caffeine. Poison Control for concerning excess; 911 for seizures, severe chest pain, or collapse. |
| Substance | Appearance, Route & Intoxication | Physical Side Effects | Severe Toxicity / Overdose & Response |
| Acetaminophen (Tylenol) | Tablets, capsules, liquids. Oral. Early poisoning may cause mild nausea/vomiting or few symptoms. | Early nausea, vomiting, sweating, abdominal discomfort. Liver injury develops later. | Overdose: Fatal liver failure can occur after significant overdose, even after feeling better. Response: Contact Poison Control immediately, even if person feels well. Antidote: N-acetylcysteine (NAC) in hospital. 911 for severe illness. |
| Diphenhydramine (Benadryl) | Tablets, capsules, liquids. Oral. Drowsiness at standard doses; excess causes anticholinergic toxidrome. | Dry mouth, blurred vision, dilated pupils, fast heart rate, urinary retention, constipation. | Overdose: Delirium, hallucinations, fast heart rate, low BP, seizures, dangerous arrhythmias. Response: Poison Control for suspected excess; 911 for seizures, severe agitation, or collapse. |
| Antidepressants & Antipsychotics | Prescription tablets, capsules, injectables. Oral/injected. Toxicity varies by class; sedation, tremor, rapid heart rate. | Nausea, dizziness, sweating, tremor, drowsiness, BP changes, movement stiffness. | Overdose: Seizures, severe arrhythmias, blood pressure changes, coma, serotonin syndrome. Response: Call Poison Control promptly for overdose. 911 for severe symptoms, seizures, or collapse. |
| Beta Blockers & Clonidine | Prescription tablets, patches. Oral/transdermal. Dizziness, fatigue, slow pulse. | Slow heart rate, low blood pressure, dizziness, fatigue. | Overdose: Dangerously slow heart rate, profound shock, seizures, breathing difficulty. Response: Prompt Poison Control evaluation; 911 for fainting, seizures, or breathing problems. |
| Benzodiazepines (Hospital Antidote) | Prescription tablets. Oral. Sedation, slurred speech, poor coordination. | Drowsiness, muscle weakness, slowed reflexes. | Overdose: Deep unconsciousness, respiratory depression. Response: Hospital antidote: Flumazenil (receptor antagonist) can reverse sedation but is used cautiously due to acute withdrawal seizure risks in chronic users. |
| Combination / Situation | Why It Matters |
| Opioids + alcohol, benzos, or sedatives | Greatly increases risk of profound sedation, aspiration, and fatal respiratory depression. |
| Opioids + xylazine | Naloxone reverses the opioid component, not xylazine. Continue airway and breathing support. |
| Stimulants + opioids | One drug can mask the subjective effects of the other without eliminating overdose risk (respiratory failure, stroke, overheating still occur). |
| MDMA / Serotonergic drugs + antidepressants | Risk of serotonin toxicity (agitation, confusion, sweating, high fever, muscle rigidity, seizures). |
| Counterfeit pills or powders | Contents may not match expectations; lookalike prescription pills frequently contain illicit fentanyl or nitazenes. |
| Situation | What You May See | What To Do |
| Suspected Opioid Overdose | Unresponsive, slow/absent breathing, pinpoint pupils, gurgling/snoring, blue/gray color. | Naloxone + 911 + rescue breathing/CPR. Repeat naloxone per directions if breathing does not normalize. |
| Unconscious but Breathing | Cannot wake up but chest rises adequately. | Recovery position, monitor breathing continuously, call 911. |
| Seizure | Rhythmic jerking, loss of consciousness, stiffening. | Protect head, clear hazards, time seizure, do not restrain, do not put anything in mouth. Call 911 if prolonged or poisoning-related. |
| Severe Overheating | Hot skin, confusion, collapse, high temperature. | 911. Move to cool area, remove excess clothing, use cool wet cloths, ice packs to neck/groin. |