Discomforting physical effects

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A discomforting physical effect can be defined as any substance-induced alteration of one's physical state which is unpleasant, undesirable, uncomfortable, painful or otherwise a source of distress. They most often indicate a temporary and normal part of the manner in which the substance interacts with the body but can also indicate the need for attention or medical treatment if they begin to predominate over the experience or otherwise become unable to ignore.

Those who experiment with or use psychoactive substances, especially hallucinogens, should also be aware that some of the other effects that the substance may produce (such as anxiety, paranoia, disconnectivity and delusions) may lead to a distorted perception of what is actually happening to them. While this risk can be partly mitigated by taking harm reduction measures such as having a knowledgeable and trustworthy trip sitter to watch over and provide sober, third-party input, it should be remembered the potentially serious health consequences that may result from these effects can never be mitigated completely.

This page lists and describes the various discomforting physical states which can occur under the influence of certain psychoactive substances:

Abnormal heartbeat

Main article: Abnormal heartbeat

An abnormal heartbeat (also called an arrhythmia or dysrhythmia) is any of a group of conditions in which the electrical activity of the heart is irregular.

The heartbeat may be too fast (over 100 beats per minute) or too slow (less than 60 beats per minute) and may be regular or irregular. A heartbeat that is too fast is called tachycardia, and a heartbeat that is too slow is called bradycardia. Although many arrhythmias are not life-threatening, some can cause cardiac arrest.

Much like class 1b antiarrhythmics, cocaine is well known to be a voltage-gated sodium ion channel blocker, which may cause potentially fatal arrhythmias such as ventricular tachycardias and QT interval elongation at higher doses.[1] Parasympatholytics such as atropine block the vagal effects of acetylcholine on the sinoatrial node, often resulting in sinus tachycardia, hence atropine is often used clinically for symptomatic bradycardia.[citation needed]

In the context of substance usage, many compounds alter one's heartrate. For example, stimulants tend to increase one's heart rate whilst depressants tend to decrease it. Combining the two can often result in dangerously irregular heartbeats.


Main article: Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. It usually results in painful defecation and small, compact feces. Constipation is a common side effect of opioids. Symptoms of opioid-induced constipation may be reduced by increasing the amount of dietary fruit, fiber and water consumed. Laxatives may also be used for temporary relief.

Decreased heart rate

Main article: Decreased heart rate
This picture shows sinus bradycardia seen in lead II with a heart rate of about 50.

Decreased heart rate or bradycardia is described as a heart rate that is lower than the normal heart rate at rest. The average healthy human heart normally beats 60 to 100 times a minute when a person is at rest. When the heart rate fluctuates to lower levels under 60 BPM, it is described as bradycardia or an abnormally low heart rate.

It can also be a psychological effect, such as a natural response to feelings of relaxation and serenity. This is a common effect of sedating substances especially depressants such as benzodiazepines or opioids.


Main article: Dehydration

Dehydration can be defined as any excessive loss of bodily water within a living organism which results in an accompanying disruption of metabolic processes. Besides an uncomfortably dry mouth and feelings of general thirstiness, symptoms of dehydration may include headaches, decreased blood pressure (hypotension), and dizziness or fainting when standing up. Untreated dehydration generally results in delirium, unconsciousness, swelling of the tongue, and (in extreme cases) death.

In relation to the consumption of psychoactive substances, mild dehydration is common under the influence of many different drugs, particularly stimulants. At moderate levels, this can be generally described as a sense of consistent and uncomfortable thirst throughout the duration of the experience which necessitates sipping at a drink to maintain fluid levels and to avoid an uncomfortably dry mouth. At extreme levels (which generally only occur with the use of deliriants), these experiences of dehydration become so powerful that one may find themselves with painfully dry eyes and mucus membranes, rendering them incapable of swallowing due to excessive and unquenchable thirst.

Water intoxication

It's important to note that regardless of how dehydrated one may become under the influence of any substance, careful effort and consideration should always be put into ensuring that one does not drink water excessively as it can result in a state known as water intoxication. This can be potentially fatal and is classed as a disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside of safe limits by over-hydration. Although extremely rare, there have been a few notable deaths which were clearly triggered by the excessive overconsumption of water under the influence of drug-induced dehydration. The average toxic dosage of water in a human being is roughly ten litres, however, this can be easily avoided by simply sipping at water and making a conscious effort to not drink unnecessarily large amounts.


Main article: Diarrhea
A type 6 - 7 stool can be classified as diarrhea.

Diarrhea or diarrhoea is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe.

In the context of psychoactive substance usage, certain compounds have been known induce to diarrhea or can at least increase the likelihood of it occurring. This is not as dangerous as the same condition when it occurs through infection as it only remains whilst one is under the influence of the drug.

Difficulty urinating

Main article: Difficulty urinating

Difficulty urinating also known as urinary retention, can be defined as the experience of a decreased ability to pass urine. This can be due to painful burning sensations within the urethra or a simple lack of bladder control which prevents or inhibits one from urinating even with a full bladder.


Main article: Dizziness

Dizziness can be defined as the experience of the perception of motion (usually a spinning motion). It is often associated with nausea and vomiting as well as a loss of motor control, causing a difficulty standing or walking.

The medical literature lists three types of dizziness:

  1. Objective - The first is known as objective and describes when the patient has the sensation that objects in the environment are moving.
  2. Subjective - The second is known as subjective and refers to when the patient feels as if he or she is moving.
  3. Psuedovertigo - The third is known as pseudovertigo, an intensive sensation of rotation inside the patient's head.

Frequent urination

Main article: Frequent urination

Frequent urination, or urinary frequency, can be defined as the need to urinate more often than usual. It is often, though not necessarily, associated with urinary incontinence and large total volumes of urine. However, in other cases, urinary frequency involves only normal volumes of urine overall.

In the context of substance usage, many compounds result in the need to urinate excessively. This can be triggered by dehydration resulting in the consumption of large amounts of water or it can be a direct result of the substance itself.


Main article: Headaches

A headache can be described as a pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions. The brain tissue within the skull itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain.

In the context of substance usage, the overuse of certain substances can cause painful headaches, particularly during the offset of the experience and if the user is dehydrated or has not eaten enough food.

Increased heart rate

Main article: Increased heart rate
Heartrate above 100BPM
Increased heart rate or tachycardia is described as a heart rate that is faster than the normal heart rate at rest. The average healthy human heart normally beats 60 to 100 times a minute when a person is at rest.[2] When the heart rate fluctuates to higher levels over 100 BPM, it is described as tachychardia or an abnormally high heart rate.

This is a common effect of stimulating substances especially stimulants as a direct result of dopaminergic or adrenergic modulation.[3][4] It can also be a psychological effect, such as a natural adrenal response to shock or fear. As awareness is heightened, such responses often become more heightened, especially with astonishing or confusing hallucinations. Other mechanisms for increased heart rate exist as well, such as deliriants effect as an acetylcholine inhibitor, one of the main modulaters of heart rate in the peripheral nervous system.[5][6]

Increased perspiration

Increased perspiration, or hyperhidrosis, can be described as a condition characterized by increased sweat which is in excess of that required for the regulation of body temperature.

Increased perspiration is a hallmark symptom of sympathetic arousal (the "fight-or-flight" response) and is a common effect of stimulant drugs. Any psychoactive drug which exerts considerable serotonergic, dopaminergic, or adrenergic effects may cause increased perspiration. It is also a common symptom of benzodiazepine and alcohol withdrawal.[7] Cholinergics and, to a lesser extent, opioids have been additionally implicated in causing this as well.[citation needed]

Increased blood pressure

Increased blood pressure is a condition in which the pressure in the arteries is elevated to abnormal levels. This effect is commonly experienced on stimulating and vasoconstricting drugs such as amphetamines and phenethylamine psychedelics.


Main article: Itchiness

Itchiness is the sensation that causes a person the desire or reflex to scratch at their skin. Substances such as opioids, that activate histamine receptors or trigger histamine release can cause this effect. A way to counteract the itchiness in cases of substance use is to take an antihistamine such as DPH (Diphenhydramine).

Muscle cramps

Main article: Muscle cramps

Muscle cramps can be defined as an involuntary temporary strong muscle contraction or overshortening which may cause severe aches and pains. Usually the onset is sudden while the cramp resolves spontaneously in a few seconds to minutes.

In the context of substance usage, certain compounds induce muscle cramps which, depending on the drug, can range from mild to extremely uncomfortable in their intensity and are rare to frequent in their consistency.

Muscle spasms

Main article: Muscle spasms

Muscle spasms can be described as an experience where one undergoes a sudden involuntary contraction of a muscle or a group of muscles.

The term most commonly refers to a muscle cramp which may be accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes. There are a variety of other causes of involuntary muscle contractions which may be more serious, depending on the cause.


Main article: Nausea

Nausea is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting.

In the context of substance usage, nausea and vomiting can occur as a result of stomach irritation through the consumption of materials which it is not used to digesting such as chemical powders or plant matter. Alternatively it may occur as a direct result of how the particular drug effects the brain and is therefore inseparable from the experience itself regardless of the method of consumption. This effect usually occurs at the onset of the experience and dissipates as the peak takes its toll.

Physical fatigue

Main article: Physical fatigue

Physical fatigue (or muscle fatigue) is the temporary physical inability of the muscles to perform optimally. It is a side effect characterized by feelings of tiredness and weakness. It can occur after prolonged physical exertion and extended periods of wakefulness. People who are fatigued may find it difficult to complete physical actions and may not be capable of getting out of bed or performing everyday household tasks. It can generally be treated with a period of rest or sleep.

Cognitive fatigue, the mental equivalent of this component, frequently occurs simultaneously alongside of physical fatigue.


Main article: Photophobia

Photophobia can be described as a symptom of abnormal physical intolerance to the visual perception of light. As a medical symptom, photophobia is not a morbid fear or psychological phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes.

In terms of hallucinogen usage, this component is usually triggered by the way in which substance induced pupil dilation disables the eye's ability to adjust itself accordingly depending on current levels of light exposure.

Restless leg syndrome

Main article: Restless leg syndrome

Restless legs (also known as restless legs syndrome or RLS) is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, head, and even phantom limbs. Moving the affected body part modulates the sensations, providing temporary relief.

RLS sensations range from pain or an aching in the muscles to "an itch you can't scratch", an unpleasant "tickle that won't stop", or even a crawling feeling. The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.

In the context of substance usage, certain compounds induce states of restless leg syndrome throughout the experience of them. This can be mild in its effects or extremely intense and uncomfortable. Opiate withdrawal can produce this effect as well.


Main article: Salivation

Salivation can be described as the production and excretion of excess salivatory fluid as mediated by both the sympathetic and peripheral nervous system.[8][9] Salivation is a common side effect induced by a wide array of substances, but is most common with sedating substances and depressants. Salivation can also be triggered psychologically, such as through pleasant odors or pleasurable foods.


Main article: Seizure
Generalized 3 Hz spike and wave discharges in EEG during a seizure

An epileptic seizure (colloquially a fit) is a brief episode of signs and/or symptoms due to abnormal, excessive, or synchronous neuronal activity in the brain.[10] The outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness (absence seizure). The disease of the brain characterized by an enduring predisposition to generate epileptic seizures is called epilepsy,[11][12] but seizures can also occur in people who do not have epilepsy.

This can occur due to a variety of causes and is common during withdrawals from prolonged chronic benzodiazepine usage or during an overdose on certain substances such as stimulants, synthetic cannabinoids and the 25x-NBOMe series of psychedelics. It has also been noted that opioid overdoses can cause seizures. This is believed to happen because many opioids, despite being depressants, have significant intrinsic activity at the sigma receptors.

Stomach cramps

Main article: Stomach cramps

Stomach cramps can be described as intense feelings of sudden pain or discomfort which occur as a result of directly ingesting psychoactive compounds and/or the materials which they reside within.

This effect is usually accompanied by prolonged periods of nausea and can therefore be mitigated using the same techniques.

Stomach bloating

Main article: Stomach bloating

Stomach bloating can be described as an uncomfortable physical side effect which results in one's stomach becoming temporarily bloating and expanded in a manner which looks similar to pregnancy. This effect can be moderately uncomfortable but is not painful or dangerous. It most commonly occurs with certain serotonergic psychedelics which is likely a result of complex interactions occurring due to the large amount of serotonin receptors present within the intestinal wall. The duration of this effect can last anywhere from a couple of hours to several days and can be reduced by drinking plenty of water.

Temporary erectile dysfunction

Temporary erectile dysfunction is an effect which occurs under the influence of certain substances in various degrees of intensity. It can be described as a difficulty in achieving and maintaining an adequate erect penis for the purpose of sexual intercourse. This effect is often induced by moderate to high dosages of stimulating substances due to the way in which they affect one's blood flow.

Temperature regulation suppression

Temperature regulation suppression can be defined as an inability to maintain a normal temperature. This results in feelings of constantly fluctuating between being uncomfortably cold and uncomfortably hot. It varies in its intensity between different substances but is particularly common within stimulating compounds.

Teeth grinding

Main article: Teeth grinding

Teeth grinding (also known as bruxism or jaw clenching) is a fairly common effect mostly associated with stimulants and stimulating psychedelics. It can be described as a compulsive and often uncontrollable urge to grind one's teeth. In extreme cases, this can result in painful damage to one's tongue, teeth and inner cheek.

The most effective methods for quickly alleviating uncomfortable bruxism include using chewing gum or a baby's pacifier (also called a dummy) to occupy one's jaws without causing damage. Magnesium (preferably glycinate) is also very effective at alleviating bruxism when it is taken at a dosage of 200mg once 6 hours before and again at 1-3 hours before ingesting a stimulant such as MDMA or amphetamine.[13]


Main article: Vasoconstriction

Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels (in particular the large arteries and small arterioles). The process is the opposite of vasodilation, the widening of blood vessels.

Subjective side effects of vasoconstriction include feelings of tightness within one's arms and legs. It occurs under the influence of certain substances and can range from mild in its effects to extremely uncomfortable.


  1. O’Leary, Michael E, and Jules C Hancox. “Role of Voltage-Gated Sodium, Potassium and Calcium Channels in the Development of Cocaine-Associated Cardiac Arrhythmias.” British Journal of Clinical Pharmacology 69.5 (2010): 427–442. PMC. Web. 27 June 2017.
  2. http://my.clevelandclinic.org/services/heart/prevention/exercise/pulse-target-heart-rate
  3. http://www.fasebj.org/content/4/8/2469.short
  4. http://europepmc.org/abstract/MED/17274456
  5. http://content.onlinejacc.org/article.aspx?articleid=1140162
  6. http://www.sciencemag.org/content/213/4504/220.short
  7. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED | http://www.benzo.org.uk/manual/bzcha03.htm
  8. http://dictionary.reference.com/browse/salivation
  9. http://web.archive.org/web/20080401093403/http://www.lib.mcg.edu/edu/eshuphysio/program/section6/6ch4/s6ch4_7.htm
  10. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/15816939
  11. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/15816939
  12. ILAE official report: a practical clinical definition of epilepsy (PubMed.gov / NCBI) | http://www.ncbi.nlm.nih.gov/pubmed/24730690
  13. Rollsafe - Safety and Supplements for MDMA/Ecstasy/X | http://www.rollsafe.org/