The short version
- Counterfeit pills may contain fentanyl or nitazenes — potent synthetic opioids.
- Mixing depressants (alcohol, benzos, opioids) is a leading cause of overdose deaths.
- Naloxone reverses opioid overdose and is safe to give even if you're unsure.
- Put an unconscious person on their side and stay with them.
- Nitrous oxide can cause lasting nerve damage through B12 depletion.
- Emergency responders are there to treat, not to prosecute — call.
The single most important change in drug risk
The biggest danger with illegal drugs in the 2020s is not the drug you intended to take — it's what's actually in it. Synthetic opioids such as fentanyl and nitazenes are now found in counterfeit pills and in powders sold as other things. They are potent at microgram doses, and pills pressed to look exactly like real prescription medication are common.
This is why the old rule 'know your dose' has been replaced by a blunter one: a pill you didn't get from a pharmacy is an unknown substance, regardless of what's stamped on it.
Categories, briefly
You don't need a pharmacology course, but knowing what a substance broadly does to a body helps you recognise trouble.
- Stimulants (cocaine, MDMA, speed, misused ADHD medication) — raise heart rate, temperature and blood pressure. Risks include overheating, dehydration, heart problems, seizures, and severe low mood in the days afterwards. MDMA specifically carries a risk of dangerous overheating and, from drinking too much plain water, of dangerously low blood sodium.
- Depressants (benzodiazepines, GHB, opioids) — slow breathing and consciousness. The dose gap between 'effect' and 'stopped breathing' can be small, and it shrinks dramatically when combined with alcohol. Counterfeit 'Xanax' is a common route to accidental opioid exposure.
- Opioids (heroin, oxycodone, fentanyl, tramadol) — highest overdose risk of anything on this list. Naloxone reverses an opioid overdose and is available without prescription in many places.
- Psychedelics (LSD, psilocybin, ketamine at higher doses) — low physical toxicity but high psychological risk, especially with existing mental health difficulties. Accidents while disoriented are the main physical danger. Ketamine also causes serious bladder damage with regular use.
- Nitrous oxide ('balloons') — often assumed harmless. Heavy use depletes vitamin B12 and can cause nerve damage, numbness and difficulty walking, sometimes lasting. Suffocation risk if used in an enclosed space or with a mask.
- Prescription medication that isn't yours — the dose was calculated for someone else's body and other medications. This includes ADHD medication used to study.
Overdose: what to do
Memorise this section rather than the drug list. Being the person who acts is more useful than being the person who knows the chemistry.
- Call emergency services immediately for: unconsciousness, slow or stopped breathing, blue or grey lips, chest pain, a seizure, very high temperature, or severe confusion.
- Tell them exactly what was taken if you know. They are not police and their job is to treat, not prosecute.
- Unconscious but breathing → put them on their side (recovery position) and stay with them.
- Suspected opioid overdose → give naloxone if available and call for help. It's safe even if you're wrong about what they took.
- Overheating on a stimulant → move somewhere cool, sip water slowly, don't down litres of it.
- Never leave someone alone to sleep it off, and never put them in a cold shower.
- Many countries have 'good Samaritan' protections, and no jurisdiction prefers a body to a callout. Call.
Why people use, and what else works
Most teenage substance use isn't about rebellion. It's about managing something: anxiety in social situations, boredom, sleep, feeling numb, or fitting in. That's worth naming, because if a substance is doing a job for you, stopping only sticks once something else does that job.
If you're using anything to cope, that's not a moral failing — it's a sign you're carrying something heavy without enough support. The coping toolkit and regulation skills in this app are a start, and a GP, school counsellor or a service like FRANK, Talk to Frank or SAMHSA can talk it through confidentially.
Myths worth binning
❌Pills from a friend are safe because they look real.
Counterfeit pressed pills are visually identical to genuine medication.
❌You'll get arrested if you call an ambulance for a friend.
Many places have legal protections for callers, and saving a life comes first.
❌Nitrous is harmless because it's legal in some places.
Heavy use causes B12 depletion and potentially lasting nerve damage.
Check what stuck
Quick multiple choice, with an explanation after every answer. Nobody sees your score.