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acute crisis

Nosebleed or Mucosal Injury

When If nosebleeds, pain, or persistent crusting occur after nasal use (cocaine, amphetamine, ketamine, MDMA, cathinones).

review pending

Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. Lean the head forward, not back. Pinch the nostrils between thumb and index finger for 10 minutes.
  2. 2. Cool with a cold cloth on the back of the neck or the forehead.
  3. 3. If bleeding lasts over 20 minutes, if it is very heavy, or if a larger injury is suspected: get medical care.

Don't do

  • Do not tilt the head back — blood runs into the stomach and can trigger vomiting.
  • Do not keep insufflating, not even 'just a small line' — it worsens the injury.
  • Do not stuff anything into the nose (tampon, cotton) without medical guidance.

A nosebleed after nasal use is usually acutely harmless — chronic nasal damage (septal perforation, mucosal atrophy) is the actual problem.

Practical risk reduction for nasal use:

  • Grind powder finely (clumpy particles cause more injury)
  • Use your own tube, never share (hepatitis C risk)
  • Rinse the nose with warm water or saline solution (0.9% NaCl) after use
  • Take breaks between uses, alternate nostrils
  • If there is pain or crusting: pause, do not “push through”

Hepatitis C transmission via shared tubes is epidemiologically documented. Drug-checking services usually hand out individual tubes for free, as does addiction counseling.

For repeated or heavy nosebleeds unrelated to substances: get an ENT evaluation — rule out other causes (high blood pressure, clotting disorders).