1. 1-Hexadecanol: Minimal risk.

2. 1-Phenethyl-4-propionyloxypiperidine: 1-Phenethyl-4-priopionyloxypiperidine Likely intermediate in fentanyl synthesis. Data very limited.

3. 1-Propionyl-4-anilinopiperidine: 1-Propionyl-4-anilinopiperidine is a research chemical, as such effects are unknown. It is suspected to be a fentanyl or fentanyl analog precursor.4-ANBocP

4. 2 C-E: 2 C-E (2,5-dimethoxy-4-ethylphenethlamine) is a synthetic stimulant/hallucinogen. Adverse effects include high heart rate and blood pressure, agitation, delirium, hallucinations. Although very rare a few deaths have been associated with 2 C-E use.

5. 2,5-Dimethoxy-4-bromophenethylamine: 2C-B is a CNS stimulant and hallucinogen. Adverse effects include hallucinations, elevated blood pressure, heart rate, and body temperature. Confusion, psychosis and seizure have also been reported.

6. 3-MeO-PCE: 3-methyloxyeticyclidine (3-MeO-PCE) is a novel hallucinogen. It is a structural analog of PCE, a PCP derivative. Information on toxicity and clinical effects is very limited. Adverse effects of PCP and similar dissociative anesthetics include confusion, agitation, cognitive impairment, catatonia, elevated heart rate and blood pressure.

7. 3-Methyl 4-ANPP

8. 3,4-MDPHP: 3,4-Methylenedioxy-?-pyrrolidinohexaphenone is a stimulant of the cathinone class. Data on toxicity is limited.

9. 4-ANBocP is a research chemical that can be used as a precursor for 4-ANPP. The pharmacologic activity of 4-ANBocP is unknown.

10. 4-ANPP: 4-ANPP is used as a precursor for the manufacture of fentanyl-type drugs; it is also an impurity found in fentanyl preparations. 4-ANPP has minimal pharmacologic activity.

11. 4-ANPP: Likely byproduct of fentanyl synthesis. Pharmacologic data limited.

12. 4-Bromo 4-ANPP: Likely precursor for fentanyl analogue synthesis.

13. 4-chloro-4-ANPP: 4-Chloro-ANPP-There is very limited information available on this substance. It is likely a fentanyl precursor.

14. 4-F-4-ANPP: Despropionyl-4-fluorofentanyl is likely a precursor chemical for fentanyl analog synthesis.

15. 4-FBF: Synthetic fentanyl analogue. Toxicity data limited but likely similar risk to fentanyl. Deaths have been reported in the US. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

16. 4-FIBF: Synthetic fentanyl analogue. Toxicity data limited but likely similar risk to fentanyl. Deaths have been reported in the US. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

17. 4-Fluorofentanyl: 4-fluorofentanyl is a synthetic halogenated substituted fentanyl analogue. Based on very limited data it is at least as potent as fentanyl and high risk for overdose.

18. 4-Fluoromethylphenidate: 4-Fluoromethylphenidate- A fluorinated analog of the stimulant medication methylphenidate (Ritalin, Concerta) that first appeared in Europe in 2015. This is a novel psychoactive substance that can be purchased online. Human exposure and toxicity data is limited, but would expect stimulant effects.

19. 4-Methylaminoantipyrine: Metamizole is a pain medication and antipyretic used in human and veterinary medicine. The main risk of metamizole is agranulocytosis (low WBC count).

20. 4-methylphenidate: 4-methylphenidate is an analog of methylphenidate (Ritalin) that was developed as a research chemical. Animal studies suggest that stimulant properties are higher than methylphenidate. Clinical effects in humans are poorly characterized.

21. 4F-Phenethyl-4-ANPP: 4F-Phenethyl-4-ANPP is a research chemical that recently appeared in the drug supply. It is likely an impurity or precursor for analog fentanyl synthesis.

22. 5-monoacetylmorphine: 6-MAM is an active metabolites of heroin. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

23. 6-MAM: 6-MAM is a unique metabolite of heroin that is then metabolized to morphine. Heroin is less potent than fentanyl.

A

24. Acetaminophen: Acetaminophen is an analgesic that in overdose can cause liver dysfunction and failure.

25. Acetyl clonidine: Acetyl clonidine is a clonidine-related compound available for purchase on the internet. Data is very limited.

26. Acetylcodeine: 6-Acetylcodeine is a metabolite and/or impurity often seen in heroin. Expect opioid effects similar to codeine. Mouse studies suggest that it may increase risk for seizures, but this has not been evaluated in human study.

27. Acetylcodeine: Acetylcodeine is an impurity of illicit heroin synthesis. Expect opioid effects similar to codeine. Mouse studies suggest that it may increase risk for seizures, but this has not been evaluated in human study.

28. Acetylcodeine: Metabolite and/or impurity often seen in heroin. Less potent than codeine. Expect opioid effects similar to codeine. Mouse studies suggest that it may increase risk for seizures, but this has not been evaluated in human study.

29. Acetylfentanyl: Acetylfentanyl is 15 time more potent than morphine, but less potent than fentanyl which is 80-100x more potent than morphine. Clinical toxicity studies in humans are lacking, but it has been reported in many overdose deaths. Acetylfentanyl can also be readily converted to fentayl. It would be expected to cause toxicity consistent with other opioids including risk of decreased or stopped breathing and unresponsiveness or decreased level of consciousness.

30. ADB-BUTINACA: ADB-BUTINACA is a synthetic cannabinoid that can be bought over the internet. Toxicity effects are poorly characterized but synthetic cannabinoids have been reported to causes severe poisoning and death.

31. AH-7921: Atypical synthetic opioid often bought over the internet as a research chemical. Human toxicity data not available, based on animal models thought to be as potent as morphine.. Based on animal data has opioid effects. Overdose and fatalities have been reported.

32. Alpha-D2Pv: Alpha-D2Pv is a new stimulant drug in the cathinone class similar to the synthetic stimulant “flakka.” Data is very limited on clinical effects, toxicity, and pharmacology. It can be purchased on the internet. Adverse effects of the cathinone class includes elevated heart problems, elevated blood pressure, insomnia, anxiety, psychosis, and hallucinations.

33. Alpha-php: alpha-PHP is a synthetic cathinone. Adverse effects include vomiting, agitation, paranoia, hypertension, unconsciousness, tachycardia, seizures, cardiac arrest, muscle break down or death.

34. Amphetamine: Amphetamine: stimulant that can cause abnormal heart rhythms, high heart rate, elevated blood pressure, hallucinations, restlessness, psychosis, kidney injury. In rare cases it can cause hyperthermia, seizures, and death.

35. Aprodine: aprodine is an anticholinergic and also contains pseudoephedrine. Expect stimulant and anticholinergic effects. In overdose can have elevated heart rate, abnormal heart rhythms, seizures.

36. Aspirin: Aspirin is an analgesic agent with risk of bleeding, lung injury and neurotoxicity including seizures in overdose. Aspirin overdose can cause death.

B

37. Bacitracin: Bacitracin is a topical antibiotic. Main risk is hypersensitivity or allergic reaction.

38. Baking Soda: Minimal risk.

39. Benadryl: Diphenhydramine is a medication that in overdose can cause sedation, abnormal heart rhythms, confusion, seizures, low blood pressure, coma and even death.

40. Benzaldehyde: Benzaldehyde is used as a preservative in food, cosmetics, and personal care products. It is considered generally safe for its intended use as a flavoring agent. Human data on injection risk and inhalational toxicity is limited.

41. Benzocaine: Benzocaine is a local anesthetic often found in prescription sprays, ointments and lozenges. The main toxicity concern related to benzocaine is methemoglobinemia, which are changes to hemoglobin that alter its ability to carry oxygen.

42. Benzoic Acid: Benzoic acid is a metabolic product of cocaine metabolism.

43. Benzoylecgonine: Benzoylecgonine is a major metabolite of cocaine.

44. Benzyl alcohol: Benzyl alcohol is an aromatic alcohol that if it is inhaled in high conc. or anindividual has a high exposure it can cause CNS depression and resp depression

45. Benzyl benzoate: Benzyl benzoate is a topical agent used for scabies. Main toxicity concern in adults is skin sensitivity.

46. Benzyl Fentanyl: Benzylfentnayl is a precursor used to make fentanyl. Pharmacologically inactive.

47. Betaserc: Antihistamine agents are often added to the drug supply. They are cheap and readily available and can increase/exaggerate the sedating effects when added to drugs. Some antihistamines are reported to cause euphoria if injected. Main side effects of betaser are headache, nausea, and indigestion.

48. Bipiperidinyl 4-ANPP: Likely byproduct of fentanyl synthesis. Pharmacologic data limited.

49. Bipiperidinyl Acetylfentanyl: Likely byproduct of fentanyl synthesis. Pharmacologic data limited.

50. Bipiperidinyl Fentanyl: Likely byproduct of fentanyl synthesis. Pharmacologic data limited.

51. Bromazolam: Bromazolam is a research benzodiazepine that has never been approved for medical use. It is a derivative of flubromazolam, a highly potent NPS. It can be purchased over the internet. In overdose it can cause sedation and/or decreased or stopped breathing. This risk is heightened by co-exposure to other sedating medications such as opioids or alcohol.

52. Bromobenzene: Bromobenzene is a solvent that can cause skin and eye irritation. It has been shown to cause reproductive toxicity in animals.

53. Buprenorphine: Buprenorphine (Suboxone/Subutex) is used to treat opioid use disorder or withdrawal. It is less likely than other opioids to cause overdose or decreased breathing. However, in people without opioid tolerance or dependence or if taken with other sedating substances, such as benzodiazepines or alcohol, can lead to opioid overdose.

54. Butanediol: 1,4-butanediol is metabolized by the body to gaba-hydroxybutyrate (GHB). It is often used as a substitute for GBL and GHB as it can be legally purchased. In overdose it can lead to coma and/or decreased/stopped breathing.

55. Butanoyl-4-FF: Fentanyl analogue. Toxicity data is limited. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

56. Butyrfentanyl: Fentanyl analogue. Based on limited data potency 7x greater than morphine. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

C

57. Caffeine: Caffeine will have additional stimulant effects. In overdose can cause elevated heart rate, abnormal heart rhythm, and seizure.

58. Calcium Stearate: White waxy powder, cheap, toxicity risk low, minimal effects.

59. Cannabigerol: Minimal toxicity risk

60. Carfentanil: Carfentanil is an extremely potent opioid; estimated to be 100 times more potent than fentanyl. It is typically used in veterinary medicine. Risks of carfentanil exposure include unresponsiveness, overdose, decreased, stopped breathing and death.

61. CBD: Minimal toxicity risk

62. CBN: Minimal toxicity risk

63. Cellulose: Often added as a bulking agent. Low toxicity, minimal effects.

64. Chlorofentanyl: 4-Chlorofentanyl is an active synthetic opioid with reported potency less than fentanyl. Toxicity concerns are similar to fentanyl and include sedation, decreased breathing and overdose.

65. Cholesteryl Stearate: Minimal risk.

66. Clonazepam: Clonazepam is a benzodiazepine that can cause sedation and slowed or stopped breathing. It is especially dangerous if combined with other sedating medications such as opioids and ethanol.

67. Clonazolam: Clonazolam is a designer benzodiazepine that can be purchased online. It has been reported in the literature as a drug of abuse since 2012. Clonazolam is considered one of the most potent benzodiazepines and can lead to sedation, stopped or slowed breathing and/or loss of consciousness.

68. Clonidine: Clonidine is an FDA approved pharmaceutical approved for use in the management of hypertension, ADHD, and ad an adjunctive therapy for management of cancer pain. Off label it is frequently used for treatment of opioid withdrawal. In overdose it can cause sedation, slowed heart rate, and blood pressure. Rarely it can cause decreased or slowed breathing. If combined with other sedating agents risk of overdose is heightened.

69. Cocaine: Cocaine will have stimulant effects- risk of seizure, stroke, heart attack, abnormal heart rhythm, muscle breakdown, kidney injury.

70. Codeine: Codeine is an opioid that can be metabolite of heroin (more likely in this case) or parent opioid in itself. Consistent with opioid effects it can cause sedation and in overdose there is risk of decreased breathing and/or unresponsiveness.

71. Creamers: sterility concerns, no other known health risk

72. Creatine: Creatine is a popular performance enhancement supplement used to increase muscle mass and enhance muscle recovery. Side effects include muscle cramping.

73. Cyclohexanone: Cyclohexanone is used as a solvent and is also abused as an inhalant. Inhalation or contact with material may cause irritation or burn skin, eyes, and throat. Vapors can cause dizziness, weakness, or loss of consciousness.

74. Cyclopentyl Fentanyl: Fentanyl analogue. Less potent than fentanyl. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

75. Cyclopropyl Fentanyl: Fentanyl analogue. Limited data suggests slightly less potent than fentanyl. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

76. Cyphenothrin: Skin, mucous membrane, and lung irritation. In high dose can cause neurologic effects and/or seizure.

D

77. Deschloroketamine: Deschloroketamine is a ketamine analog. It is a research chemical that recently has been used as a “legal” alternative to ketamine. Anecdotal reports from people using the drug state it has increased potency compared to ketamine. Data on clinical effects and pharmacology are very limited. Adverse effects of ketamine and similar dissociative anesthetics include confusion, agitation, cognitive impairment, catatonia, elevated heart rate and blood pressure. Ketamine is also associated with bladder damage. It is unknown if this occurs with ketamine analogs.

78. Despropionyl-3-methylfentanyl is likely a precursor for 3-methylfentanyl synthesis, which is a fentanyl analogue that is likely as potent as fentanyl.

79. Dextrose: Minimal risk.

80. Diazepam: Diazepam is a benzodiazepine that can cause sedation and slowed or stopped breathing. It is especially dangerous if combined with other sedating medications such as opioids and ethanol.

81. Dioctyl Fumarate: Dioctyl fumarate is a co-polymer. The toxicity profile of this compound is unknown.

82. DMT: chemical product used to make polyesters, toxicity risk likely low.

83. Docosanol: Docosanol is a topical antiviral. Main risk is hypersensitivity or allergic reaction.

84. DPT: DPT adverse effects include agitation, anxiety, perceptual distortions, mydriasis, hypertension and nausea. Seizures and death have been documented in overdose.

85. DXM: DXM, dextromethorphan,-is commonly found in cold preparations and can produce hallucinations, psychosis, and seizures. DXM can cause neurobehavioral effects such as hallucinations, "out of body" sensation, and dissociation. Life threatening serotonin toxicity can occur, especially if combined with other serotonergic agents or an MAOi. Additionally DXM can cause elevated heart rate, high blood pressure, and sweating.

E

86. Ecgonidine: Ecgonidine can be a breakdown product of smoked cocaine or a minor metabolite of cocaine breakdown in the body.

87. Ehtylecgonidine: Methylecgonidine is a pyrolyzation product of base cocaine (formed when crack cocaine is heated). Ecgonidine is formed as a metabolite of methylecgonidine.

88. Ephedrine: Ephedrine is a stimulant medication medically used to prevent low blood pressure and treat asthma. Risk of ephedrine include stroke, heart attack, abnormal heart rhythm, death.

89. Ethyl-4-ANPP: Ethyl-4-ANPP- There is very limited information available on this substance. It is likely a fentanyl precursor.

90. Etizolam: Etizolam is structurally very similar to benzodiazepines, a class of drugs that cause sedation. Etizolam is not approved for medical use in the US, but is a prescription medication in some countries. It can be purchased over the internet as a research chemical. Recently it has been found in illicit drugs in the US and Europe. In overdose it can cause sedation and/or decreased or stopped breathing. This risk is heightened by co-exposure to other sedating medications such as opioids or alcohol.

91. Etofylline: Risk includes fast hear rate or abnormal rhythm or seizure.

92. Etonitazepyne: Etonitazepyne is an analog of etonitazene. It demonstrates similar potency to etonitazene, significantly higher potency than fentanyl. Overdose fatalities with etonitazepyne have been reported. High risk of overdose with use.

F

93. Feldspar: May contain aluminum and silica. Toxicity unknown- would depend on dose and absorption.

94. Fenfluramine: Fenfluramine toxicity profile includes anxiety, dizziness, blurred vision, drowsiness, confusion, palpitations. Cases of pulmonary hypertension and aortic dissection are reported associated with use. Chronic usage of the combination of fenfluramine with phentermine (known as "fen-phen") has lead to significant incidence of cardiac valvular disease. Overdosage can cause cardiac arrest and death.

95. Fentanyl: Fentanyl is a highly potent opioid with high risk of overdose including findings of decreased or stopped breathing and unresponsiveness or decreased level of consciousness.

96. Ferric Sulfate: In overdose liver toxicity, low blood pressure, cardiovascular collapse, altered mental status.

97. Flour: Minimal risk.

98. Flualprazolam: Flualprazolam is a benzodiazepine derivative structurally similar to alprazolam (Xanax). Since 2017 it has been encountered in the drug supply. Effects include sedation, somnolence, confusion, ataxia (abnormal gait), and slurred speech. In high doses and/or if combined with other sedating drugs can cause coma and decreased or stopped breathing.

99. Fluorexetamine: Fluoroexetamine is a design drug and dissociative hallucinogen in the arylcyclohexylamine family. Data is limited, but expect effects similar to ketamine and PCP.

100. Furanylfentanyl: furanylfentanyl is a fentanyl analog with similar potency to fentanyl. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

G

101. Gabapentin: Gabapentin is structurally similar to GABA and frequently used to treat neuropathic or chronic pain. It has also been used as an antiepileptic and as an adjunct for management of alcohol withdrawal. Clinically may present with sedation. If combined with other sedating medications and or alcohol may lead to shallow or slowed breathing.

102. GHB: GHB (Gamma-hydroxybutyrate) is used as a treatment for narcolepsy. It is also used as a drug in recreational setting such as nightclubs for euphoric effects, by body builders due to alleged reported release of growth hormone, and has been used in the criminal setting of drug facilitated sexual assault. It structurally looks like GABA and acts at both GABA B and GHB receptors in the central nervous system. Toxicity risks include delirium, agitation, hallucinations, abnormal muscle movements. Severe toxicity concerns include sudden unconsciousness or coma with slowed or stopped breathing, slow heart rate and low blood pressure. Chronic use can leave to withdrawal syndrome similar to other sedating substances such as alcohol/benzodiazepines.

103. Glucose: Minimal risk.

104. Guaifenesin: Guaifenesin is an expectorant used in medicine to relieve nasal and lung congestion. In cough and cold preparations it is often combined with dextromethorphan.

H

105. Heroin: Heroin is an opioid which in overdose can cause unresponsiveness, slowed or stopped breathing. 6-MAM is a unique metabolite of heroin that is then metabolized to morphine. Heroin is less potent than fentanyl. 6-MAM is a metabolite of heroin.

106. Hexamine: Hexamine (methenamine) is a urinary antibacterial agent, used to suppress or eliminate bacteria in the urine. It is also used in the rubber industry, in adhesives, coatings, and sealing compounds, as a dire fixative, in fire logs and briquettes for camping, and as an antimicrobial food additive. With therapeutic use side effects are rare- include abdominal discomfort, nausea, vomiting, liver problems, and rash. In overdose rare cases of urinary tract irritation and damage are reported. When burned it can emit toxic fumes of formaldehyde and oxides of nitrogen. Rash, skin irritation, and blister formation have been reported with occupational exposure in industrial settings.

107. Hyaluronic Acid: Low toxicity, minimal effects.

108. Hydrocodone: Hydrocodone is an opioid analgesic. It is available via prescription in oral formulations with acetaminophen. Carries an opioid risk profile including CNS and respiratory depression, but is significantly less potent than fentanyl.

109. Hydromorphone: Hydromorphone (Dilaudid) is an opioid drug used for pain control. Toxicity includes unresponsiveness and decreased, slowed, or stopped breathing.

110. Hydroxypropyl Distarchphophate: Minimal risk.

111. Hydroxyzine: Hydroxyzine is an antihistamine that can cause sedation.

I

112. Ibuprofen: Ibuprofen is a non-steroidal anti-inflammatory available over the counter. Adverse effects most commonly described from ibuprofen exposure are gastritis and kidney injury.

113. Inositol: Inositol- would not expect significant toxicity.

114. Isotonitazene: Isotonitazene is a potent synthetic opioid often sold over the internet as a designer drug. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

J

115. JWH-018: JWH-018 is a synthetic cannabinoid. Severe symptoms have been reported from synthetic cannabinoid use: seizures, heart attack, acute kidney injury, pulmonary edema, stroke, delirium, psychosis, rapid loss of consciousness, vomiting, and multiple organ failure.

K

116. Ketamine: Ketamine is an anesthetic agent used in medicine in the US since 1972. It is structurally similar to PCP. Ketamine is often used outside of medicine for its hallucinogenic effects. Adverse effects of ketamine include hallucinations, delirium, abnormal behavior, nausea or vomiting, hypertension. Additionally, depending on the dose ketamine can cause respiratory stimulation or depression, sedation, abnormal heart rate, seizures or abnormal heart rhythm. Chronic use has been associated with bladder and urinary tract problems.

L

117. Lactose: Minimal risk.

118. Lanolin: Lanolin is a skin care product. Minimal effects.

119. Levamisole: Levamisole is an antihelminth found as a frequent cutting agent in cocaine- it can cause problems with blood cell lines, vessels, and/or a necrotic rash.

120. Lidocaine: Lidocaine is a local anesthetic that can cause local numbing at the injection site. In overdose can cause abnormal heart rhythms and seizure.

121. Limonene: Limonene is a plant-derived essential oil. As a hydrocarbon limonene can cause breathing problems (coughing, gagging, lung inflammation) and sedation and/or coma. Abnormal heart rhythms can result from hydrocarbon inhalation/exposure.

122. Lorazepam: Lorazepam is a benzodiazepine that can cause sedation. At high dose or if combined with other sedating agents it can cause decreased breathing or unresponsiveness.

123. LSD: LSD (Lysergic acid diethylamide) is a hallucinogen that acts at serotonin receptors. Effects include changes in perception, visual and auditory hallucinations, paranoia, mood fluctuations. Toxic effects include elevated heart rate, blood pressure. Rare toxic effects of seizure and muscle injury can occur.

M

124. Mannitol: Mannitol is low risk; however it is osmotically active so can see fluid/electrolyte imbalance, kidney dysfunction, and hypersensitivity reactions. If it extravasates during IV injection can cause compartment syndrome.

125. MDA: MDA is a drug similar to MDMA, an entactogen synthetic amphetamine derivative. Compared to MDMA it has similar effects but longer duration of action. It can cause elevated blood pressure, fast heart rate, hyperthermia (elevated body temperature), serotonin toxicity, hyponatremia.

126. MDMA: MDMA (aka ecstasy) is an amphetamine derivative. It can cause elevated blood pressure, fast heart rate, hyperthermia (elevated body temperature), serotonin toxicity, hyponatremia. Potential adverse effects of MDMA include dizziness, hyperactivity, anorexia, headache, anxiety, disorientation and insomnia. Although rare more severe toxicity can include neuro behavioral disturbances, seizures, elevated body temperature, low blood sugar, electrolytes changes- most notably low sodium, muscle damage and breakdown, serotonin toxicity, kidney and liver damage and panic disorder/psychosis.

127. MDMB-4en-PINACA: MDMB-4-en-PINACA has caused severe poisoning and/or death in multiple cases. In most of the deaths it was mixed in with other substances. Rapid loss of consciousness, unresponsiveness, cardiovascular effects (such as elevated blood pressure, fast heart rate, heart attack, and stroke), seizures, vomiting, delirium, psychosis, and aggressive and violent behavior, and sudden death have all been reported related to MDMB-4-en-PINACA exposure. Understanding of the pharmacology and mechanism of toxicity is poor for MDMB-4-en-PINACA as data is very limited. The toxic and lethal dose of MDMB-4en-PINACA is unknown.

128. Meclizine: Meclizine is an antihistamine used mainly to treat vertigo. Side effects include sedation.

129. Meclonazepam: Meclonazepam is a designer benzodiazepine with a long duration of action. Based on animal data it is more potent than benzodiazepines diazepam and lorazepam. In overdose it can cause sedation and/or decreased or stopped breathing. This risk is heightened by lack of familiarity with the drug, mixing into other substance, and if taken with other sedating medications such as opioids or alcohol.

130. Meconin: Meconin is a metabolite of the heroin contaminant noscapine.

131. MeOAc-Fentanyl: Methoxyfentanyl is a fentanyl analogue that is thought to be 3-5x less potent than fentanyl. Risks in overdose consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

132. Metamizole: Metamizole is a pain medication and antipyretic used in human and veterinary medicine. The main risk of metamizole is agranulocytosis (low WBC count).

133. Methadone: Methadone is a long acting opioid. Risks include decreased or stopped breathing, unresponsiveness, and rarely conduction changes in the heart leading to abnormal heart rhythms.

134. Methamphetamine: Methamphetamine: stimulant that can cause abnormal heart rhythms, high heart rate, elevated blood pressure, hallucinations, psychosis, kidney injury. Chronic use has been linked with increased risk for heart failure.

135. Methocarbamol: Methocarbamol in overdose can cause sedation, seizures, death

136. Methyl Benzoate: Methyl benzoate is a volatile hydrolysis byproduct of cocaine.

137. Methyl Salicylate : Methyl salicylate (oil of wintergreen) is a common ingredient in Chinese herbal medications as well as topical ointments used for the management of muscle aches and pains. One teaspoon (5mL) of oil of wintergreen contains approximately 7 g of salicylate, the equivalent of 22 adult aspirin tablets. Ingestion of oil of wintergreen can cause severe salicylate poisoning and or death, especially in young children. Topical exposure to methyl salicylate is usually minimal but absorption can be increased if it is applied over a large portion of the body or over areas of skin breakdown. Salicylate toxicity can lead to low blood sugar, confusion, seizures, nausea, vomiting, ringing in the ears, metabolic dysfunction, lung injury, bleeding and death.

138. Methylecgonidine Cinnamate: this is a naturally occurring tropane alkaloid in the coca plant that is structurally similar to cocaine, but pharmacologically inactive. It likely appears in the drug supply due to processing impurities from the crude plant.

139. Methylecgonidine: Methylecgonidine is a pyrolyzation product of base cocaine (formed when crack cocaine is heated). In sheep models it has been shown to cause low blood pressure and low heart rate.

140. Methylmethcathinone: Methylmethcathinone is a synthetic derivative a cathinone, a stimulant derived from the khat plant with similar properties to amphetamine. Data on toxicity and pharmacology is very limited. Toxicity effects including fast heart rate, nasal irritation, restlessness, and severe anxiety and agitation have been reported anecdotally. Adverse effects of the cathinone class includes elevated heart problems, elevated blood pressure, insomnia, anxiety, psychosis, and hallucinations.

141. Metrotonin: N,N-dimethylamphetamine (N,N-DMA)- is an analog of methamphetamine. In the past it has been synthesized from N-methyl-ephedrine. It can also be a pyrolysis by-product, an indirect indicator of methamphetamine smoking or a synthesis byproduct. Similar to methamphetamine, it is a stimulant that in overdose can cause abnormal heart rhythms, high heart rate, elevated blood pressure, hallucinations, psychosis, kidney injury.

142. Mirtazapine: Mirtazepine is an antidepressant that can cause somnolence, dizziness, agitation, hypertension. In overdose it can cause abnormal heart rhythms, seizures, and death.

143. Morphine: Morphine's risk of overdose is consistent w opioid class unresponsiveness, coma, decreased or stopped breathing, death.

144. Mobrtar: Mortar is a paste that quickly hardens. Data on injecting toxicity is limited. Mortar is a general term that can indicate a number of substances. concern can cause hypersensitivity reaction or particulate matter could cause irritation and inflammation locally or systemically. Additionally skin, nose, throat, and respiratory tract irritation risk exists as well as burns. If ingested it can harden and cause stomach or intestinal obstructions.

145. MSM: Methylsulfonylmethane is a dietary supplement without proven efficacy. In the illicit drug supply it is frequently found as an adulterant most often of methamphetamine. Available data suggests it is relatively safe without known toxicity.

N

146. N-Benzylfuranylfentanyl: Suspect likely a precursor for fentanyl analogue synthesis. Data on human toxicity minimal.

147. N-Phenylpropanamide: N-phenylpropanamide is a likely degradation product or impurity of fentanyl analogue synthesis. For example, it been documented as a degradation product of acetylfentanyl.

148. Nicotine: Nicotine can lead to adverse GI effects of nausea, vomiting, muscle breakdown and/or fasciculations. Serious toxicity can lead to seizures, weakness, and difficulty breathing.

149. Norcocaine: Norcocaine is a pharmacologically active metabolite of cocaine with a similar toxicity profile.

150. Norephedrine: Phenylpropanolamine (norephedrine) is a stimulant drug that is used as an ingredient in OTC drugs, prescription decongestants, and weight loss products. Phenylpropanolamine increases risk of hemorrhagic stroke or bleeding into the brain. Due to this risk the FDA has taken steps to remove it from all pharmaceutical products and issued a public health warning. Additional risks associated with phenylpropanolamine include elevated heart rate, abnormal heart rhythms or heart attack. Phenylpropanolamine (norephedrine) was removed from the market in the US due to elevated risk of hemorrhagic stroke. It is available outside the US for use to treat cold symptoms/congestion and as an appetite suppressant. It has similar stimulant activity. In overdose can cause agitation, stroke, elevated heart rate, cardiac toxicity.

151. Norfentanyl: Fentanyl metabolite and intermediate in some routes of fentanyl synthesis.

152. Noscapine: Noscapine is an opioid alkaloid that has been used clinically as an antitussive (cough medicine). Noscapine can also be found as an opium-derived impurity in illicit heroin. Toxicity profile of noscapine includes adverse effects of nausea, dizziness, headache, tremor, and rash

153. NPP: Likely byproduct of fentanyl synthesis. Pharmacologic data limited.

154. Nuts: Hypersensitivity, allergic reaction

O

155. O-DSMT: O-Desmethyltramadol is the main active metabolite of tramadol an opioid which in overdose can cause decreased or difficulty breathing, sedation, unresponsiveness, or seizures.

156. Oleamide: Oleamide is a fatty acid amide- toxicity profile in humans unknown at this time.

157. Omega-3 Fatty Acid: Minimal risk.

158. Orthoboric Acid: Most ofen will causet local irritation; in high amounts can cause systemic toxicity including gastrointestinal toxicity, kidney injury, lethargy, seizures, coma and cardiovascular collapse.

159. Oxandrolone: Oxandrolone is an anabolic steroid, often used to improve physique and performance. Single use unlikely to have symptoms or side effects. Long term use is associated with virilization in women and reduced fertility in men. Hepatotoxicity is rare.

160. Oxycodone: Oxycodone is an opioid. In overdose can cause decreased or stopped breathing and unresponsiveness.

P

161. P2P: highly flammable; can cause eye irritation, dizziness or drowsiness.

162. Palmitic Acid: Minimal risk.

163. Papaverine: Papaverine is an alkaloid extracted from the opium poppy; it is frequently found as a contaminant of illicit heroin. Papaverine is used in medicine as a vasodilator and antispasmodic. Adverse reactions include headache, nausea, dizziness, sweating. If injected intraarterially low blood pressure and slowed heart rate can occur.

164. Parrafin: Minimal risk, but some people can experience hypersensitivity, allergic reaction

165. PCP: PCP (phencyclidine) is a dissociative anesthetic used for hallucinogenic properties. It can cause hallucinations, sedation, abnormal eye movements, and discoordination. In overdose risk of acute psychosis, fast heart rate, elevated blood pressure, seizure, agitated delirium. Rare cases of coma and/or stopped or slowed breathing have been reported.

166. PDMS: Toxicity data sparse, but likely minimal risk.

167. PE Wax: minimal risk

168. PE: minimal risk

169. PEG: minimal risk

170. Ph-Fentanyl: Phenylfentanyl is a fentanyl analogue with higher potency than fentanyl. Given high potency high risk for overdose leading to unresponsiveness, coma, decreased or stopped breathing, death.

171. Phenacetin: Phenacetin is an outdated analgesic that was pulled from the market in the US and Europe due to kidney damage. Also associated with increased risk urothelial cancer. Phenacetin is a common cutting agent in cocaine due to its similar analgesic and physical properties.

172. Phenethyl 4-ANPP: Phenethyl-4ANPP is a research chemical that recently appeared in the fentanyl drug supply. It is likely an impurity or precursor for fentanyl synthesis. Although data is limited its pharmacologic activity is thought to be minimal.

173. Phenethyl-4-F-4-ANPP: Phenethyl-4-Fluoro-4-ANPP is a research chemical that recently appeared in the drug supply. It is likely an impurity or precursor for 4-fluoro-fentanyl synthesis. Currently there is no data on its pharmacologic activity. 4 fluorofentanyl is a synthetic halogenated substituted fentanyl analogue. Based on very limited data it is at least as potent as fentanyl and high risk for overdose.

174. Phenibut: Phenibut is a synthetic GABA derivative, structurally similar to baclofen. It is available in the US as a dietary supplement. Adverse effects include confusion, sedation, blurry vision. Overdose has resulted in coma, agitation, seizures, and death. Chronic use can lead to dependence and a withdrawal syndrome including upon cessation of use.

175. Plaster of Paris: Plaster of Paris (calcium sulfate hemihydrate) can cause skin, nose, throat, and respiratory tract irritation. Can also cause burns. If ingested it can harden and cause stomach or intestinal obstructions. I don’t know of any reported cases of intravenous injection of plaster of paris- I would worry about obstruction and foreign body reactions at the local or systemic level. Plaster of Paris has been used in orthopedics for treatment of skeletal defects. Possible dangerous combustion products reported include sulfur oxides, carbon monoxide, and carbon dioxide.

176. Powdered Sugar: sterility concerns, no other known health risk

177. Procainamide: Procainamide is a drug used to treat abnormal heart rhythms. Side effects caninclude abnormal heart rhythm, blood cell changes, and rarely a drug-induced lupus like syndrome.

178. Procaine: Procaine is a local anesthetic that can cause numbing and local pain relief. In overdose the main risks are cardiac, abnormal heart rhythm, and neurologic including risk of seizures.

179. Promethazine: Promethazine has been used in medicine as an antihistamine, antiemetic, and sedative. Adverse reactions include drowsiness, abnormal involuntary muscle movements, unsteady gait, blurred vision, anxiety, low blood pressure and changes to heart rate. In overdose can cause coma, convulsions, decreased or stopped breathing, and death.

180. Pseudoephedrine: Pseudophedrine is available in cough and cold preparations. It has been used to manufacture illicit methamphetamine. In overdose can cause tachycardia, hypertension, dizziness, abnormal heart rhythms.

181. Pumice Stone: Data on injecting toxicity is limited. concern can cause hypersensitivity reaction or particulate matter could cause irritation and inflammation locally or systemically.

182. PVA: minimal risk

Q

183. Quetiapine: Quetiapine is an antipsychotic medication. Risks of overdose include low blood pressure, confusion and sedation, anticholinergic signs (blurry vision, dry mouth, sedation, confusion, tachycardia, urinary retention), and abnormal muscular activity. In large overdose can sometimes cause difficulty breathing. With overdose and/or chronic exposure can rarely cause life-threatening neuromuscular changes and hyperthermia due to neuroleptic malignant syndrome.

184. Quinine: Quinine is a frequent diluent used in heroin preparations. Risks of quinine include kidney damage, cinchonism, gastric disturbances, thrombosis and hypotension (IV use), cardiac toxicity, and death.

R

185. Ritilin: Similar to other stimulants it can cause abnormal heart rhythms, high heart rate, elevated blood pressure, hallucinations, psychosis, kidney injury.

S

186. Salicylic Acid: Salicylic acid is the main ingredient in aspirin. Toxicity can lead to low blood sugar, confusion, seizures, nausea, vomiting, ringing in the ears, metabolic dysfunction, lung injury, bleeding and death.

187. Sertraline: sertraline is an antidepressant medication. Risks include serotonin toxicity (abnormal muscle tone and movements, elevated heart rate and temperature) and abnormal heart rhythms especially if combined with similar agents or taken in overdose.

188. Sildenafil: Sildenafil is a prescription drug used to treat erectile dysfunction and pulmonary hypertension. The main side effects of this drug are low blood pressure. If this medication is combined with nitrates it can cause severe low blood pressure. Rare side effects include a painful prolonged erection (priapism) and hearing loss.

189. Sodium Sulfate: minimal risk

190. Somatropin: somatropin is a recombinant human growth hormone protein. Short term risk minimal.

191. Sorbitan Tristearate: Not a hazardous substance

192. Sorbitol: Not a hazardous substance

193. Stachyose Tetrahydrate: Not a hazardous substance

194. Stearic Acid: minimal risk

195. Sucrose: Not a hazardous substance

T

196. Tapentadol: Tapentadol is an opioid pain medication with potency between tramadol and morphine. In addition to risk of sedation and decreased or stopped breathing in overdose, tapentadol can place patients at risk for seizures.

197. TCP: TCP (Tenocyclidine) is an analog of PCP (phencyclidine) with similar hallucinogenic properties. TCP is reported to be more potent that PCP by weight with a longer duration of action. TCP was first synthesized and reported in the literature in the 1950s.

198. Testosterone cypionate: Testosterone cypionate is a steroid hormone that is sometimes used by athletes for body building. Adverse effects of excess testosterone are decreased sperm counts and increased breast size in men and changes in the menstrual cycle and hair growth in women. Additionally, testosterone can cause acne mood disorders and problems with blood clots, the liver, and heart.

199. Tetracaine: Tetracaine is a local anesthetic that can cause numbing and local pain relief. In overdose (rare) the main risks are cardiac, abnormal heart rhythm, and neurologic including risk of seizures.

200. Tetracosane: Data on injecting toxicity is limited. concern can cause hypersensitivity reaction or particulate matter could cause irritation and inflammation locally or systemically.

201. Tetramisole: Tetramisole is the racemic form of levamisole marketed for veterinary use. There is limited data on toxicity.

202. Thaumatin: Thaumatin is a low calorie sweetener. Minimal risk

203. THC: Adverse effects of THC vary significantly by age. Neurologic changes are more prominent in children and include ataxia, excessive movement of limbs, lethargy, and unresponsiveness. In adolescents and adults some individuals can experience dysphoria (depressed mood) or agitation or psychosis. Tachycardia, increased blood pressure, conjunctival injection, and increased appetite are common signs and symptoms of cannabis intoxication. Cannabis also slows reaction times and impairs concentration.

204. Tile Adhesive: Data on injecting toxicity is limited. concern can cause hypersensitivity reaction or particulate matter could cause irritation and inflammation locally or systemically.

205. Toothpaste: Minimal risk.

206. Tramadol: tramadol is a synthetic opioid that in additional to opioid effects can result in seizures, serotonin toxicity.

207. Trazodone: Trazadone is an FDA approved pharmaceutical used as an antidepressant. Adverse effects may include drowsiness, confusion, fatigue, incoordination, dry mouth and headache. In overdose it can cause hallucinations, seizures, respiratory arrest, abnormal heart rhythms and death.

208. Triacetin: Triacetin (aka glyceryl triacetate) is an oily colorless liquid that has been used for a wide range of purposes including food additive (flavoring agent), cosmetic fungicide, and solvent in cosmetic formulas. It can be found naturally in cod-liver oil, butter and other fats, but also can be synthesized. It is approved by the FDA as a safe food additive.

209. Tropacocaine: Tropacocaine is a cocaine-related alkaloid that would be expected to have similar stimulant effects.

U

210. U-47700: U4770 is a highly potent synthetic opioid. high risk for overdose leading to unresponsiveness, coma, decreased or stopped breathing, death.

V

211. VF: Valerylfentanyl is an opioid sold as a research chemical; expected clinical effects would be similar to other opioid class including decreased or stopped breathing or unresponsiveness. Clinical data is very limited but it is reported to be less potent than fentanyl.

212. Vitamin A: Dietary supplement. At usual doses would expect minimal toxicity. At very high doses rarely can cause liver toxicity, nausea, vomiting, vertigo, bone and muscle pain.

213. Vitamin B3: Niacinamide is a form of vitamin B3, a water soluble vitamin. Cases of liver toxicity are reported with use.

214. Vitamin C: limited health risk; vitamin C is a lipid soluble vitamin, if normal kidneys the body can eliminate it in the urine.

215. Vitamin E: Vitamin E is a fat soluble vitamin that works in the body as an antioxidant. Rarely at very large doses vitamin E can cause toxicity including decreased ability of the body to deal with oxidative stress.

W

216. Wellbutrin: Bupropion is an FDA approved drug for depression and smoking cessation. Its chemical structure is similar to a cathinone (bath salt). As such it has stimulant properties. In overdose or when insufflated or injected bupropion can cause seizures, status epilepticus, abnormal heart rhythms, and cardiovascular collapse.

217. Whey Protein: sterility concerns, no other known health risk.

X

218. Xanax: Alprazolam is a benzodiazepine that can cause sedation and slowed or stopped breathing. It is especially dangerous if combined with other sedating medications such as opioids and ethanol.

219. Xylazine: Xylazine is a veterinary sedative that can cause decreased level of consciousness/unresponsiveness, low blood pressure, a slow heart rate, and rarely decreased breathing. If combined with other sedating agents higher risk of overdose. It has also been associated with increased risk of skin ulceration.