Stimulants (amphetamine, methamphetamine, cocaine, cathinones) keep arousal high while ketamine is redosed toward a hole. Blood pressure and heart rate are already elevated before dissociation hits.
Clinical consequences:
- Delayed hole threshold invites higher ketamine totals
- Chest pain / arrhythmia risk rises under stimulant load
- Hyperthermia is easier to miss once dissociation dulls awareness
- Agitation after the hole can rebound hard
Practical risk reduction: space substances by hours, avoid stacking in heat, measure pulse if available, and never leave someone alone after a hole. Points of contact: party support / drug checking projects and Deutsche Aidshilfe.