Harm Reduction Guide

The Harm Reduction Framework

Harm reduction is a public health approach grounded in evidence, not judgment. It recognises that people use substances for a wide variety of reasons, and that providing accurate safety information is more effective at reducing deaths and injuries than prohibition or moral condemnation alone.

This guide is intended to reduce risk, not encourage use. The safest choice is always not to use. If you choose to use, these principles are designed to keep you alive and healthier.

Testing Your Substances

Reagent test kits use chemical reactions that produce a colour change when they contact specific compounds. They are inexpensive, widely available, and can prevent deaths caused by misidentified or contaminated substances.

Essential Test Kits

• Marquis Reagent — General purpose. Turns purple-black for MDMA, orange-brown for opiates, red for amphetamines
• Mecke Reagent — Confirms MDMA and other substances; turns blue-green for MDMA
• Folin Reagent — Specific for serotonergic compounds including MDMA
• Simon's Reagent — Distinguishes MDMA from MDA (reacts with secondary amines only)
• Mandelin Reagent — Tests for ketamine, opioids, and stimulants

Fentanyl Test Strips

Fentanyl test strips are the single most important harm reduction tool in the current drug supply landscape. Illicitly manufactured fentanyl has contaminated virtually every category of street drug — stimulants, sedatives, and pressed pills. A dose as small as 2 milligrams (invisible to the naked eye) can be fatal to a non-opioid-tolerant person.

• Dissolve a small sample in water according to strip instructions
• One line = fentanyl detected; two lines = not detected
• A negative result does not guarantee safety — test strips do not detect all fentanyl analogues
• Even if fentanyl is detected, naloxone availability and not using alone remain critical

Limitations of Testing

• Reagent kits confirm the presence of expected compounds but cannot test for purity or concentration
• A positive test for the intended compound does not mean no adulterants are present
• Testing a small sample from one part of a batch may not represent the entire batch (hot spots)
• Use multiple test kits — no single kit detects everything

Dosing Safely

Start Low, Go Slow — Always

This principle has prevented more deaths than any other single harm reduction strategy. Dose potency varies enormously between vendors, batches, and even within a single purchase. Tolerance also varies dramatically between individuals and across time.

• Begin with 10–20% of your intended dose for any new vendor or batch
• Allow full onset time before reassessing — do not redose prematurely
• Onset times vary significantly by route: oral (30–90 min), insufflation (5–20 min), inhalation (seconds to minutes)
• If using after a tolerance break, your previous dose is now too high — start at 20–25% of your last dose

Accurate Measurement

• Use a precise milligram scale (0.001g resolution) for any powdered substance
• Volumetric dosing: dissolve in a measured liquid volume for consistent micro-doses
• Never eyeball powder doses — visual estimation of milligram amounts is unreliable

Naloxone — Overdose Reversal

Naloxone (brand name Narcan) is a medication that rapidly reverses opioid overdose by blocking opioid receptors. It is safe to administer even if opioids are not confirmed — it causes no harm if opioids are absent.

How to Administer

• Nasal spray (Narcan): Insert tip into one nostril and press plunger firmly. May need to repeat in second nostril after 2–3 minutes if no response
• Intramuscular injection: Inject into thigh or upper arm muscle. Faster onset than nasal
• Naloxone wears off in 30–90 minutes — opioids may outlast it; stay with the person and repeat if needed
• Even after successful reversal, call emergency services — the person may re-overdose

Where to Get Naloxone

• Many pharmacies dispense naloxone without a prescription in the US, UK, Canada, and Australia
• Harm reduction programs distribute free naloxone kits with training
• NEXT Distro (US) provides naloxone by mail in eligible states
• Always carry at least two doses — fentanyl overdoses frequently require multiple doses

Never Use Alone

Using alone is one of the most significant risk factors for overdose death. When someone is present, an overdose can be identified and reversed. When alone, there is no one to intervene.

• Always have a trusted person present who knows what you are taking and how to respond
• Tell them the substance, approximate dose, and when you took it
• Show them where the naloxone is kept

If You Must Use Alone

• Never Use Alone hotline (US): 1-800-484-3731 — stay on the phone; if you become unresponsive, they dispatch emergency services to your location
• Brave app: Mobile app that monitors for signs of overdose and alerts a contact
• Keep a door unlocked so emergency services can enter
• Have naloxone within arm's reach — not in a bag or cupboard

Dangerous Drug Combinations

Polydrug use — combining multiple psychoactive substances — dramatically increases overdose risk and adverse event risk. Some combinations are particularly dangerous:

• Opioids + Alcohol: Both depress breathing — combination multiplies risk
• Opioids + Gabapentinoids (gabapentin, pregabalin): Increases respiratory depression significantly
• Stimulants + MAOIs: Can cause fatal serotonin syndrome or hypertensive crisis
• MDMA + Lithium: Increases seizure risk substantially
• Psychedelics + Stimulants: Unpredictable intensification, cardiovascular stress

Check every combination using TripSit's Combination Chart (tripsit.me) before use. Categorises interactions as: Dangerous, Caution, Low Risk + Decrease, Low Risk + No Synergy, Low Risk + Synergy.

Support Resources

• DanceSafe (dancesafe.org) — Free drug checking services at events and by mail (US)
• The Loop (wearetheloop.org) — Drug checking and harm reduction (UK/Europe)
• TripSit (tripsit.me) — Drug combination checker, factsheets, live chat support
• Erowid (erowid.org) — Comprehensive substance information library
• SAMHSA Helpline: 1-800-662-4357 — Free, confidential treatment referral (US)
• Frank (talktofrank.com) — UK drug information and helpline
• Never Use Alone: 1-800-484-3731 — Call while using opioids if alone (US)