Educational content. This article does not provide dosing, sourcing or buying information. In an emergency call 112 (EU), 999 (UK) or 911 (US).
Ketamine- and PCP-like designer drugs such as 2F-DCK, DCK, 3-MeO-PCP, 3-HO-PCP, O-PCE, DMXE and MXP can cause two very different kinds of emergency: a person who is deeply sedated and cannot protect their own airway, or a person who is severely agitated, overheated or psychotic. This article explains both, and what to do. For the background, see Dissociative Designer Drugs: Side Effects and Health Risks.
Two kinds of dissociative emergency
Warning signs
Dangerously sedated
- Cannot be woken, or only for a moment
- Vomiting while barely conscious, which can lead to choking
- Slow, shallow or gurgling breathing; blue or grey lips
- Lying in water, cold or an unsafe place and unable to move
Dangerously agitated
- Severe confusion, panic, paranoia or hallucinations that do not settle
- Aggressive or violent behaviour, or rigid, unresponsive staring (catatonia)
- Very fast heartbeat, chest pain, severe headache
- Hot, flushed skin, high temperature or seizures
The most dangerous combinations
- Alcohol: greatly increases nausea, vomiting and loss of consciousness, and with it the risk of choking.
- GHB/GBL: can cause sudden unconsciousness and breathing problems; together with dissociatives, the risk of coma rises sharply.
- Benzodiazepines and opioids: add to sedation and slow breathing; fentanyl and nitazenes make this especially dangerous.
- Stimulants (cathinones, cocaine, amphetamines): add to the strain on the heart and blood pressure, particularly with PCP-type compounds.
- Some antidepressants and tramadol: several arylcyclohexylamines also act on serotonin, so combinations may contribute to serotonin toxicity.
- Water, heights and traffic: not drugs, but a leading cause of death and injury while dissociated.
What to do
- Call emergency services if someone cannot be woken, is breathing abnormally, has a seizure, chest pain or very high temperature, or is a danger to themselves or others.
- If they are drowsy or unconscious but breathing, put them in the recovery position so they cannot choke on vomit.
- If they are not breathing normally, start CPR as the call handler instructs.
- If they are agitated, move them to a quiet, dim, cool place, speak calmly and do not crowd or restrain them unless there is immediate danger.
- Keep them away from water, stairs and roads.
- Stay with them and tell responders everything that may have been taken.
Reducing the risk of harm
Avoiding these drugs is the only way to remove the risks. Public-health services also advise never using alone, never mixing with alcohol, GHB, sedatives or stimulants, staying away from baths, pools and open water, and using drug-checking services, since products sold under one name often contain another.
Where to get help
- Emergency: 112 (EU), 999 (UK), 911 (US).
- Netherlands: Drugs Infolijn (drugsinfo.nl); DIMS drug testing.
- UK: FRANK (talktofrank.com).
- US: SAMHSA National Helpline, 1-800-662-4357.
Frequently asked questions
Is a “K-hole” an overdose?
It is a state of very deep dissociation. It becomes an emergency if the person vomits, stops breathing normally, is in an unsafe place, or has taken other depressants.
Why are PCP-like drugs more likely to cause agitation?
Compounds such as 3-MeO-PCP act on several brain systems, which can produce stimulant-like effects, high blood pressure and psychosis in addition to dissociation.
Can someone die from a dissociative alone?
Deaths have been reported, often with other substances present, and accidents during intoxication are a major cause of death.
This article is for general information and does not replace medical advice.
