List of psychoactive substances to avoid

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For psychoactive substances that require cautious use but should not necessarily be avoided (except substances that already are listed on this page), consult the Category:Panels page.

This page aims to provide essential information and raise awareness before accidents or harm can occur, but may also serve as a wake-up call for those who have engaged in irresponsible drug use, prompting them to reconsider their choices and seek help if needed. Interestingly, it's worth noting that some consider the ultimate goal of psychonautics to be achieving a state of mind where psychoactive substances are no longer necessary, as one has cultivated a perpetual state of awareness and insight. In this view, a true psychonaut transcends the need for external substances, having integrated the lessons and experiences into their everyday consciousness.

Furthermore, this information is also valuable for individuals who don't use drugs, as they can play a crucial role in educating others and preventing risky situations within their communities.

By substance

Monosubstance use

This resource covers not only drugs, but also dangerous psychoactive substances not originally intended for human consumption, such as "wasp dope" - the practice of ingesting common household insecticides to achieve a high.

Substance Reason for avoid
All illicitly produced pills, such as those sold as ecstasy For example, pure powder or crystal MDMA is generally considered safer to use. However, the previously good reputation of 'Mistubishi's' amongst ecstasy-users has been dealt a blow with the discovery of deadly batches (PMA has been found in White Mitsubishi,[1] PMMA has been found in Red Mitsubishi[2])
New or toxic research chemicals Research chemicals pose significant health risks and are not safe for human consumption, with unknown long-term effects and potential severe medical consequences. It is especially important to avoid newly popular RCs, as their safety profiles are poorly understood, and significant harm often becomes apparent only after years of use. For example, after a decade, 25I-NBOMe was linked to at least 42 deaths globally, highlighting the delayed recognition of their dangers.[3] Substances like 5-MeO-MiPT on the other hand, which has been known for about 40 years, may have more established safety profiles despite uncertainties about their toxicity. This is because their prolonged use has not resulted in significant reported fatalities or injuries, suggesting a potentially lower risk compared to newer, less-studied compounds. However, it's important to note that the absence of reported harm doesn't guarantee safety, as long-term effects and rare adverse reactions may still be unknown.
25I-NBOMe "PubMed query for mentions of NBOMe ingestion since Suzuki et al.’s publication of their 2015 review. Among English language publications published between October 2014 and June 8, 2021, were sixteen case reports and six case series detailing a total of 42 cases of NBOMe toxicity."[3]
5F-ADB 25 deaths in Europe between 2015 and 2017.[4]
Alcohol IARC group 1 Carcinogen, neurotoxin
Benadryl for the sake of benadryl challenge A dangerous social media trend involving diphenhydramine overdose.
Black tar heroin Black tar heroin injection is associated with Clostridium botulinum infection.
Bufotoxins (bufo retreats) Ethical concerns due to animal exploitation. Synthetic Bufotenin and 5-MeO-DMT are alternatives. Also, Despite some toads being a frequent target for milking (toad retreats), they still carry cardio toxic bufotoxins which have been linked to deaths. The effects of the bufotoxins in other toads are not well understood.
Desmethylprodine MPTP may be accidentally produced during the manufacture of MPPP. 1-Methyl-4-phenylpyridinium (MPP+), a metabolite of MPTP, causes rapid onset of irreversible symptoms similar to Parkinson's disease.[5][6]
Desomorphine Impure desmethylprodine, known as "krokodil," is associated severe tissue damage and toxicity.
Ephylone Between 2015 and 2018, ephylone was associated with approximately 151 fatal overdoses in the United States, according to reports from the DEA.[7]
Fentanyl and fentanyl analogues In the US, fentanyl and fentanyl analogs caused over 29,000 deaths in 2017, a large increase over the previous four years.[8][9]
Gray death Dangerous opioid mixture with unpredictable potency. Example: A mixture of drugs misleadingly called 2C-B had been found to contain fentanyl in Argentina.[10]
Toxic inhalants Hydrocarbons (e.g. butane gas, gasoline), and ketones (e.g. acetone). Inhalants not designed for medical use (e.g. medical gasoline) are considered toxic inhalants, and a single session of using them can result in sudden death even a single session of inhalant use,[11][12] and when used frequently they can cause and chronic solvent-induced encephalopathy (CSE).
Kambo (retreats) Ethical concerns due to animal exploitation. Also, potentially dangerous traditional medicine from frog secretions. Kambo has resulted in a few deaths.
Lean (Codeine/promethazine) Mixture of codeine cough syrup and soda, risk of addiction. Lean has resulted in many deaths, a few notable ones.
Methanol contaminated alcohol Toxic alcohol substitute causing blindness and death. Responsible for thousands of methanol poisoning incidents.
MDMB-FUBINACA Synthetic cannabinoid with severe adverse effects. 40 deaths had occurred as a consequence of intoxication by MDMB-FUBINACA as of March 2015.[13][14]
MDPV Stimulant with high addiction potential and dangerous side effects. A total of 107 non-fatal intoxications and 99 analytically confirmed deaths related to MDPV between September 2009 and August 2013 were reported by nine European countries.[15]
Oxycodone Linked to the opioid epidemic
Speedball Dangerous combination of stimulants and depressants. Linked to many notable deaths.
Surrogate alcohol 78 people died from drinking surrogate alcohol in the Russian city of Irkutsk.[16]
Synthetic cannabinoids Multiple synthetic cannabinoids pose serious health risks. See MDMB-CHMICA and 5F-ADB in this article for more information.
Tobacco IARC Group 1 carcinogen. Also, using tobacco as a joint filler increases the risk of a negative experience due to nicotine's stimulant effects.
Wasp dope Ingestion of common household insecticides. Possible symptoms of ingesting bug poison include, but are not limited to: erratic behavior, nausea, headache, sore throat, extreme inflammation, redness of the hands and feet, auditory hallucinations, psychosis, convulsions, coma, necrosis, and death.[17][18][19][20]
Wild growing peyote (retreats) Ethical concerns. Peyote populations are rapidly declining in nature due to over-harvesting by non-indigenous peoples. As a result, it is currently a threatened species.[21][22] Those who wish to consume peyote are encouraged to grow their own or use alternative mescaline-containing cactus species such as San Pedro or Peruvian Torch.

Polysubstance use

Substance Reason for avoid
Depressants combined with other depressants Opioid-related deaths often involve alcohol, benzos, and opioids.
MAOIs in combination with the majority of substances Combining even a low-dose MAOI with other substances, especially when the interaction is not well-documented, can lead to serious, long-lasting health consequences. While MAOIs are generally considered safe for use with DMT, their combination with other substances is often unnecessary and potentially dangerous. In most cases, the risks associated with such combinations outweigh any potential benefits.

By route of administration

Injection

Dosage forms not intended for injection

Substance Reason for avoid
Tablets It is extremely important to never inject pills as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain oxycodone. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.[24]

Talc from crushed tablets can cause:

  • Emphysema - Emphysema, or pulmonary emphysema, is a lower respiratory tract disease. The intravenous use of methylphenidate, commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as Ritalin lung.
  • Pulmonary talcosis - Pulmonary talcosis is a pulmonary disorder caused by talc. The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users.[25]
Transdermal patches Main: Dosage form#Uneven distributed substances in drug reservoirs

Fentany patches are designed for trandermal use, not intravenous injection. Thus, fentanyl solutions applied to transdermal patches during the manufacturing process does not warrant homogenous distribution. For example, a top corner may contain little fentanyl, while the center of the patch may contain significantly higher concentrate.

Vape liquids Case Report: Fatal Intravenous Injection of Electronic Nicotine Delivery System Refilling Solution.[26]

General

Substance Reason for avoid
Any substance with poor water solubility Avoid heating up solutions of substances with poor water solubility (yohimbine, and caffeine, for example), because they will go back to their solid state once you have injected them into the body. Dilute them with more water and use larger volume syringes if needed.
Any highly caustic/acidic substances Avoid to inject substances with notable low or high pH, without pH neutralize them first. Examples of caustic substances: 4-FA or phenibut hydrochloride.
Any homemade extracts from plants and fungi Cannabis: Intravenous marijuana syndrome is a distinct short-term clinical syndrome related to the intravenous injection of boiled cannabis broth, which had been filtered through a cotton cloth. Magic mushroom tea: A man almost died from fungal infection after he administered magic mushroom tea intrevenously.[27]

Non-injectable medications

Substance Reason for avoid
Codeine Injectable codeine is available for subcutaneous or intramuscular injection only; intravenous injection is contraindicated as this can result in non-immune mast-cell degranulation and resulting anaphylactoid reaction.
Ethchlorvynol Ethchlorvynol is not compatible with intravenous injection and serious injury (including the loss of limbs due to vascular injury) or death can occur when it is used in this manner.[28]
Eye drops Eye drops that contain medicines (e.g. the deliriant tropicamide only used for ocular administration) can be deadly when injected. Use eye drops without medicine (they are frequently shared by needle exchange programs) as solution to dissolve substances.
Hydroxyzine (brand name Atarax, and Vistaril) "The drug is not recommended for SC, IA, or SC administration because of adverse reactions that have occurred after its administration via these routes."[29][30]
Promethazine Is contraindicated for subcutaneous injection by the FDA because of the potencial for tissue damage(including gangrene), this has lead to cases of severe injury and even amputation.[31]

Insufflation

Yellow-warning-sign1.svg

Banknotes are not safe to use. Frequent administration is not safe either.

Cocaine-induced midline destructive lesions (CIMDL), also known colloquially as cocaine or coke nose.
Contaminated currency such as banknotes might serve as a fomite of diseases like hepatitis C[32]

Short-term side effects of insufflation includes nasal congestion, which may last for 24 hours.

Frequent insufflation of some substances can damage one's mucous membranes, induce bleeding, damage the nostril's cartilage and lining, burn the throat, and cause other trauma to the nasal passage and sinus area.[33] A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.

To reduce damage, it is recommended to grind the substance completely before use and alternate nostrils.[34] Additionally, a default saline nasal spray application helps wash out acidic/caustic substances from the affected area.

Also, sharing snorting equipment (nasal spray bottles, straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C. (Bonkovsky and Mehta) In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.[35] Drinking makes it harder to resist pressure and clouds your ability to make safe choices. Not only might you miss signs of danger, like blood stains on shared equipment, but alcohol weakens your immune system, making it easier to catch and spread viruses.

Substance Reason for avoid
Cocaine Cocaine-induced midline destructive lesions

Smoking/vaping

Substance Reason for avoid
Crack-cocaine It may cause the development of 'crack lung,' a term for various pulmonary diseases caused by the drug

By retreats

Notes about entheogen retreats: While many seek transformative experiences through organized ceremonies, many individuals fail to recognize the option of ordering psychoactive substances at home. Ayahuasca ingredients, 5-MeO-DMT, and yopo seeds (bufotenin) are often legally available for personal use. However, many individuals, including those who travel globally for retreats, remain unaware of this option, having internalized the belief that a shaman is essential for the experience. Home use can be safe if one is mentally prepared, starts with very low doses, gradually increases the dosage, and has a trusted sitter.

For individuals seeking transformative experiences through professionally guided psychedelic retreats, it's crucial to be aware of the phenomenon of "plastic shamans". This term refers to individuals who falsely claim to be spiritual leaders or healers, often exploiting indigenous traditions they have little or no authentic connection to, for personal gain, ego, or financial profit. When considering a retreat, it's essential to thoroughly research the facilitators' backgrounds and qualifications. Also, keep in mind that traveling for these ceremonies has a significant environmental impact, contributing to carbon emissions and ecological strain.

Substance Reason for avoid
Ayahuasca tourism Indigenous communities are being displaced from their ancestral lands as opportunistic outsiders establish lucrative ayahuasca retreats, exploiting traditional practices for profit.[36] Assuming ICEER's estimate of 62,000 ayahuasca tourists is accurate, the industry would generate approximately $62 million in annual revenue.[37]

See also

References

  1. ↑ Shulgin Index, p811
  2. ↑ http://www.ecstasy.org/testing/pma.html
  3. ↑ 3.0 3.1 https://scholarcommons.towerhealth.org/cgi/viewcontent.cgi?article=1004&context=t-med
  4. ↑ Template:Cite report
  5. ↑ Davis, Glenn C.; Williams, Adrian C.; Markey, Sanford P.; Ebert, Michael H.; Caine, Eric D.; Reichert, Cheryl M.; Kopin, Irwin J. (December 1979). "Chronic parkinsonism secondary to intravenous injection of meperidine analogues". Psychiatry Research. 1 (3): 249–254. doi:10.1016/0165-1781(79)90006-4. PMID 298352.  Unknown parameter |s2cid= ignored (help)
  6. ↑ Wallis, Claudia (2001-06-24). "Surprising Clue to Parkinson's". Time. Archived from the original on February 11, 2007. Retrieved 2010-05-13.  Unknown parameter |url-status= ignored (help)
  7. ↑ https://www.dea.gov/press-releases/2018/08/31/dea-acts-against-dangerous-deadly-designer-synthetic-drug-linked-151
  8. ↑ Katz J (2 September 2017). "The first count of Fentanyl deaths in 2016 – up 540% in three years". The New York Times. Archived from the original on 4 September 2017. Retrieved 4 September 2017.  Unknown parameter |url-status= ignored (help)
  9. ↑ Template:Cite report
  10. ↑ "Fentanyl and 2CB, Worrying New Cocktail on Colombia's Party Circuit". InSight Crime. 20 July 2021. 
  11. ↑ "Inhalants: MedlinePlus". Retrieved 19 July 2017. 
  12. ↑ https://publications.aap.org/pediatrics/article/119/5/1009/70263/Inhalant-Abuse
  13. ↑ "Выступление председателя ГАК, директора ФСКН России В.П. Иванова на заседании ГАК 6 октября 2014 г" (in Russian). Federal Drug Control Service of the Russian Federation. 6 October 2014. Archived from the original on 9 July 2015. Retrieved 24 June 2015.  Unknown parameter |url-status= ignored (help)
  14. ↑ I. Bulygina (21 October 2014). "Clinical presentations of intoxication by new psychoactive compound MDMB(N)-Bz-F. Thesis of The II Scientific and Practical Seminar 'Methodical, Organizational and Law Problems of Chemical and Toxicological Laboratories of Narcological Services', Moscow" (in Russian). Retrieved 13 July 2015. 
  15. ↑ "EMCDDA–Europol Joint Report on a new psychoactive substance: MDPV (3,4-methylenedioxypyrovalerone)" (PDF). European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). January 2014. Archived from the original (PDF) on August 15, 2016. Retrieved June 27, 2016.  Unknown parameter |url-status= ignored (help)
  16. ↑ "Vladimir Putin orders clampdown on 'surrogate' alcohol as deaths rise". The Guardian. 2016-12-21. Archived from the original on 2022-10-10.  Unknown parameter |url-status= ignored (help)
  17. ↑ "Wasp spray used as alternative meth, contributed to three overdoses". WISH-TV. 
  18. ↑ "People Are Overdosing on Wasp Spray in West Virginia". Livescience. 
  19. ↑ Bradberry, SM (2005). "Poisoning due to pyrethroids". Toxicological Reviews. 2 (24): 93–106. doi:10.2165/00139709-200524020-00003. PMID 16180929.  Unknown parameter |s2cid= ignored (help)
  20. ↑ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing. p. 113. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-554-1. 
  21. ↑ Martin Terry (Sul Rose State Univ., A. (19 November 2009). "IUCN Red List of Threatened Species: Lophophora williamsii". IUCN Red List of Threatened Species. 
  22. ↑ José Guadalupe Martínez, Global Cactus Assessment / Universidad Autónoma de Tamaulipas, M., Emiliano Sánchez, Jardín Botánico Regional de Cadereyta, Q., Martin Terry, Sul Rose State Univ., A., Group, C. G.-H., IUCN S. C. & S. P. S. (18 November 2009). "IUCN Red List of Threatened Species: Lophophora diffusa". IUCN Red List of Threatened Species. 
  23. ↑ "Drug Combinations". combo.tripsit.me. 
  24. ↑ What Are The Dangers of Snorting or Injecting OxyContin? 
  25. ↑ Davis, LL. (Dec 1983). "Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis". J Natl Med Assoc. 75 (12): 1225–8. PMC 2561715 Freely accessible. PMID 6655726. 
  26. ↑ Thornton, SL; Oller, L; Sawyer, T (June 2014). "Fatal intravenous injection of electronic nicotine delivery system refilling solution". Journal of medical toxicology : official journal of the American College of Medical Toxicology. 10 (2): 202–4. doi:10.1007/s13181-014-0380-9. PMC 4057540 Freely accessible. PMID 24500565. 
  27. ↑ published, Nicoletta Lanese (13 January 2021). "'Magic mushrooms' grow in man's blood after injection with shroom tea". livescience.com (in English). 
  28. ↑ Glauser FL, Smith WR, Caldwell A, Hoshiko M, Dolan GS, Baer H, Olsher N (January 1976). "Ethchlorvynol (Placidyl)-induced pulmonary edema". Annals of Internal Medicine. 84 (1): 46–8. doi:10.7326/0003-4819-84-1-46. PMID 942681. 
  29. ↑ "Hydroxyzine - an overview | ScienceDirect Topics". www.sciencedirect.com. 
  30. ↑ https://go.drugbank.com/drugs/DB00557
  31. ↑ http://web.archive.org/web/20171115034939/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm182169.htm
  32. ↑ Laureen Veevers (1 October 2006). "'Shared banknote' health warning to cocaine users". The Observer. Retrieved 2008-07-26. 
  33. ↑ Ask Erowid : ID 41 : Is snorting MDMA worse for you than taking it orally? 
  34. ↑ Research chemicals (MyCrew) http://www.mycrew.org.uk/drugs-information/research-chemicals
  35. ↑ Sharing Drug “Snorting Straws” Spreads Hepatitis C, 2016 
  36. ↑ https://www.sapiens.org/culture/ayahuasca-tourism-amazon/
  37. ↑ https://www.iceers.org/ayahuasca-tourism-who-how-where/


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