When a bad trip is an emergency, and what to do while you wait

Call the emergency number straight away if someone on a trip cannot be woken, has trouble breathing, has blue lips or fingertips, has a seizure, is overheating and not cooling down, or is a danger to themselves or others. The numbers are 112 anywhere in the EU, 999 (or 112) in the UK and 911 in the United States. FRANK, the UK government's drug information service, lists the first four of these signs as reasons to call 999 now (FRANK, emergencies).

A bad trip on its own is frightening, and most of the time the right help is a calm sober person and a quiet room. This page is about the moments when that is no longer enough.

Call now if you see any of these

The lithium example comes from an analysis of online reports: 47% of 62 reports of lithium combined with a classic psychedelic described a seizure (Nayak et al. 2021). The last row matters because a blotter sold as LSD can contain NBOMe compounds, which have caused fatal poisonings (Zawilska et al. 2020).

What to tell the operator

FRANK suggests a simple script: "I need an ambulance. My friend has taken [drug] and they are [symptoms]. We are at [location]." Then answer the questions and follow the instructions.

• Say what was taken, how much if you know, and roughly when.
• Mention alcohol, other drugs and any medication.
• Keep the packaging, the rest of the blotter or the pills, and give them to the crew. FRANK notes this helps the medical team.

Fear of the police keeps people from calling. FRANK states that in most circumstances ambulance staff will not tell the police (FRANK, emergencies). Rules differ per country, but in every one of them the call is the right decision when someone's breathing or life is at risk.

While you wait for the ambulance

• Stay with them. FRANK: do not leave them alone, even for a moment.
• If they are awake, keep them calm. Speak softly, do not shout or shake them.
• If they are unconscious but breathing, put them in the recovery position: on their side, so the airway stays open and vomit cannot block it. The NHS recovery position guide shows the steps.
• If they are not breathing, start CPR. The operator will talk you through it.
• Clear the space. Move sharp or heavy objects, keep them away from stairs, windows and water.
• Send someone to the door to guide the crew in, and switch on a light.

Overheating

Overheating can happen when someone has combined substances, or has spent hours in a hot, crowded room. FRANK's steps for someone overheating:

1. Move them somewhere cool.
2. Remove excess clothing.
3. Let them sip water slowly.
4. Fan them or use a cool, damp cloth.
5. Call 999 (or 112 or 911) if their temperature does not drop.

Someone who is a danger to themselves or others

A small share of hard trips turn dangerous. In a survey of 1,993 people about their worst mushroom trip, 11% said they had put themselves or others at risk of physical harm and 2.6% had behaved aggressively or violently (Carbonaro et al. 2016). FRANK warns that people have hurt themselves during a bad trip (FRANK, LSD).

If someone tries to run off, climb or attack, do not try to hold them down on your own. Keep your distance, keep exits to traffic, balconies and water closed if you can do so safely, and call the emergency number. Your own safety counts too.

No trip killers

It is tempting to end a frightening trip with a pill. Emergency doctors in Manchester analysed 128 Reddit threads with 709 posts about "trip killers": benzodiazepines made up 46% of the recommendations and antipsychotics 18%, mostly without warnings. They point to risks of oversedation, low blood pressure and slowed breathing, and note that information on trip killers is not available through drug advice services (Yates and Melon 2024). Leave medication to the ambulance crew and the hospital.

Not an emergency, but you need someone to talk to

• US: the Fireside Project psychedelic support line, phone or text 62-FIRESIDE (623-473-7433), 11 a.m. to 11 p.m. Pacific (Fireside Project).
• UK: FRANK on 0300 123 6600 (FRANK).
• Netherlands: Drugs Infolijn, 0900-1995, weekdays 9:00 to 17:00 (DRUGSinfo contact).

None of these replaces an ambulance. When in doubt, call the emergency number.

After the crisis, see the days after a bad trip. To keep it from happening again, start with testing what you take.