What each rating means

Every pair of substances on MixSafe gets one of seven ratings, listed here from most to least concerning. A rating describes what the two do together. It says nothing about how risky either one is on its own.

  1. Dangerous

    Shown asDangerous

    High risk of death or life-changing injury. Do not combine.

    These combinations can kill, and the reaction is hard to predict. There is no amount of either that makes this a low-risk mix. If it has already happened, the pair page lists the signs to watch for.

    For exampleAlcohol + KetamineAlcohol + BenzodiazepinesAlcohol + Opioids

  2. Unsafe

    Shown asUnsafe

    Risk of serious physical or psychological harm. Not recommended under any circumstances.

    A real chance of serious harm. If both are already in your system, do not add more of either, do not be alone, and know the signs on the pair page.

    For exampleAlcohol + CocaineLSD + TramadolMushrooms + Tramadol

  3. Caution

    Shown asCaution

    Carries risk that is worth understanding before combining. Reduce doses and do not use alone.

    Not usually physically harmful at ordinary doses, but it can go wrong: overstimulation, a much stronger trip than planned, or physical strain at high doses. Take less of each and do not use alone. Check the risk type on the pair: caution about the body and caution about the headspace need different care.

    For exampleAlcohol + MDMAAlcohol + AmphetaminesAlcohol + SSRIs

  4. No data

    Shown asNo data

    We have no interaction data for this pair. That is NOT the same as safe — it means nobody has documented it here. Treat it as unresearched and assume risk.

    A gap in the data is a question nobody has answered yet, not an answer. Treat the combination as unresearched: small amounts of each, spaced apart, with someone around.

  5. Low risk, increased effect

    Shown asLow / synergy

    Low risk of harm, but the effects amplify each other. Doses that are fine alone can be far too much together.

    The combination is not expected to hurt you, but each makes the other stronger. The risk is the dose: normal amounts of each can add up to far more than you meant to take. Take less of each than you would alone.

    For exampleAlcohol + CannabisAlcohol + NicotineCannabis + MDMA

  6. Low risk, decreased effect

    Shown asLow / decrease

    Low risk of harm from the combination, but one substance is expected to blunt the other. Redosing to chase the missing effect is the usual way this turns dangerous.

    One blunts the other. Harm usually comes from taking more to get the missing effect back, and the extra dose is still there when the blunting wears off.

    For exampleAlcohol + LSDAlcohol + MushroomsBenzodiazepines + Cannabis

  7. Low risk, no synergy

    Shown asLow / no synergy

    Neither substance is expected to meaningfully change the other. Both still carry their own individual risks.

    Neither is expected to change the other much. The rating is about the combination only: each drug still carries its own risks, and a heavy dose of either is still a heavy dose.

    For exampleAlcohol + CaffeineCannabis + SSRIsCaffeine + Cannabis

01 / Risk type

Physical, headspace, or both

Pairs rated caution or worse also say where the risk sits: in the body, in the experience, or both. Two pairs with the same rating can need very different care. Headspace risk vs physical risk.

02 / Three or more

Whole-mix warnings

A pair rating cannot see what three drugs do together. When a mix stacks the same kind of risk, MixSafe adds a whole-mix warning above the pairs. These have their own pages:

03 / Data

Where the ratings come from

Most pairs come from the TripSit drug combination chart, a peer-maintained harm-reduction dataset. Pairs it does not cover are researched and written by MixSafe, with citations on the pair. When a specific drug has no answer of its own, it can borrow its class’s answer, for example kratom using the answer for opioids. The pair says when that has happened, because a class default is not a finding about that drug. Anything else is rated no data. More about the data.