Twenty Drug Combinations That Carry the Highest Level of Risk

Aug 04 2016

Twenty Drug Combinations That Carry the Highest Level of Risk

August 4th, 2016

A recent post on TripSit, a harm reduction website that aims to “help you stay as safe as possible if you choose to use substances,” provides a comprehensive visual safety guide to different drug combinations, ranking them from lowest to highest risk.

Drug-mixing is often wrongly overlooked in discussions about “overdose” deaths—yet most opioid-related fatalities, for example, do not involve opioids alone but opioids combined with other drugs, typically sedatives such as benzodiazepines or alcohol.

Interestingly, no combinations involving LSD, psilocybin mushrooms, DMT or cannabis make it to Tripsit’s highest level of danger. It’s also important to point out that no drug is entirely without risk—even if risks can be hugely mitigated by safer use practices. It should be noted, too, that people buying illegal drugs often have no way of knowing which substances they’ve actually purchased.

Here are 20 drug combinations that fall into Tripsit’s most dangerous category—though this is by no means an exhaustive list. Check out the original guide to get a fuller picture.

1. Alcohol + Ketamine

2. Alcohol + Dextromethorphan (DXM), the active ingredient in most OTC cough medicines

3. Alcohol + Opioids

4. Alcohol + Tramadol (a painkiller sold under the brandname Ultram, among others)

5. Alcohol + Benzos

6. SSRIs (which include many anti-depressants like Lexapro, Prozac, Zoloft) + Dextromethorphan (DXM)

7. SSRIs + Tramadol

8. SSRIs + MAOIs (an older type of anti-depressant, that are dangerous in combination with many other substances too)

9. Opioids + Benzos

10. Opioids + Tramadol

11. Opioids + Cocaine

12. Opioids + DXM

13. Opioids + Ketamine

14. MDMA + DXM

15. MDMA + Tramadol

16. Cocaine + Tramaldol

17. Amphetamines + Tramadol

18. Tramadol + Ketamine

19. Tramadol + DXM

20. GHB/GBL + Benzos, Tramadoz, Opioids, alcohol, Ketamine, DXM

  • This is a touchy issue. Thank you for broaching it. I think it should be presented with the message that most overdoses are intentional. Even if the guy at the smoke break at your last meeting said “most OD’s are caused by lost tolarence and anyone who says otherwise is an idiot”.

  • This article needs to be shared. There are so many people out there mix n matching their substances without knowing the reality of just how much risk they are taking. Projects like the festival testing will reveal just how many people do not know what is in their hand but still take the risk of putting it in their system. Alcohol again ranking quite high in there, it’s in every high risk listing, it’s rating high in the public health issue bracket, takes up the majority of A&E’S time and resource nearly every single weekend, also, substance use while pregnant has had a little limelight in the media a few weeks ago, with the emphasis as usual on illicit substances, a although it touched on prescription medications it didn’t say enough. Alcohol should be a top priority here as well. Illicit substances may cause discomfort and ‘possible’ risks of longer lasting symptoms but there is not so much evidence to support this, however, Alcohol foetal syndrome and some of the primary issues that arise from that are for life. The sad thing about overdose is that around 80% of individuals over dose in company, but 85% are found alone. 8 out of ten overdose situations are prescription medications, and the majority of overdose situations are accidental. It’s very rare that someone will go out of their way to commit suicide while under the influence. It’s usually accidental and quite a high statistic of those dying will have been poly drug users unaware of the contraindications around the cocktail. International Overdose Awareness Day, 31st August. Great info for presentations on and around that day, Thanks.

    • “the majority of overdose situations are accidental. It’s very rare that someone will go out of their way to commit suicide while under the influence. It’s usually accidental… poly drug users unaware of the contraindications… International Overdose Awareness Day, 31st August. Great info for presentations….”

      You people scare me.

      • ‘You people?’ Arecwe different in some way then? Pray tell? It’s a well known and well recorded fact that the majority of overdoses are unplanned and accidental due to a number of reasons, periods of abstinence such as prison or hospital, present high risk, age factors into it, gender, body weight, health, there are a number of reasons including prohibition and the resulting unregulated products with no quality control. A study in Melbourne Australia by Heale P, Dietze P and Fry C. Showed that there are varying rates of intentional overdoses reported among survivors. The overall results of the study revealed that ‘A substantial minority, 17% of overdoses are intentional’ 67% of those who had tried had tried within the last 6 months. Overall the end scope of the research showed that 11% of the total sample had intentionally overdosed. Out of those actually involved in the study 21% overdosed during the study, 4% of the overall study. Self reports of intentional overdose fell into two categories, precipitating events and emotional trauma or states of mind. The outcome of the research was that a relatively low portion of overdose situation were actually intentional. There areca number of similar studies available on respectable sites such as pubmed, nih gov, etc. Contributing factors to accidental death include quality of product, no regulation, no security, prohibition at its best. Periods of abstinence, prison, hospital, etc. Age and deteriorated mental and physical health in older generation and hedonism alongside lack of harm reduction education in the younger generation. Add to that the fact that there are numerous Fentanyl cut product to mention the most prominent at present, again prohibitive legislation great success story, so its Russian Roulette even for the most seasoned addict. Tolerance, ignorance, non regulation all fueled by punitive legislation with the imminent deterioration of health by far outweighs any other contributing factor to overdose, especially a decision to waste the rest if your life, no matter how bad things get, and, a drug you’ve probably worked bloody hard to get the money to buy. I suggest you change your title, it’s false advertising and when reading your comments makes you sound amateur and unlikely to get much business m, if you are a business.

        • Wow that was a spirited defense. Thanks! Actually many people leaving prisons and rehabs overdose intentionally because they are suicidal. Life is easy in the institution but outside its much harder and people aren’t quite so nice and you have to get a job – yuck! Just go to your local AA/NA meeting and see for yourself. Overdoses are intentional in 90% of the stories. Of course they lie to doctors and researchers. No one wants to admit to being suicidal. BUT you agree that drugs must be decriminalized and enforced abstinence kills. And that is what is most important. As for me I am an expert and my business is fine and I don’t take advice from industry shills. 🙂

          • I’m not sure what a ‘shill’ is but I can assure you I am not a decoy trying to stimulate any form of response, or divert from the facts, nor am I an industry shill. I am a ling term drug user, and recovering drug worker who has lived in and around drug users for the last 40 years. And, during those years I can count on one hand how many intentional overdoses I gave witnessed and, or discussed with individuals. I find it quite dangerous that you claim to be an expert and carry such a misconception as your truth. And quite precariously point out that most substance users are liars while you defend your unevidenced and unrealistic statement. When leaving prison, its the excitement if freedom and the lack of concern around tolerance that results in overdose situations. Sadly those leaving prison arec8 tines more likely to experience a fatal overdose due to tolerance levels and sadly the majority of ‘problematic’ users are in the revolving door circuit which throws the bodies metabolism and everything else out if sync. I personally have experienced release from a number of facilities and believe me, on release day I am anything but suicidal! I’m gate happy, horny and on the move. The clean tine behind the door has set off the natural chemicals usually surpressed by the substances and I’m like Zebadee on a mission. Tolerance is the last thing on my mind, but the first thing on my medical records. Every time.

          • “nor am I an industry shill. I am a ling term drug user, and recovering drug worker” – LOL – get your story straight.

            In CA Prop 47 decriminalized some drugs and they released a bunch of people and sentenced them to AA meetings and their stories were all the same: “I was really excited when I got out of jail but then I got really depressed because no one was waiting for me so I went to my drug dealer and got a nice stash and went to the park to lay down.” Your comment is pure propaganda but it is easy enough to debunk just by listening to the addicts themselves.

            “most substance users are liars” – I never said that but you could forgive someone for thinking that after reading your comment.

            Bottom line: most overdoses are completely intentional, as proven by the empty bottles of every drug in the house lying around the body. But the addiction industry needs to pump the ‘oops I took one too many’ propaganda to keep the money flowing. Argue all you want and see if you don’t end up proving all my points and debunking all of yours one after another:

          • I was attempting humour and can assure you my story is straight. People who use drugs are more than capable of maintaining employment given the right approach, right environment and open-minded employers. Not that that is what my comment made. I have spent my whole life in the company of users of all kinds of substances at all levels. And I can count on one hand how many intentional overdose situations I’ve come across in all that time. If you look closely at statistical data in its own environment, keeping each group seperate, such as mental health, long term physics health, age gender, body weight, etc, its easier to understand the overall collated statistics, and in son individual groups intentional suicide does take prevalence, however the main area where intentional suicide is most common is in mental health, therefore the intention may not be a choice made in the best state of mind and might possibly have changed given the at times rapid cycling thought process. Everywhere else you look on this particular subject, meaning the Office of National statistics, World Health Organisation, National Institute for Clinical Excellence, European Monitoring Centre for Drugs and Drug Addiction, and many more International data collection services that influence top researchers and policy makers clearly show that at least 80% of overdose situations are accidental and very rarely will a drug related death be intentional. The need for better peer education and involvement, effective harm reduction programs, supervised consumption facilities, etc, and primarily a complete overhaul and reformation of drug policy moving away in what may seem radical proportions from prohibition and the United Nations Utopian dream of a drug free society, which has created the opposite, a veritable Orwellian nightmare, with a eugenic foundation, culling the poor. The current situation may make those caught the system feel suicidal but the repeated euphoric bliss and oblivious escapism found in Opioids is far too welcoming and engulfing to waste by intentionally over dosing on your hard earned drug of choice. I have been released from prison on a number of occasions and not once have I ever left a facility depressed, quite the opposite actually. And by the tine depression would be setting in I would already gave desensitised myself to my surrounding and reached the desired numb oblivion that actually kept me alive in some cases, but eventually nearly killed me. My bodies ability to cope could not keep up with my tolerance levels and nearly every hit resulted in my going over. Age and time, probably the two most effective and successful treatment options available and most definitely the only two that guarantee a long lasting m, sustainable outcome. .

          • I think the issue that we are exposing here is that we are relying on statistical data that can change in every town, let alone every country. The statistical data in say Seattle at one point showed a huge intentional suicide rate whereas statistics in say Estonia showed a huge unintentional drug related statistic. However this could reflect a completely different picture the month after. I think personally this is a fluctuating, and impossible issue that we have found here that could be proven using statistics by both of us at any given time and also challenged with the same proven statistical data by either of us at another just as easily. If that makes sense. The basis is that whether or not the reasons that make the drug related death statistics so high are the same, lack of attention to the underlying issues of social inequalities and restrictions to appropriate care and a disinvestment in services that address the public health issue in favour of the lucrative criminal justice approach of locking those who struggle the most up rather than offering them support. #SupportDontPunish Addiction has become the scapegoat for all that is wrong with society, when in fact it is a product of social and health inequality, resulting in far too many deaths regardless of whether the choice was intentional or accidental. Those that show contempt prior to investigation need to educate themselves and become part of the solution, demonisation and ignorance are part of the problem and the result is far from the desired outcome for anyone involved in the debate to end the so called ‘War On Drugs’ which has never been about drugs. Greed, power, fear, colour, control….. yes…..drugs… Except maybe as a weapon to numb down the opposition. 🙂

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