If you’re worried about someone else

You have probably found something, or noticed someone changing, and everything you have read so far has told you to be afraid without telling you what to do. This page is the second part.

If they are unwell right now — unconscious, not breathing normally, seizing, confused, or unrousable — go here or call 911.

Start here: call Poison Control, even with no emergency

1-800-222-1222 — free, 24 hours, staffed by medical toxicologists.

Almost nobody knows this: they answer identification questions. You do not need an emergency, and you do not need a name — you can describe a powder, read out a label, or describe a vial. This is a normal call for them and it is what the service exists for.

They are not law enforcement. They do not report you or the person you are calling about. This is the single most useful and least used resource available to you.

What you may be looking at

The things covered on this site do not look like drugs. That is most of why they are missed.

• Unlabelled white or off-white powder, often in a resealable bag or a plain plastic tub. Frequently with a scoop.
• A small digital scale, the jewellery kind that measures very small amounts. On its own this is one of the strongest signals, because these compounds are measured rather than counted.
• Small glass vials of powder, sometimes with rubber stoppers, alongside a bottle of clear liquid and insulin syringes. This is peptide territory — see BPC-157, melanotan II, gray-market GLP-1s.
• Bags or bottles labelled with a chemical name and a code — RAD-140, LGD-4033, MK-2866, GW-501516, MK-677. Often carrying the words “for research purposes only, not for human consumption.” That phrase is a legal shield, not a description of what anyone intends.
• Packages from research-chemical or peptide vendors, usually plain, often from overseas, arriving regularly.
• Small brightly-branded bottles or blister packs from a petrol station or smoke shop, sold as mood or energy supplements. This is where tianeptine lives, and it is an opioid.
• Green powder or capsules, or small “shot” bottles — likely kratom.

How to find out what it is, without a confrontation

• Search the exact name on the label, including any numbers and hyphens, and look it up on this site or anywhere else.
• Check the order history — email confirmations and card statements name the vendor, and the vendor's site names the product.
• Photograph what you found and put it back. You will want the picture when you talk to someone, and a photograph does not tip anyone off.
• Call Poison Control and describe it. Genuinely, this works.

Something to bear in mind before you decide how serious this is: the median person buying these is an adult in their twenties or thirties, usually trying to fix something specific — anxiety, an injury that will not heal, weight, or being unable to sleep. Understanding the problem they were trying to solve will get you further than anything else in this section.

What not to do

Do not flush or throw away a supply that someone is physically dependent on.

This is the instinct almost everyone has, and with some compounds it is the single most dangerous thing you can do. With alcohol, benzodiazepines and phenibut, abrupt withdrawal can cause seizures and delirium and has put people in intensive care. Taking away the supply does not produce a person who stops. It produces a person in acute withdrawal who now cannot tell you what is happening, and who will replace it within hours from a worse source.

Also worth avoiding:

• Do not lead with anger or disappointment. Not because their feelings matter more than the situation, but because it reliably produces concealment — and concealment is the thing that kills people, since it means nobody knows what is in them when it matters.
• Do not present it as a choice between the substance and you. If they are dependent, they cannot win that, and the outcome is usually that they stop telling you things.
• Do not assume it is an emergency, and do not assume it is not. That is what the Poison Control call is for.

How to talk about it

The goal of the conversation is not that they feel bad this time. It is that they tell you the truth next time — because the moment that decides how this ends is the one where something has gone wrong and they have to choose whether to say so.

Things that tend to work:

• Say what you found and that you looked it up, plainly, without a speech.
• Ask what it does for them. Take the answer seriously — most of these compounds work, which is the part that scare campaigns get wrong and which they know perfectly well.
• Say the specific thing you are worried about, rather than a general one. “I read that stopping this suddenly can cause seizures” lands. “Drugs ruin lives” does not.
• Ask what they would want you to do if something went wrong, and agree it in advance. This is the most useful sentence available to you.
• Say once, clearly, that you will not be angry if they need help at three in the morning — and then be right about that.

If they say they want to stop, the useful next step is this page, and then the stopping page for whatever it is. Do not let them stop abruptly on their own.

The money and insurance problem

“Get them to a doctor” is not actionable for a lot of families, so here is what actually exists.

• Poison Control, 1-800-222-1222 — free, no insurance, no questions, at any hour.
• SAMHSA National Helpline, 1-800-662-4357 — free and confidential, refers to treatment regardless of ability to pay. Directory at findtreatment.gov.
• Federally qualified health centres must charge on a sliding scale based on income. No money and no insurance does not make someone ineligible, and many can prescribe addiction treatment directly.
• Medicaid in expansion states covers adults on income alone — no asset test, and no waiting for an open enrolment window, because a change in income or loss of coverage opens enrolment at any time. A great many people who assume they cannot qualify, do.
• Emergency departments can begin treatment and refer onward, and cannot turn someone away for inability to pay.

One last thing

You are not going to be able to supervise this, and trying to will exhaust you without changing the outcome. The things that actually help are narrow and worth more than vigilance: they know you will pick up the phone, they know you will not be angry, and somebody in the house knows what they are taking so that an emergency department can be told.

If you want to understand what they are taking, start here.