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The gold standard for comprehensive, trustworthy drug information, including dosages and more.
An exceptional resource with very detailed evaluations of dozens of novel, lesser-known, and lesser-studied substances. No longer being updated, but the information is excellent.
Blog containing very indepth discussion, analysis, and reporting on various novel substances from the perspective of the author, including detailed trip reports for extremely rare drugs.
A database of user-compiled descriptions of subjective drug effects. Includes cognitive effects as well as all five senses. An excellent resource for helping others put words to their experiences, especially intense ones.
A fairly comprehensive introductory guide to wounds, wound care, and complications, including graphics.
"We provide pipes to harm reduction groups regardless of their ability to pay. Purchasing with Smoke Works directly supports underfunded outreach groups." Online/nationwide as well as in-person initiative, specializing in pipes and pieces.
Erowid Experience Vaults are an invaluable resource for tens of thousands of drug experience reports submitted over the course of almost three decades.
Scary-looking link that is actually a real website providing free access to any scientific journal.
Drug Experiences & Guides written by Dominic Milton Trott who self-administered over 150 psychoactive substances
Community-driven harm reduction organization focused on providing support and education for safe drug use, offering resources such as detailed drug information, safety guidelines, and real-time assistance for individuals experiencing difficult substance use situations
a international online harm-reduction community dedicated to reducing the risks associated with drug use through open discussion, accurate information, and supportive resources, aiming to empower individuals to make informed decisions and promote safer practices
The buyer’s DNM bible aims to be a complete guide that covers all steps that users have to take in order to buy securely from darknetmarkets.
A list of drugs identified by the Toronto Drug Checking Service, with an explanation of each. Not comprehensive but includes more unusual substances or adulterants (like fentanyl analogs, novel benzos, etc).
The William G. Nash Foundation will work to facilitate honest discussion and close gaps in college campus safety by engaging in the following key activities:
- Grantmaking to organizations and student groups working to reduce harm and introduce restorative justice on the college campus.
- Partnering with like-minded organizations to raise awareness and create programming when needed to meet a goal.
- Contribute to public discourse on harm reduction and psychedelic use in uncontrolled campus settings through legislative advocacy, media campaigns, opinion editorials, grey literature and peer-reviewed publications.
- Work to advocate for reality-based substance use education and culture/policy change at institutions of higher learning and high schools across the country.
An educational organization that believes all teens should have access to honest drug information & safer use guidelines.
A 57-page guide aimed at RNs (registered nurses) providing care to unsheltered individuals, with emphasis on assessments, plans, and procedures.
"Open Collective is a legal and financial toolbox for grassroots groups. It’s a fundraising + legal status + money management platform for your community. Whether you're a mutual aid group, a community initiative, an open-source software project, or a climate change activist, Open Collective helps groups unlock access to money."
Australian drug alert & warning system indicating market trends and possible issues.
A network of European-based field drug checking NGOs that share their data amongst each other.
Spain-based mail-in drug checking service (consent required) that also offers quantitative analysis for a fee.
Australian walk-in drug checking service.
A page showing a list of active drug checking services in BC and Canada as a whole.
An evaluation of the 2022 Zürich drug checking service's cocaine sample data.
Free mail-in advanced drug checking service for Pennsylvania residents. Also offers quantitative testing, an extremely rare service in the United States.
A series of guidebooks aimed at drug checking service providers. Very robust and indepth.
Charleston, WV-based community group that promotes health and dignity in PWUD. Syringe disposal, naloxone, etc. Volunteer programs.
"An online co-learning community dedicated to remaining hyper-focused on the intersection of psychedelics & neurodivergence. Peer-supported psychedelic integration for those navigating autism, ADHD & other neurological variations. Psychedelics aside, we also welcome anyone, of any neurotype, to join us for open discussions hosted in alignment with the neurodiversity paradigm."
Independent, underfunded harm reduction programs may apply for access to larger discounts on more items. Smoke Works recirculates revenue to bolster burgeoning, independent harm reduction programs struggling to experience economic prosperity (STEP). Benefits to STEP Program include: 20% off essential harm reduction supplies. Monthly technical assistance call with other independent harm reduction groups and SW staff. Priority Material Aid Requests.
(Free supplies for low-income groups) Smoke Works' Material Aid Program covers needs when budgets won't. Requests for harm reduction supplies from our catalog can be made by active account holders. We understand that large or small, budgets never meet demand. All active accountholders are welcome to submit requests for supplies.
Canadian document explaining standard operating procedures for crushing up drugs before testing them. Includes images, references, and very detailed descriptions of the crushing process to maximize the effectiveness of drug checking procedures.
"Sociocracy For All (SoFA) is a nonprofit that helps organizations, communities, workplaces and collectives to learn how to organize in a decentralized way and make their decisions with equity, efficiency, empowerment, trust and transparency using sociocracy."
In collaboration with toxicology labs, medical examiner and coroner offices, crime laboratories, clinical partners, and the National Institute of Justice (NIJ), the CFSRE is documenting the first reports of NPS in the United States and around the world through analysis of toxicology samples and drug materials. These reports, called “new drug monographs”, are generated using comprehensive analytical techniques (e.g. GC-MS, LC-QTOF-MS, NMR, FTIR) and include available information about the new drug(s) identified at the time of reporting, as well as the analytical data generated during testing. These reports are intended to assist with the rapid identification of NPS in forensic casework and related disciplines, and should not be used for confirmatory purposes alone.
A fully-fledged database of links and embedded content touching on topics ranging from sex work to pregnancy to gender identity to syringe exchanges to drug information. A one-stop shop by very trusted sources. NEXT Distro is also an online syringe exchange.
A website dedicated to safer use, overdose prevention, and harm reduction tips made by people who use drugs. Designed for social service programs (syringe exchanges, health departments, etc.) but usable by anyone.
A Google Drive folder containing literature, slides, and analyses of the movement of xylazine and fentanyl through the drug market, particularly in 2023. Includes information about wound care, market trends, and drug landscape monitoring, predominantly in Baltimore/Maryland.
This case study focuses on the consequences of the switch to mobile needle exchange services immediately after the closure [of one of the oldest fixed site needle exchanges in a large city in Canada] and examines the impact of the closure on changes in risk behavior related to drug use, needle distribution and access to services The context surrounding the closure was also examined. Conclusion: Closing the fixed site needle exchange had an adverse effect on already vulnerable clients and reduced access to comprehensive harm reduction services. While official public policy supports a fixed site, politicization of the issue has meant a significant setback for harm reduction with reduced potential to meet public health targets related to reducing the spread of blood borne diseases. This situation is unacceptable from a public health perspective.
A wide variety of trainings on all sorts of harm reduction topics.
A broad series of trainings on topics ranging from harm reduction program funding to community to foundations. Particularly geared towards individuals who want to work in harm reduction.
Nationwide nonprofit committed to improving healthcare outcomes and destigmatization around HIV.
Podcast covering the drug war, hosted by people who use drugs.
"Every day CNVC, along with its Certified Trainers in Nonviolent Communication (NVC), teaches and supports the growth and sustainability of NVC in over 65 countries, and growing."
A tool/technique for being effective when you're asserting a boundary, asking for something, or saying no. From “DBT,” Dialectical Behavioral Therapy.
Scientific journal arguing against the introduction of nalmefene to the opioid overdose reversal drug market. The American College of Medical Toxicology and the American Academy of Clinical Toxicology state in this article that nalmefene's new appearance on the clinical market for these drugs and potential to cause debilitating withdrawal outweighs any potential benefit it may offer over traditional naloxone formulations.
Georgia Overdose Prevention’s mission is to educate Georgians about the new laws governing drug overdose incidents and to distribute opioid overdose rescue kits to anyone who knows a person at risk for opioid/opiate overdose. We created and were instrumental in the passage of Georgia’s 911 Medical Amnesty and Naloxone Access Law in 2014.
New England-based rural naloxone and FTS distribution program
NEXT Distro guide to the "post-overdose" state, where someone who has been revived or otherwise come out of an OD is cared for and protected. Goes into detail about precipitated withdrawal, demystifying and debunking naloxone administration, and ways to support and respect people who use drugs as they regain consciousness.
Two-image graphic series from the University of Pittsburgh explaining information about xylazine and self-care/wound care practices.
A nonprofit selling accessible, low-cost naloxone to harm reduction programs. Invaluable resource for anyone distributing naloxone locally.
An FDA-approved naloxone product that contains 3 mg intranasally rather than 4. Current research does not support the need for higher-dose naloxone, which may have worse health outcomes for people with opioid tolerance. HRT is a nonprofit organization.
A map-based directory of all syringe exchanges in the United States.
First syringe access program in West Virginia. Follows a harm reduction model.
Scientific journal funded by the NIH and SAMHSA explaining the general uses, importance, and administration of naloxone. Includes discussion of IM versus IN formulations.
As physicians, pharmacists, scientists, and specialists in poison information, we are experts in pharmacology, toxicology, and the management of opioid overdose and addiction. We applaud the effort to seek out new therapeutic strategies for management of these patients.
We are concerned that use of a longer-acting reversal agent would not improve on current practice and could potentially cause harm. When withdrawal is precipitated by an opioid antagonist, there are few good management options. In most cases, the best strategy is to address and support the patient’s signs and symptoms until the effects of the antagonist wane. In the case of naloxone, which has a relatively short duration of action, severe withdrawal usually lasts less than an hour with symptoms typically persisting no more than 90 minutes.[25–27] A longer-acting antagonist is anticipated to cause longer-lasting precipitated withdrawal and may lead to worse patient outcomes. Clinical experience with both naltrexone and nalmefene suggests prolonged withdrawal is a complication of a longer-acting opioid antagonists.[28] Although a longer-acting antagonist may be theoretically beneficial for resuscitation of opioid-naive individuals in an opioid-induced mass casualty incident, this type of event has never been reported in North America and this application is unstudied.
We are also concerned that patients who receive nalmefene may require longer periods of observation, by up to several hours, to observe for recrudescent effects as the antagonist effects wane. Patients who receive nalmefene will still need medical observation to ensure that respiratory depression does not recur after the effects of the medication subside. This will prolong ED visit length and challenge patient and clinician expectations, further burdening a taxed system. Further clinical study is needed to understand whether a reduction in repeat antagonist use justifies a longer length of stay or longer period of withdrawal.
Finally, we are concerned that IN nalmefene has not been adequately studied for effectiveness in the actual setting and patient population: for patients with severe opioid intoxication in the out-of-hospital environment. Lack of proof of safety and efficacy in real-world use could result in significant harm if widely utilized.
The potential benefits of nalmefene over naloxone (greater opioid receptor affinity, longer duration action) carry risk of causing harm. These benefits, if present, should be demonstrated in the clinical environment, balanced with the risks, and compared to naloxone prior to broad adoption of nalmefene.
HMA’s Compassionate Overdose Response Summit suggests “high dose” naloxone isn’t necessary.
More than 100,000 people in the United States die every year from drug overdoses, driven by the availability of illicitly manufactured fentanyl. On March 19, 2024, HMA held the Compassionate Overdose Response Summit to discuss overdose response and reversal drugs like naloxone in the context of a fluctuating drug supply. Forty experts participated in consensus-building discussion on a standard of care opioid overdose response protocol. Throughout four panel presentations, a critical message emerged: those responding to an overdose should aim to restore breathing without causing withdrawal by supporting the person’s breathing, giving low or standard doses of naloxone (0.4 mg intramuscular injection and <4 mg intranasal spray) until spontaneous breathing is restored, and creating a calm environment. Despite fluctuations in the drug supply, standard dose naloxone is effective.
The standard dose of naloxone is considered 0.4 mg intramuscular injection and <4 mg intranasal spray. It is extremely effective and preferred by people who experience overdose. Reports at the Summit from four states (Missouri, Kentucky, Pennsylvania, and New York) made clear that an increase in naloxone dose is not a necessary response to the presence of fentanyl in the drug supply. Negative reactions following naloxone administration may be avoided, and anger can potentially be managed via low-dose naloxone titration and a calm, compassionate, and considerate communication style between the person who overdosed, the person who administered an opioid antagonist, and bystanders, including EMS.
Another key takeaway from the Summit, and shared in the report released today, was the acute and long-term adverse outcomes of withdrawal on people who experience overdose. The way a person is treated during an overdose, i.e., the communication style of the responder, likelihood of withdrawal, and the care they are offered after, affects their risk behavior such as using more opioids to feel better. In a study from New York State, those who received 8 mg nasal spray were more likely to experience withdrawal than those who received 4 mg nasal spray. People who experience withdrawal after an overdose may be discouraged from seeking help in the future.
Background: Fatal overdoses involving fentanyl/fentanyl analogs (F/FA) have increased in the US, raising questions about naloxone doses for F/FA overdose reversal. Emergency medical services (EMS) data provide an opportunity to examine naloxone administration changes as fentanyl increases in the illicit opioid supply.
Methods: Administered naloxone intranasal-equivalent total dose (INTD) in milligrams (mg) was calculated for Kentucky EMS suspected opioid overdose (SOO) encounters (n=33,846), 2018-2021, and patterns of administration were examined. County-level F/FA availability was measured as 1) proportion of fatal drug overdoses involving F/FA, and 2) F/FA police seizures. Linear mixed models estimated changes in INTD in relation to local F/FA availability accounting for patient characteristics.
Results: From 2018-2021, SOOs increased by 44% (6853 to 9888) with an average INTD increase from 4.5mg to 4.7mg, with more than 99% of encounters resulting in successful reversal each year. For SOO encounters examined by outcome at the scene (i.e., non-fatal fatal vs fatal), average INTD for non-fatal were 4.6mg compared to 5.9mg for fatal overdoses. Mixed modeling found no significant relationship between INTD and the two measures for local F/FA availability.
Conclusion: As F/FA-involved overdose risk increased, we observed a modest increase in INTD administered in SOO EMS encounters - just slightly higher than the 4mg standard dose. The lack of significant relationship between F/FA and naloxone dose suggests that naloxone utilization in SOO with EMS involvement remains effective for overdose reversal, and that EMS naloxone dosing patterns have not changed substantially.
The average number of naloxone doses administered by law
enforcement (LE) responders was the same regardless of formulation.
There were no significant differences in hospital transportation or
survival between groups.
No benefits to administration of 8-mg intranasal naloxone compared with 4-mg product were found. More data are needed to determine whether higher-dose intranasal naloxone would provide added benefits.
"Project DAWN (Deaths Avoided With Naloxone) is a network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health. As of October 2023, there are 182 Project DAWN programs registered in Ohio. Project DAWN programs distribute naloxone and provide training at one or various Project DAWN sites, or locations, to prevent opioid overdose and promote harm reduction. Many Project DAWN programs operate multiple sites, usually with partnering agencies. Program partnerships and settings include:"
Background: Illicitly manufactured fentanyl (IMF) prevalence has increased. However, there is uncertainty about naloxone dose(s) used by nonmedical bystanders to reverse opioid overdoses in the context of increasing IMF. Methods: We used community naloxone distribution program data about naloxone doses and fatal opioid overdoses from the Allegheny County Medical Examiner. From January 2013 to December 2016, staff interviewed participants who administered naloxone in response to 1072 overdoses. We calculated frequencies, percentages, and conducted a 1-way analysis of variance (ANOVA). Results: Despite increases in fentanyl-contributed deaths, there were no statistically significant differences between any of the 4 years (2013-2016) on average number of naloxone doses used by participants to reverse an overdose (F = 0.88; P = .449). Conclusion: Even though IMF is more potent than heroin and is a rapidly increasing contributor to drug overdose deaths in Allegheny County, the average dose of naloxone administered has not changed. Our findings differ from studies in different areas also experiencing increasing IMF prevalence. Additional investigations are needed to clarify the amount of naloxone needed to reverse opioid overdoses in the community caused by new synthetic opioids. (https://sci-hubtw.hkvisa.net/ can be used to access the entire article)
"Massachusetts Overdose Prevention Helpline is a virtual spotting / overdose detection service for people who use drugs."
The number one risk factor for fatal overdose is using alone and we are there for you when others cannot be. We connect people who are using drugs with a trained operator who can call for help in case of overdose.
This is not a recovery or treatment helpline; we are committed to your safety and confidentiality and provide this service to anyone who is at risk of overdose.
Scientific journal comparing the efficacy of naloxone in a market saturated with fentanyl versus heroin. Clear efficacy for both, but significant increase of overdose and death when fentanyl replaces heroin due to potency and need for timely naloxone administration.
A Penn medicine guide for treating xylazine withdrawals and related overdoses. Sample: "Some patients with chronic fentanyl use who are co-exposed to xylazine may develop physiologic dependence and a withdrawal syndrome. There is little known about the characteristics, incidence, or
severity of xylazine withdrawal syndrome. Patients and providers report/observe irritability, anxiety, restlessness and dysphoria. The possibility of additional autonomic effects, including tachycardia, diaphoresis and hypertension may occur in patients following xylazine abstinence within 8-24 hours. It is important to exclude (by detailed and collateral history, chart review, past and current drug screen results review when available) co-use of other agents (benzodiazepines or alcohol) and/or initiate prophylaxis or
treatment of withdrawal syndromes associated with benzodiazepine or ethanol use when these autonomic symptoms are present."
Background: Illicitly manufactured fentanyl (IMF) prevalence has increased. However, there is uncertainty about naloxone dose(s) used by nonmedical bystanders to reverse opioid overdoses in the context of increasing IMF. Methods: We used community naloxone distribution program data about naloxone doses and fatal opioid overdoses from the Allegheny County Medical Examiner. From January 2013 to December 2016, staff interviewed participants who administered naloxone in response to 1072 overdoses. We
calculated frequencies, percentages, and conducted a 1-way analysis of variance (ANOVA). Results: Despite increases in fentanyl-contributed deaths, there were no statistically significant differences between any of the 4 years (2013–2016) on average number of naloxone doses used by participants to reverse an overdose (F D 0.88; P D .449). Conclusion: Even though IMF is more potent than heroin and is a rapidly increasing contributor to drug overdose deaths in Allegheny County, the average dose of naloxone
administered has not changed. Our findings differ from studies in different areas also experiencing increasing IMF prevalence. Additional investigations are needed to clarify the amount of naloxone needed to reverse opioid overdoses in the community caused by new synthetic opioids.
As rates of substance use have increased in the United States, rates of substance-involved pregnancies have also been on the rise, inspiring new civil policies designed to punish pregnant and parenting individuals who engage in substance use or are living with an untreated substance use disorder. Proponents of punitive civil policies argue that such policies will deter substance use behaviors and/or that substance use during pregnancy deserves punishment for harming the fetus. Current scientific evidence invalidates both claims, offering compelling evidence that punitive civil policies often worsen the harms of substance use for both parent and child. In this commentary, we review this evidence and explain how punitive policies that threaten child removal and the termination of parental rights exacerbate the very problems they are ostensibly designed to reduce. Rather than coercive and punitive responses, families affected by substance use need greater access to affordable, evidence-based treatment as well as services that address the structural and relational concerns underlying substance use. Above all, responses to perinatal substance use in both policy and practice should prioritize keeping families together.
A list of inclusive terminology, including definitions and suggested alternative language.
This guideline on the treatment of substance use disorders (SUDs) in pregnant adults (≥18 years old) was developed by the New York State (NYS) Department of Health (DOH) AIDS Institute (AI) to establish a New York State standard of care. The goal of this guideline is to ensure that healthcare providers in New York State are aware of and able to provide appropriate options for SUD treatment during pregnancy and to: Inform clinicians of available treatment options for SUDs to expand access to SUD treatment for pregnant individuals. Provide evidence-based recommendations to guide the management of substance use and SUDs during pregnancy. Promote a harm reduction approach to SUD treatment in pregnancy by providing practical strategies for reducing the negative consequences of drug and alcohol use during pregnancy. Increase awareness among healthcare providers about the stigma associated with drug and alcohol use during pregnancy.
Brief one-page resource demonstrating the recommended flow of medication treatment for pain patients taking buprenorphine. Harm reduction oriented.
An organization geared towards women-identifying individuals who use psychedelics, including storytelling, guides, and information.
A website with podcasts, zines, films, and slow studies offering insight into indigenous, climate-oriented, human-centric, and ecological issues.
Gabon-based NGO promoting cultural knowledge and heritage in West Africa, especially around iboga and Bwiti.
Indigenous-centered news outlet promoting storytelling and heritage protection of communities around the globe.
A BIPOC-led psychedelic organization promoting healing and justice in communities of color. Hosts workshops and integration circles.
Alabama-based nonprofit focusing on issues of incarceration, poverty, and economic justice.
A website compiling statistical information about various elements of the War on Drugs, including data about a huge variety of topics.
One of the most respected drug policy organizations in the world. An essential resource with many trainings and resources on all sorts of intersectional topics.
Nonprofit in Canada advancing the rights of PWUD (people who use drugs), especially from a policy standpoint.
Nonprofit cannabis voter project supporting Americans in directly contacting representatives to demand legalization.
Broken No More is an organization formed by families and friends of those suffering from a drug disorder (addiction). We have lived the trauma of addiction with our loved ones and we have seen the devastating results of this disorder. And, too many of us, have experienced the loss of a loved one from a drug overdose. Broken No More was formed with the hope that more enlightened drug policies will reduce the stigma and help to stem the tide of addiction and overdose.
Cannabis-oriented news & policy website dedicated to changing cannabis laws.
Harm Reduction Hacks is the product of a series of 38 qualitative conversations with harm reduction leaders representing every region of the US that took place in the Fall of 2020 and the Spring of 2021.
For Harm Reduction Hacks, two waves of leaders representing every region of the US participated in one-on-one conversations in the Fall of 2020 and spring of 2021. These leaders represented a wide variety of organizational types and structures providing harm reduction services in the US, including stand-alone non-profits, fiscally sponsored projects, horizontal collectives, and programs embedded in both county health departments and larger community-based organizations (CBOs).
This data was then analyzed for themes, practical tips, and other information. That analysis, and the wisdom of people who have between them nearly 500 years of lived experience, are woven throughout the information, tips, and insights in Harm Reduction Hacks.
"We work to prevent overdoses and save lives through harm reduction. By building innovative technology that promotes connection and providing on-the-ground support throughout Ohio, we strive to empower people who use drugs to build strong, healthy communities." Also includes a map to Columbus-based harm reduction initiatives: https://thesoarinitiative.org/columbus-resources-map/
A sex work advocacy website with a large library of resources available around policy, rights, and liberation.
A database of police alternatives sorted by state and city.
A mental health support website that offers an interactive self-care guide for when you're not feeling well. (It rules.)
"Fireweed Collective offers mental health education and mutual aid through a Healing Justice and Disability Justice lens. We support the emotional wellness of all people and center QTBIPOC folks in our internal leadership, programs, and resources."
A 5-step guide to receiving feedback from others.
Mutual aid-based support group meetings for learning about & practicing harm reduction, without expectations of changes in behavior. Wide array of meetings including some for PWUD, some for friends & family of PWUD, meetings specific to various marginalized identities, etc.
"Support for safer drinking, reduced drinking, or quitting. HAMS is a peer-led and free-of-charge support and informational group for anyone who wants to change their drinking habits for the better. The acronym HAMS stands for Harm reduction, Abstinence, and Moderation Support. HAMS Harm Reduction strategies are defined in the 17 elements of HAMS. HAMS offers support via an online forum, a chat room, an email group, a facebook group, and live meetings. We also offer harm reduction information via the HAMS Book, the articles on this web site, and the HAMS podcast. HAMS supports every positive change. Choose your own goal - safe drinking, reduced drinking, or quitting alcohol altogether."
13-page printable guidebook including information about effects, history, and overdose complications, as well as instructions for using xylazine test strips (vetted for accuracy), Minnesota harm reduction resources, and citations.