DOM Dosage Guide

## Recognizing DOM Overdose DOM overdose most commonly results from taking more than 10 mg (often unknowingly, due to imprecise dosing or mislabeled tablets) or from redosing before the first dose takes effect. Because DOM's onset can take 1-3 hours and peak occurs at 4-6 hours, the full severity of an overdose may not be apparent until hours after ingestion. **Signs of DOM overdose:** - Extreme psychological distress: severe panic, paranoid delusions, inability to recognize surroundings or people, bizarre or violent behavior, amnesia - Sustained heart rate above 130 bpm, especially with chest pain or palpitations - Blood pressure significantly elevated (systolic above 170 mmHg) - Severe vasoconstriction: fingers and toes pale, cold, blue, or painfully numb - Profuse sweating, jaw clenching, muscle tension throughout the body - Hyperthermia (body temperature above 39°C/102°F) - Seizures (rare but documented at high doses) **The timeline matters:** DOM overdose effects can last 20+ hours. What looks like a bad trip at hour 4 may still be intensifying at hour 6. Reassess continuously. ## Emergency Response 1. **Call emergency services for any severe symptoms.** State: "Overdose of a long-acting psychedelic amphetamine called DOM or STP. Effects last 14-20 hours. Do NOT administer chlorpromazine -- it makes it worse. Benzodiazepines are appropriate." This specific guidance about chlorpromazine could prevent a iatrogenic catastrophe 2. **Benzodiazepines are the first-line treatment.** Diazepam (10-20 mg oral or IV) or lorazepam (1-2 mg) can reduce agitation, anxiety, and seizure risk. Repeat as needed. Unlike with most psychedelic emergencies, aggressive benzodiazepine dosing is appropriate given DOM's extreme duration 3. **Monitor vasoconstriction.** Check fingers and toes regularly for color, temperature, and sensation. If extremities are pale, blue, or significantly cold, keep them warm (do not apply direct heat -- warm blankets, warm room). Severe cases may require vasodilator therapy (nifedipine, phentolamine) in a hospital setting 4. **Monitor cardiovascular status.** Blood pressure and heart rate should be checked regularly. Hypertensive crisis (systolic above 180 mmHg or diastolic above 120 mmHg) requires medical management 5. **Cool if hyperthermic.** Standard cooling measures: remove excess clothing, ice packs to armpits and groin, mist and fan. Hyperthermia in DOM overdose is less severe than in serotonin syndrome from thio-2C compounds but still requires attention 6. **Maintain safety.** A severely distressed person on DOM may be agitated, confused, and unable to recognize helpers. Approach calmly. Speak slowly and clearly. Do not restrain physically unless there is immediate danger -- restraint can worsen agitation and increases risk of rhabdomyolysis. Dim lights, reduce noise, create as calm an environment as possible ## Managing a Difficult but Non-Emergency Experience If the person is distressed but physically stable (heart rate under 130, no vasoconstriction, no hyperthermia, no seizures): - This will last a very long time. Settle in. The single most valuable thing you can do is stay calm and stay present - Benzodiazepines, if available, can take the edge off severe anxiety without terminating the experience entirely - Reassure constantly: "You took a very long-lasting psychedelic. This is going to take many hours to wear off, but it will wear off. You are safe." - Change the environment if the current one is contributing to distress. Move rooms. Put on different music. Step outside briefly if safe to do so - Offer water regularly. Electrolyte drinks if available. Food is unlikely to be tolerated until very late in the experience - Do not leave the person alone at any point during the experience ## The Duration Factor The most important thing helpers need to understand about DOM is the timeline. A difficult experience that begins at hour 4 may not resolve until hour 16 or later. Standard trip-sitting advice assumes a 4-8 hour experience. DOM requires sustained, patient support that may span an entire day and night. If you are sitting for someone on DOM, clear your schedule completely. Good Samaritan laws apply. Never delay medical care because of legal concerns.