The Quick And Dirty Guide To Drug Use Harm Reduction

To safely use recreational drugs, one of the most important concerns is protecting your brain. Certain drugs are markedly neurotoxic (e.g., methamphetamine), whereas others are essentially benign from a brain health standpoint.

The immediate environment associated with your recreational drug use also affects the impact on your brain. Rolling on MDMA at 10x a typical dose and dancing for 36 hours without stopping to hydrate is going to take a greater toll than taking half a dose under the supervision of a psychiatrist to help treat your refractory PTSD.

Neuroprotection refers to protecting the brain against some form of neurological insult, e.g., UV irradiation, traumatic brain injury, neurodegenerative disease, cerebral ischemia, etc. We’re also going to summarize some tips, behaviors, and dietary supplements that may confer neuroprotection based on the class of drug being used (or abused). I say “may confer neuroprotection” because many of these claims depend on studies done in animal models or even *in vitro *and cannot be neatly translated to human health.  Moreover, some of the comments below are anecdotal and aren’t even evidence-based at all.


  • Drinking a moderate of alcohol everyday (1-2 units) is much better for your brain than binge drinking twice a month. It’s rapid changes in blood alcohol content (BAC) that are damaging; the brain easily adapts to gradual changes.
  • Alcohol-induced neurotoxicity does not occur during intoxication, it occurs during alcohol withdrawal (kindling).
  • Always take vitamin B1 (thiamine) with alcohol. The metabolism of alcohol depletes vitamin B1; hence alcoholics are chronically deficient. Alcohol-induced brain damage is ultimately mediated by B1 deficiency (Wernicke-Korsakoff Encephalopathy). When alcoholics arrive in the emergency room, the first thing a physician will do is administer intravenous vitamin B1, since this may save the patients brain from irreversible brain damage.


The primary risk with opioids is respiratory depression, characterized by a decrease in breathing frequency, tidal volume and hypoventilation. A sufficiently high dose of almost any opioid will result in complete cessation of breathing. Hypoventilation arising from respiratory depression results in hypercapnia (elevated carbon dioxide in the blood), acidosis (acidification of blood), and hypoxemia (low blood oxygen saturation), and eventual death.

The brain is particularly sensitive to both blood flow and oxygen, requiring an uninterrupted supply of both. Hence, the main risk of opioid use is inadvertent overdose, which can result in brain damage (due to hypoxemia).
Some tips:

  • Avoid fentanyl, which is extraordinarily potent. Fentanyl is the worst  offender when it comes to inducing respiratory depression. Some heroin is cut with fentanyl, which is dangerous for obvious reasons.
  • Keep naloxone or naltrexone on hand to reverse opioid-induced respiratory depression; this way you could (theoretically) take low-dose naltrexone before passing out to reverse respiratory depression while unconscious. The problem of course is that if you’re high enough to spontaneously lose consciousness, you probably won’t have the presence of mind to use this prophylactic measure.
  • Avoid co-administration of benzodiazepines, z-drugs (e.g., Ambien) alcohol, GHB, barbiturates or other CNS depressants along with opioids; combining different classes of depressants markedly decreases the lethal dose (LD50).
  • Apart from the risk of respiratory depression, opioids are not directly damaging to the brain (neurotoxic).
  • Be extremely careful about taking a break from using opioids, and then re-starting your habit. Due to tolerance from chronic use, a dose you were previously taking everyday can kill you if you haven’t used in a long time.


Cannabis is completely safe (in the sense that it is not lethal in overdose). However, from a brain-health perspective, long-term use can still deleteriously affect working memory and motivation. David foster Wallace also likes to talk about how Cannabis can be really really addictive for some people and that it totally qualifies as a drug of abuse.
Some helpful tips:

  • Use a high-cannabidiol strain or co-administer a CBD extract when you smoke. CBD has neuroprotective properties and may enhance neurogenesis- the birth of new neurons in the hippocampus. CBD also has antipsychotic properties that may offset some of the psychotomimetic effects of THC.
  • Cycloxygenase (COX) inhibitors, like NSAIDS (e.g., aspirin or ibuprofen), may help mitigate some of the negative effects of THC
  • Nicotine is a working memory enhancer that may offset some memory problems by binding acetylcholine receptors in the brain (nicotine =/ tobacco)


I think the cost/benefit analysis for MDMA use is not favorable. There are simply other safer highs out there that are less likely to adversely affect mental health.

The jury is still out on whether or not MDMA is actually neurotoxic at typical doses. However, the specter of neurotoxicity has been raised by a number of studies, most of which were conducted in either rodents or monkeys. Proposed strategies to mitigate hypothetical MDMA neurotoxicity usually include an antioxidant regimen (Vitamin C, Vitamin E, Resveratrol/Pterostilbene, Curcumin, Astaxanthin, Melatonin, etc.)

While using MDMA, make sure to:

  • Stay cool (hypothermia is neuroprotective)
  • Avoid polysubstance abuse
  • Have time to allow your brain to recover after use


See my article on amphetamine use harm reduction for a complete guide to this topic.


Strangely, cocaine is actually not as neurotoxic to the dopaminergic system as amphetamine. Amphetamine releases catecholamines in spades, whereas cocaine is a trimonoamine reuptake inhibitor. Cocaine inhibits the reuptake of serotonin, dopamine and norepinephrine, increasing the synaptic concentration of all three neurotransmitters. The main risk posed by Cocaine use is a major cerebrovascular event.

Cocaine users also tend to over-drink, because cocaine decreases the subjective perception of impairment. Some users may also drink to manage stimulant-related edginess. It goes without saying that the mixture of alcohol and cocaine is worse for your brain than either substance alone. It is thought that Cocaethylene is formed in vivo when both alcohol and cocaine are present in the blood, which may contribute to the addictive potential of this combination.

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