The potential to #xylazine access being drastically clamped down upon is increasing by the day.

https://www.vice.com/en/article/dy7bey/republicans-dea-tranq-dope-xylazine

In the event that this *can't* be prevented, I think it's time for #harmreduction to start preparing for what would be next.

Here's a literature review from 2017, talking about human exposure to medetomidine:

https://print.ispub.com/api/0/ispub-article/52514

It's another veterinary tranquilizer, used mostly for dogs. It's sold to vets in 10mL bottles (as opposed to xylazine's 100mL bottles), and is roughly 10x as potent.

Now with tranqdope, the currently accepted best practice is to treat any opioid OD as you would otherwise, and to wait out the sedative effects of xylazine. See @dorazepam's recent talk with @Medscape on the topic.

https://www.youtube.com/watch?v=h6QPH8ISa54

Harm reductionists on the street, like @Destinie1226 and @nc_usu have been using supplemental oxygen, as exposure to alpha-2 agonists lowers blood pressure and blood oxygen levels.

That lack of oxygenation is also what happens when your lungs stop.

---
RT @Destinie1226
So far, oxygen tanks used to reverse an overdose have been a game changer with all the tranq in Philly’s dope supply. Recommend anyone doing street based outreach lo…
https://twitter.com/Destinie1226/status/1539934944415420416

Oxygenation is also already standard procedure at overdose prevention sites, both those staffed by @OnPointUnited and across Canada like those by @BCCSU as well.

Xylazine makes this all the more vital, and surely will even moreso should more potent a2-agonists enter the supply.

But that's not even a hypothetical! It's already happening. Two samples tested by @nabarund at UNC Chapel Hill came back containing medetomidine.

https://www.streetsafe.supply/search?q=medetomidine

Time will tell if this is a blip or a pattern, but clamping down on scheduling sure won't help.

Back to that paper I mentioned earlier, about what to do in the case of human medetomidine OD. A much more immediate problem than with xyl (cardiac arrest).

There's a handful of tranq reversal drugs, many not suited for human use. But atipamezole..

https://pubmed.ncbi.nlm.nih.gov/16389294/

Atipamezole seems well suited for the job. It's already been studied for human use (may also be useful as an anti-Parkinsonian), but isn't FDA-approved.

Universal healthcare would mean drugs like this could be studied and approved without needing to be entrepreneurial ventures.

You know; public health that is actually fully empowered to serve the public's health. That'd be nice.

So, overall: what to do?

1. Halt escalations of the war on drugs, incl rescheduling xylazine
2. Fast track a2-antagonists (we'll likely need em)
...

3. Re-emphasize oxygenation in OD respose! Rescue breaths, but also ambu bags, O2 tanks, pulse ox's.
4. While we're at it.. let's do a Vietnam or Afghanistan and just ditch the War On Drugs altogether? Pack it up! The DEA is a failed experiment!
5. Universal fucking health care.

And as to how to reach these goals, as #pwud and #harmreduction'ists, it's also well past time to cull those content to just fixing enough that they can sleep at night.

Tactical alliances are one thing, watering down our goals is another.

See @MadEcologies for more on it