Combining drugs

Different drugs have different effects. When you divide the drugs into groups according to their effect, you can distinguish three categories: narcotics (downers), stimulants (uppers) and consciousness changing (psychedelics, hallucinogens).

Downers: sedative, sleep-inducing, heart rate lowering, consciousness constricting, blood pressure lowering.

Examples are: alcohol, GHB, sleeping pills, heroin.

Uppers: increasing heart rate, increasing blood pressure, expanding consciousness.

Examples are XTC/MDMA, speed, cocaine.

Trippers: altering consciousness.

Examples are: magic mushrooms, LSD, ketamine, 2C-B. And usually we schedule cannabis as a psychedelic as well. But it could be considered a downer as well.

Uppers + uppers

Who do people combine uppers with uppers? You feel clear headed, wide awake and active. You also have less of an appetite. Combining Ecstasy/MDMA with speed can give you the feeling of having even more energy than when you’re only taking MDMA.

Uppers stimulate, among other things, that part of the nervous system that allows the body to be active: the heart rate, blood pressure and body temperature rise and the bronchi widen. More dopamine and noradrenaline is released between neurons, which gives you more energy.


Ecstasy/MDMA and speed

This combination puts extra pressure on the heart and blood vessels and can exhaust the body even more. The hangover is often worse than the hangover from the individual drugs. Speed counteracts the ‘love-effect’ of MDMA. If you are not aware of this, you may start using more MDMA to still feel that ‘love-effect’ (that will not come). With this combination you increase the chance of brain damage (speed may increase the brain damage caused by MDMA – in any case, speed can also cause brain damage on its own).  This combination also increases the risk of overheating and the risk of serotonin syndrome, see also the risks for ecstasy.

Uppers + downers

Some people combine uppers with downers. An example: coke and alcohol. The coke keeps you awake and makes you feel fit. The alcohol takes the edge of the cocaine. This allows you to drink a lot more alcohol and you are not always aware of how drunk you are. Another commonly used combination is XTC or speed with GHB. The XTC or speed gives you extra energy. The GHB makes you feel more relaxed. GHB can also prolong your MDMA intoxication.


Uppers and downers have opposite functions: you cancel a part of the desired effect.

Alcohol + cocaine

You may start to associate alcohol with coke use. As a result, you get the urge to use cocaine faster while drinking alcohol. And when you are using cocaine you can keep on drinking alcohol very easily. In addition, cocaine also gives you the feeling that you are not or less drunk than you really are. This makes some people believe that they are still perfectly capable of driving a car (which is not the case) and it also means that you drink more alcohol than you would have if you hadn’t used cocaine.
Cocaethylene is produced by combining alcohol and cocaine. This psychoactive substance is even more harmful to the liver, puts an extra burden on the heart and blood vessels and is more addictive than alcohol or cocaine on their own. Cocaethylene has a half-life 4 times longer than cocaine and therefore takes longer to breakdown, which increases the risk of toxic effects.

The hangover from combining alcohol and cocaine is also bigger, because you have drunk more alcohol than you normally would have.

Ecstasy/MDMA/speed + GHB

GHB after MDMA is said to prolong the MDMA effect. This combination can cause you to disinhibit even more than the drugs separately already do. Keep this in mind. You might do things that you can later regret.

Some people think that combining MDMA and/or amphetamine with GHB is effective against passing out. You can feel more awake than under the influence of GHB alone. But it does not really help against passing out. There is also a chance that you will take more GHB than you would if you were only using GHB. When the MDMA or amphetamine has worn off, people sometimes still pass out. There are indications that show that when you fall into a coma due to an overdose of GHB in combination with speed or MDMA, the chance of a deep and longer coma is many times greater. Complications during the coma are also more likely. So never use ‘uppers’ to prevent from passing out. Only sensible dosing with GHB helps against passing out. In addition, there is an increased risk of epileptic activity in the brain and an increased risk of movement disorders (automatic movements, agitation, self-mutilation).

Ecstasy/MDMA + alcohol

Alcohol counteracts the effect of MDMA, so it’s pretty much a waste of your ecstasy pill. It can also make you take more MDMA to get the desired effect. If you take a higher dose of MDMA, you increase the chance of side effects. In addition, this combination can cause headaches an nausea. Because of the MDMA you don’t really notice it if you are getting drunk, so it can make you want to drink more than usual. This will make the hangover a lot more intense.

Downers + downers

Fortunately, this combination is not very common and that’s because of obvious reasons. There are people who combine GHB with alcohol. Alcohol and GHB have similar effects; disinhibition, relaxation, easier in contact with others and you become more relaxed. People who find that a nice feeling sometimes want to combine both drugs to strengthen that feeling. In addition, alcohol is the standard choice for a night out for many people and is not even seen as a drug.


GHB and other downers

The combination of alcohol with GHB, sleeping pills, tranquilizers and other downers increases the chance of an overdose and is risky! The chance of falling asleep and passing out is greatly increased when alcohol is combined with GHB. You can numb the part of your brain that controls your breathing so much so that you stop breathing , which can lead to a coma and death. It is therefore highly inadvisable to combine alcohol with GHB and benzodiazepines. Remember that tranquilizers or sedatives are also downers and, when combined with alcohol, can have the same effect as GHB combined with alcohol.


Some people combine a tripping agent with hash or weed to prolong their magic mushroom or LSD trip.


Tripper + cannabis

If you smoke weed during a magic mushroom trip, it can make the trip more intense. Keep that in mind when you use this combination. There are users who have experienced that they re-experience certain magic mushroom effects while smoking weed (weeks or even months after the trip). This can be scary and confusing. If you experience this, we advise you to stop using tripping agents and to stop smoking weed.
Some people find smoking weed while tripping relaxing. But it can also turn a good trip into a difficult experience. So think in advance whether you think cannabis will be a nice addition or whether it is actually not that necessary. Then just decide not to smoke weed at that moment.

Drugs and medicine

Combining drugs with medication can also be risky. There is little research done on the many combinations. The Jellinek website contains a medicine matrix, where you can read what the risks are per substance and per type of medicine. Unfortunately it is in Dutch only.

Risky combinations are:

MDMA/speed and anti-depressants

If you’re depressed, it’s not a good idea to take MDMA. On the evening itself, the effect can be nice, but the days after you can experience a severe depression. When you take the modern antidepressants, the so-called SSRIs, you will most likely feel very little of the MDMA. It is difficult to predict if and how the MDMA will work. So it is possible that you increase the risk on serotonine syndrome. You feel little effect from the drugs, while putting yourself at extra risk. If you use an old type of antidepressant, the so-called MAO inhibitors, it is also very dangerous to use MDMA (but also other uppers such as speed): your blood pressure can rise dangerously and you have an increased risk of serotonin syndrome.

More about serotonine syndrome.

Uppers and anti-asthma or anti-hay fever agents

It is not a good idea to combine these drugs, as they can cause your blood pressure to rise dangerously.

Unity tips

Know what you are combining. Please inform yourself about the effects of the different substances.

  • Get your drugs tested!
  • Let your friends know what drugs you’ve used or plan to use.
  • Know that each drug has its own risk and that combining them creates additional risks and can cause unpredictable effects. Your kidneys and liver have to work harder to break down the waste. This can cause more damage. Your heart is also put under extra strain.
  • Know the length of the effects of a drug so you don’t accidentally’ take risky combinations.
  • Different combinations of drugs give unpredictable effects. Therefore combining drugs is NEVER without risks.

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