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Risk reduction

The consumption of substances is never risk-free. Possible risks can be reduced if the following is taken into account:

• Inform yourself about the Substancesthat you want to consume.
• Use Drug Checking Offers. Only by analysing them you can really know what you are consuming, how high the active ingredient content is and whether there are any (dangerous) additives.
• Start with taking only a small quantity of the substance to test the effect. Light people also need less than heavy people.
• Take regular consumption breaks so that your body and mind can recover from the consumption. Bear in mind that you will tolerate less after a break.
• Take your timebefore you redose. The time for the substance to take effect depends on various factors. It can vary greatly from person to person. Some substances take longer to take effect.
• The effect of the substance is also influenced by yourself and your environment. Only use when you're in a good mood, in an evironmentwhere you feel comfortable and with peoplethat you trust.
• Substances can be consumed in different ways. Find out about the safest type of consumption.
• Only use your own consumer utensils, do not share them with others and consume in a clean environment. This reduces the risk of bacteria or pathogens being transmitted.
  • If you consume/inject substances intravenously, there is a particularly high risk of infection (e.g. from HIV or hepatitis C). Therefore, always use unused disposable syringes and fresh injection equipment. Find out about syringe exchange offers in your area.
• If you consume different substances together, the (alternating) effects can hardly be estimated. The strain on the body and psyche is particularly great. You can find more information on the topic of mixed consumption here.
• Many substances increase your body temperature. Take dance breaks to cool down and drink about half a litre of non-alcoholic drinks per hour.
• Eat something in between, e.g. fruit and light meals.
• Make sure you have safe sex and always use a condomwhen you have sex.
• Never drive a vehicle under the influence of psychoactive substances !.
• Refrain from consuming substances during pregnancy and breastfeeding. You can find more detailed information on this topic here.

"Safer Sniffing"

If you consume (insufflate) substances nasally, it can lead to a damage of the nasal mucous membranes, the nose and also to the transmission of infectious diseases. To reduce the risks, please note the following:
Before that:

• Avoid consumption when a nostril is injured or in the case of a chronic cold.
• Use a clean surface to put the "line" on.
• Crush the substance into as fine a powder as possible. This reduces the risk of larger particles getting caught in the nasal hairs and damaging the nasal mucosa.
• Always use your own tube. Make sure it is clean and has no sharp edges. Do not use banknotes for this.
• Blow your nose before consumption.

After that:

• Blow your nose another 10 minutes after consumption to clear your nose of residues (These can lead to skin irritation and, in the worst case, to the death of cells).
• Take care of your nose: A nasal rinse is suitable for this. Certain oils are also suitable for preventing dryness or skin irritation.
• Take regular consumption breaks so that the nasal mucous membranes can regenerate.

You can also find an overview of the topic of risk reduction on our Posters.

Overdosing

Are you out and about and have the feeling that someone around you has consumed too much? Then it is important to remain calm and stay with the person concerned. Check whether the person is responsive and reacts to you.

Is the person responsiveThen talk to the person calmly and kindly and show them that you are there for them. Try to find out what the person needs and observe their condition. Don't leave the person alone and, if you don't feel completely comfortable yourself, get other people to help you.

If you are at a party, make the security staff and/or organisers aware of the situation. If you are in a public area, try to make other people aware of the situation so that they can support you.

If the situation for the person concerned still does not improve, call the emergency services on 144.

If the person is unresponsive, and does not react to you, then check whether the person is breathing: To do this, lean your ear against the person's nose and mouth and stretch the person's head slightly backwards into the neck. Check whether you can hear breathing noises and/or feel breathing air. At the same time, you can look at the person's chest to see if it moves up and down. Carry out the check for 10 seconds.

If the person is not breathing you must call the emergency services (144) immediately. If someone is nearby, ask them to do so. If you are alone, call yourself. Then start chest compressions. Apply deep and regular pressure to the centre of the person's chest. Do this until the rescuers arrive and, ideally, get help from other people!

If the person is unresponsive, BUT is breathing : Lay the person on their side (recovery position). In such a way that vomit can run out of the mouth. Then call the emergency services (144) and stay with the person to continue monitoring their condition.

If you need help yourself

If you feel physically or mentally unwell, try to get professional help. If there are no professional helpers on site, contact someone close to you. Ask them to stay with you and tell them about your condition. If you have taken psychoactive substances, tell this person what and how much you have consumed so that you can be helped quickly and effectively in an emergency.

If you do not feel better the following days, you can call or write to us at any time, or you can contact a paramedic, social worker, psychologist, doctor, psychotherapist or psychiatrist. These professional groups are obliged to maintain confidentiality and are therefore not permitted to pass on any personal information/data. Only very dangerous or life-threatening situations and conditions are exempt from the duty of confidentiality. (such as acute danger to self or others)

Heat stroke

You can recognise a heat stroke by the following symptoms: no sweating despite physical activity, dizziness, headaches, sudden tiredness or cramps in the arms and legs. Move the person to a quiet place with fresh air. Cool the body with cold water or wrap it in wet blankets.

Circulatory problems

Circulatory problems are characterised by paleness, sudden outbreaks of sweating and a barely perceptible pulse. People with acute circulatory problems complain of nausea, weakness, dizziness and many people feel faint. Take the affected person out into the fresh air, lay them on the floor, put their legs up, give them something to drink and let them lie still for a while. If the condition does not change, get medical help.

Anxiety, panic attacks, "bad trip"

Take the affected person to a quiet place without party lights and with few people around. Maintain physical contact (if the person wants this) and talk to them in a calming manner, e.g:

• "This will pass"
• "This is the drug and it will lose its effect"
• "I'm staying with you"

Don't leave the person alone. If you feel unsafe, get acquaintances or friends involved. If the condition does not change, get help from experts. Contact paramedics or the emergency services, for example.

Coming down

If you want to consume psychoactive substances, plan for the fact that you will need some time to "come down" afterwards. Make sure that you don't have to fulfil any important obligations such as school or work the next day. Fill your fridge beforehand and treat yourself to a good, balanced meal, fruit juices and mineral water.

If you have a hangover, you may feel exhausted and tired. Your need for rest may be increased and you may also have difficulty concentrating. Some substances can also cause a lack of motivation, depressive moods or feelings such as anxiety or insecurity.

Note the following when coming down:

• Do not consume any other substances. They only delay the onset of the after-effects and can lead to increased negative effects. Using cannabis to "smoke down" can trigger anxiety, (pseudo-)hallucinations or panic.
• The more and more often you consume, the stronger and more frequent the after-effects can be. The mixed consumption of several substances can also increase the unpleasant effects.
• Take breaks to allow your body and mind to recover from consumption.
  If you find it difficult to reduce or stop using, or if you have other psychological or physical problems, you can seek professional help. You can also contact us for this!

Drug Checking

By chemically analysing psychoactive substances such as ecstasy and speed, the checkit! team has been able to warn you about substances that are particularly harmful to your health and gain an overview of the current black market situation since 1997. The results should help you to better assess the expected effects and risks. We are always available to provide information and advice.

In line with current developments on the substance market checkit! regularly expands and adapts its analysis devices and methods on an ongoing basis. The following methods are used for stationary drug checking:

UHPLC-DAD-ITMS³, UHPLCDAD-MS, MALDI-HRMS³, chiral-HPLC-UV and ATR-FTIR

Health

Urinary tract infections
When you consume ecstasy, your body temperature rises. You also feel less of a need to drink or sleep. This can lead to a great loss of fluids. Urinary tract infections (e.g. urethritis and cystitis) can be exacerbated by this.

Serotonin syndrome

Serotonin syndrome can occur when there is too much of the messenger substance "serotonin" in the central nervous system. In some cases, this can occur with excessive (mixed) consumption of medication and drugs.

The course of the disease can range from flu-like to life-threatening symptoms. Possible symptoms are divided into three categories:

• Physical complaints
  • Increased pulse and blood pressure
  • Cardiac arrhythmia
  • Rapid breathing
  • Heavy sweating
  • Nausea, vomiting, diarrhoea
  • Headache
• Neuromuscular symptoms (= disturbed interaction between muscles and nerves)
  • Trembling
  • Muscle cramps
  • Easily triggered reflexes
  • Involuntary muscle twitching
  • Increased muscle tension
• Psychological effects
  • Restlessness, nervousness, urge to move
  • Hallucinations
  • Impairment of consciousness
  • Heightened mood
  • Coordination disorders

In severe cases, epileptic seizures, delirium, coma and organ failure can also occur. If left untreated, a severe course of serotonin syndrome can also lead to death. Medical help should therefore be sought if symptoms occur.

Ask your checkit! counsellor about possible effects and interactions if you are taking medication and/or consuming different substances. You can also find more information on mixed consumption here

et al. From: Schifano et al. (2021): New psychoactive substances (NPS) and serotonin syndrome onset: A systematic review

HPPD - Hallucinogen Persisting Perception Disorder ("Persistent perceptual disturbance after hallucinogen use")

HPPD is a mental illness that can be triggered by the consumption of hallucinogenic substances.

Although the substances have already been broken down in the body and can no longer have any effect, perceptual effects still occur. These can be, for example, movements in the visual field, blurring of patterns or halo effects [1]. They are also referred to as "flashbacks".

Most cases of HPPD have been reported following the use of LSD, as well as psilocybin, mescaline, ketamine, dextromethorphan, MDMA, synthetic cannabinoids, ayahuasca or ibogaine. HPPD occurs more frequently in people who have previously reported mental health problems or problematic consumption. However, HPPD can also be triggered by the first use of hallucinogens. [2]

If you notice these symptoms, consult a psychiatrist to discuss possible treatment.

Agranulocytosis

Agranulocytosis is a change in the blood count in which there is a reduction in white blood cells. These play an important role in the immune defence. The weakened immune defence can lead to life-threatening infections. It can also lead to blood poisoning, which can also be fatal.

Possible symptoms are

• Fever
• Chills
• Feeling ill
• Sore throat
• Mucosal lesions
• Bleeding in the oral/nasal/pharyngeal/genital mucosa [3]

Agranulocytosis is treated with a suitable antibiotic. If the symptoms described occur after cocaine consumption, we strongly recommend that you consult a doctor, as the disease can only be cured with medical treatment.

[1] From: Nichols, D. E. (2016). Psychedelics. Pharmacological reviews, 68(2), 264-355
[2] Martinotti et al._2018_ Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives
[3] pharmawiki.ch

Substance use and the brain

General information

You can find an animated representation of what happens in the brain during drug use here and here (English)!

Perception and awareness

Whenever you have a thought, feel a sensation, see something or dream, your brain is active. When you have an object in front of you, for example an armchair, an image of the armchair forms on the retina of your eye. This image is converted into electrical signals by nerve cells and sent to the visual centre of your brain. There, through complicated neurochemical processes, an armchair is formed in your consciousness. You see the chair.

Consciousness and psychoactive substances

Psychoactive substances change your thoughts, feelings or sensory impressions by altering the processes in your brain. You then find yourself in an unusual state of consciousness. What you think, feel or see suddenly seems different. It can seem more colourful, funnier or simply more intense, but also darker, sadder, more frightening. For example, if you have had a few glasses of wine, your thoughts may become confused and your way of walking unsteady. This is because alcohol affects areas of the brain that control thought processes and movement. LSD affects, among other things, the visual centre - colours change, pictures, walls, carpets start to breathe, and so on. And ecstasy affects our emotional centre - that's why you feel positive and negative emotions more intensely for a few hours.

The brain: neurons and transmitters

The human brain consists of around 25 billion nerve cells or neurones. Each of these neurones has several hundred to tens of thousands of projections that come into contact with other nerve cells. They don't actually touch each other - they are separated by a few nanometres. In between lies the synaptic cleft. If you have an armchair in front of you, there is a lot of activity in your visual centre: electrical current is being passed along millions of nerve cells. This current causes molecules or neurotransmitters (e.g. serotonin, dopamine, noradrenaline, ...) to be released into the synaptic cleft at the end of an extension - at the synapse. These neurotransmitters bind to so-called receptors on the nearest projection.

This is how communication works in the brain:

1. Currents travelling along neurons
2. Neurotransmitters are emptied at the ends
3. The neurotransmitters are taken up at the receptors of the neighbouring cell.

If enough receptors are occupied, the current is passed on to the neighbouring cell, where neurotransmitters are released and so on.

There are probably at least 100 different types of neurotransmitters and at least as many receptors in the brain. Neurotransmitters only fit into certain receptors - like keys in locks. They cannot have any effect on other receptors.

Brain and consciousness

Although there are no clear areas of responsibility in the brain, there are some areas that are primarily responsible for certain tasks such as seeing or feeling. Exactly what you see or how intensely you feel depends on the specific area of the brain and the type and amount of neurotransmitters that are released there and absorbed by receptors. If you feel very good, there will probably be slightly more neurotransmitters working in certain areas. In this case, for example, the neurotransmitter serotonin in the so-called limbic system - the area responsible for moods and emotions.

Psychoactive substances & neurotransmitters

Psychoactive substances interfere with the neurotransmitter balance. For example, they cause neurotransmitters to be increasingly emptied or specific receptors to be occupied so that these receptors can no longer absorb any more neurotransmitters. Or they prevent the neurotransmitters from being reabsorbed into the nerve cell. The neurotransmitters then remain in the synaptic cleft and act on the receptors until they finally disintegrate or are broken down.

If the neurotransmitter balance is disturbed and either more or fewer neurotransmitters than usual are active in the brain, your feelings and perceptions also change as a result. Alcohol, for example, changes the effect of the neurotransmitters glutamate and GABA in the cerebral cortex and cerebellum - you feel relaxed, can no longer think rationally and stagger. Ecstasy causes an increased release of the neurotransmitter serotonin: you perceive feelings more intensely. LSD has the same effect on the visual centre as serotonin, only stronger: the things you see change. And cocaine and speed cause more dopamine to be present in the limbic system: you feel strong, invulnerable or possibly also anxious or stressed.

Psychoactive substances are broken down by the body after some time and thus stop influencing the natural neurotransmitter balance. However, after a lot of serotonin has been depleted in a short period of time - with ecstasy, for example - and you have perceived feelings very intensely during this time, your body now needs a certain amount of time to produce enough serotonin again. During this time, you will now experience the opposite effects: if you were previously tireless and emotionally open, you will now be exhausted and irritable and withdraw for a few days. The body needs up to three weeks to restore the original serotonin balance. In short, if you alter your brain chemistry with substances you have taken, it will take some time to return to normal. And this time can feel very uncomfortable.

Body weight

Dosage

In general, the dosage of the substance should correspond to the body weight of the person concerned. People with a lower weight often require a lower dose of a substance. On average, women have a lower body weight than men and their metabolism also works somewhat differently. Women therefore often need a lower dose of substances to achieve the same effect. Ecstasy and some other substances appear to be slightly more harmful to women than men in the long term due to minimal differences in the brain. [1]

Weight reduction

Ecstasy, speed and cocaine can suppress hunger and promote physical activity. This is why these substances are sometimes used to lose weight. However, this only works in the short term: on the one hand, side effects can occur and the risk of developing an addiction increases. On the other hand, tolerance develops - the desired effect occurs less and less. In addition, psychoactive substances severely debilitate you in the long term and rob you of important vitamins and minerals.

Take care of your body after consumption and try to reabsorb the missing nutrients and fluids quickly - this will give your body the chance to recover.

If you weigh very little or have problems with eating, contact a counselling centre. Eating disorders are chronic and dangerous illnesses. You can find more information and addresses of counselling centres here:

More information at wien.gv.at

More information at wienxtra.at

[1] Are there sex differences associated with the effects of Ecstasy_Review_ Allot Redman 2007

Menstruation

For some users, the consumption of ecstasy can lead to a worsening of menstrual symptoms. For example: low mood, depression, cramps, pain or pulling in the lower abdomen.

If you regularly consume psychoactive substances (e.g. ecstasy, speed or cocaine), consequences such as vitamin and mineral deficiencies, insufficient food intake or lack of sleep can occur. These changes in metabolism can lead to an irregular cycle or even a missed period... Nevertheless, you can still get pregnant in these cases. If you take fewer drugs and take longer breaks, your natural cycle can return.

Pregnancy

Vomiting and diarrhoea are common side effects when using psychoactive substances. Vomiting and diarrhoea can impair the effect of the contraceptive pill and make pregnancies possible.

If you could be pregnant, are already pregnant or are breastfeeding your baby, you should not consume any psychoactive substances. Not even alcohol or nicotine. If you find it difficult to stop using, talk to your gynaecologist or contact an information and advice centre

Psychoactive substances can reach the foetus via the placenta during pregnancy. Many psychoactive substances, especially alcohol, ecstasy or cocaine, but also nicotine, can lead to severe developmental disorders, behavioural disorders and premature births with low birth weight. If you consume large amounts of alcohol during pregnancy, this can lead to the development of foetal alcohol syndrome (FAS). This can lead to externally visible malformations, disorders of the internal organs, behavioural abnormalities and mental developmental delays. Tobacco and cannabis consumption should also be avoided or at least the number of cigarettes should be greatly reduced: the greater the consumption, the more likely it is that miscarriages, premature births, stillbirths or underweight babies will occur.

Psychoactive substances can also reach your baby through breast milk while you are breastfeeding.

If your girlfriend or wife is pregnant, you can support her as a partner by also largely refraining from consuming psychoactive substances.

Chemsex

"Chemsex" is a term that has emerged in the homosexual scene in the course of the use of dating apps (such as gay.de, Grindr). It describes the consumption of psychoactive substances in combination with sex. The substances are referred to as Chems and usually consumed shortly before or during sex. The focus is usually on the need for increased sexual intensity, disinhibition, but also physical performance enhancement

The following substances can play a role in chemsex:

• Alcohol
• Cannabis
• Poppers
• Methamphetamine (crystal, crystal meth, Tina, meth)
• Mephedron (Meph, Drone)
• Gammahydroxybutyric acid/gammabutyrolactone (GHB/GBL, Liquid, G, Gina)

As the substances are usually purchased on the black market, it is generally unclear which active ingredients are actually containe, how high the dosage is, or whether the substances have been mixed with cutting agents. As a result, there is always a risk of undesirable effects. Therefore, if possible, have the substances analysed before consumption.

How do the substances actually work?

Here is just a brief overview. If you click on the respective substances, you will find more detailed information about them. Depending on the substance, chems are consumed nasally, orally, but also intravenously ("slamming").

Methamphetamine: Even at low doses, methamphetamine has a strong performance-enhancing and stimulating effect. Depending on the dose, the duration of effect is around 6-30 hours and is usually characterised by extreme alertness. It can also lead to euphoria, increased pleasure and disinhibition. Needs such as drinking, eating and sleeping can be suppressed. Negative effects are often related to the (often underestimated) long duration of action. These can include irritability, aggression, feelings of anxiety (paranoia), delusions and depressive states. In principle, the more frequently the drug is used and the higher the dose, the more severe the undesirable side effects. Methamphetamine has a very high psychological dependency potential.

Mephedrone / 4-MMC: Mephedrone has a stimulating and euphoric effect. The duration of effect is approx. 1 - 5 hours, depending on the dose. Consumers report feelings of mental clarity and increased performance. A feeling of connection with other people is also reported. Needs such as drinking, eating and sleeping are suppressed. Negative effects can include hyperactivity, which is perceived as unpleasant, as well as high pulse and blood pressure. At higher doses, delusions and paranoia can occur. Memory lapses are also repeatedly reported. Mephedrone causes a strong urge to take more (craving). To date, there are no reliable findings on the toxicity of the substance.

GHB / GBL: Depending on the dosage, GHB and GBL either have a euphoric and disinhibiting effect or act as a tranquilizer. Because the concentration and purity are often unknown, the dose can hardly be estimated, which can be particularly risky with GHB/GBL. In low doses of around 0.5 - 1.5g, the alcohol-like effect dominates. It then has an anxiolytic, slightly euphoric and socially opening effect. In higher doses up to approx. 2.5g, a sexually stimulating effect can be added. In even higher doses, GHB has a strong soporific and anaesthetic effect. The duration of effect is usually 1.5 to 3 hours. Negative effects can include coordination disorders, dizziness and reduced mental performance. In the worst case, GHB/GBL overdoses (i.e. doses that lead to undesirable anaesthesia) can lead to respiratory depression and possible respiratory arrest. This is particularly possible if centrally depressant substances such as sleeping pills, opioids or alcohol are also consumed. Even a small dose of GHB/GBL can lead to a coma-like sleep. Regular use can lead to physical dependence. Withdrawal should always be carried out under medical supervision, as it can lead to serious complications!

What are the risks of chemsex?

In addition to the aforementioned risks associated with substance use, there is an increased risk of contracting sexually transmitted diseases such as HIV, hepatitis and other infections (e.g. gonorrhoea, syphilis or chlamydia). There are various reasons for this: Under the influence of Chems, it can be easier to have unprotected sexual intercourse. The disinhibiting effect can also lead to trying out unusual and riskier practices. Sex is often longer, which can more easily lead to injuries (e.g. in the anal area).

Some substances are "slammed" (injected). If shared utensils are used ("needle sharing"), diseases can be transmitted (e.g. HIV, hepatitis).

The interactions of chemicals with other substances are also risky. The combined effect often cannot be accurately assessed and some combinations are particularly dangerous. This applies, for example, to GHB/GBL and alcohol. As both substances act on the GABA receptors in the brain, there is an amplifying effect. This can lead to respiratory depression, which can be life-threatening.

What if I am already taking HIV or hepatitis medication?

The combination of HIV or hepatitis medication with Chems or other psychoactive substances can be problematic. There is a possibility that the effect of the Chems may be prolonged or intensified. However, it is also possible that the effect of the HIV or hepatitis medication is influenced (e.g. stronger side effects). Some combinations also lead to a weakening of the effect of the medication.

Another risk is posed by sexual enhancers, which are often used at chemsex parties. Both chemicals (or psychoactive substances) and drugs can lead to a drop in blood pressure or even fainting and cardiac arrest when combined with sexual enhancers. This risk is particularly high with the combination of poppers and sexual enhancers.

Further information on the combination of HIV/hepatitis medication and chemotherapy can be found here: http://www.hiv-drogen.de/wechselwirkungen

Risk Reduction

To reduce possible risks, pay attention to:

• The effect of the substance is also influenced by yourself and your environment. Only use when you're in a good mood, in an evironmentwhere you feel comfortable and with peoplethat you trust.
• Pay attention to Safer sex. If possible, clarify this with the others beforehand.
• Make sure to have plenty of condoms and lubricant (and if required gloves) with you.
• Use your own consumer utensils and don't share them.
  • If you are slamming, only use your own needles.
• Get tested regularly for HIV, hepatitis and other sexually transmitted diseases, e.g. at the AIDS service organisation (www.aidshilfen.at)
• If you had unprotected sex, or you can't remember and are not sure, then you should seek medical advice as soon as possible and/or get a so-called PEP (post-exposure prophylaxis) medication (e.g. at the HIV outpatient clinic at Vienna General Hospital).
• Use Drug Checking offers. Without a chemical analysis, no statement can be made about which substances you are consuming and how high the active ingredient content is. If no analysis is possible, test your substance(s) carefully. This means: take a small amount and wait for the effect, take your time with redosing.

You can find more information about Chemsex here: https://chemsex.at/de/