pinecones & dandelions

While were here, here is a quick runddown of symptoms of an opioid OD to look out for:

- Person’s skin might look blueish or greyish, depending on skin tone

- Skin might feel cold or clammy

- Might hear “agonal breathing” - a gasping/gulping/grunting sound sometimes mistaken for snoring

- Sometimes you might not see or hear any of these obvious signs. The person might just seem like they are sleeping or in a heavy nod.

You can check for responsiveness by verbally calling for them and doing a sternum rub (running your knuckles up and down the center of their chest), but don't spend a bunch of time trying to get them up-- every secound counts.

Second major point: when reversing an OD you are looking for a return to regular breathing, NOT for the person to wake up. Adulterants like xylazine (tranq) and medetomidine are fairly common in the US fent supply, and given that these are sedatives they can put folks out for hours at a time. Make sure to give rescue breaths and monitor breathing continuously until emergency service providers arrive (or if you are unable to call 911/999/etc, have someone stay with the person for at least 90 min). The biggest mistake I see people make is, since they're in a panic, they continuously administer naloxone without waiting and without watching for breathing bc they're worried about the person not coming to. I get that it's really scary, but it's vital that you're focusing on the correct tells.

Like last rb said too, you don't need a crazy mg amount to reverse an OD, in fact you don't need more than 4mg max (6mg if the person REALLY isn't breathing) for nasal naloxone and 0.8mg/ml max for intramuscular naloxone. This is about 2 doses for each type, and often one dose is enough to stabilize someone (when the medicine wears off any opioids left in the system will rebind to opioid receptors, though, so keeping a dose on hand is vital especially if they can't get to the hospital for monitoring). There is no evidence that high dose naloxone such as Kloxxado is more effective in reversing overdoses, and actually poses a greater danger due to its ability to quickly lead to acute withdrawal. These products are produced by for-profit companies co-opting panic surrounding the present street opioid supply, and are not recommended by anyone with experience in the field.