Psychedelics Today
PT420 – Rachel Clark – DanceSafe: Drug Testing, Fentanyl Myths, and the Importance of Consent
Tue Jul 04 2023Description
The episode covers topics such as the launch of a psychedelics course, drug testing at festivals, challenges in drug checking results, understanding opioid overdose and naloxone administration, determining cause of death and fentanyl testing, addressing drug distribution issues, consent culture and resources for drug users, recommended resources and reporting guidelines, and understanding naloxone and its use in opioid overdose.
Insights
Psychedelics Education Center Launching Navigating Psychedelics Course
Psychedelics Education Center is launching two rounds of navigating psychedelics for clinicians and wellness practitioners in July. The course covers the fundamentals of psychedelic history, science, harm reduction, integration, and transpersonal theories.
Drug Testing at Festivals and DanceSafe's Efforts
Rachel Clark from DanceSafe discusses drug testing at festivals and busts some fentanyl myths. She provides important information on identifying and treating overdoses. Drug testing services at festivals are highly utilized and popular. DanceSafe is working on implementing better systems to track and record drug checking results at festivals.
Challenges and Limitations of Drug Checking Results at Festivals
Efforts are underway to create a centralized database of drug checking results. Drug trends at festivals vary by region and event genre. Reagent tests have limitations and should be used to identify red flags rather than confirm substances. DanceSafe volunteers provide more detailed information based on their understanding of different substances on the market. The most commonly tested substances at festivals include MDMA, MDA, ketamine, cocaine, and LSD. There are limitations in testing other substances like GHB, shrooms, weed, and counterfeit benzos. On average, about 20% of reagent tests do not react as expected. Some cases have revealed that substances were not what people thought they were, such as Epsom salts sold as drugs or muscle relaxants sold as quaaludes. Counterfeit Xanax often contains other benzodiazepines like clonazolam or fluo-proazolam. Non-prescription oxies are likely to contain fentanyl. GHB may actually be GBL or 14B with different dosing requirements and risks when mixed with alcohol. There are synthetic cathinones appearing on the market like dimethyl pentalone and beautiful without confirmatory testing available in the field.
Understanding Opioid Overdose and Naloxone Administration
Transdermal absorption of fentanyl is unlikely to cause overdose. Opioid overdose symptoms include slow breathing, reduced consciousness, and pinpoint pupils. Conflating harm reduction with fentanyl test strips and naloxone can lead to misattributions and unnecessary panic. Administering naloxone when not indicated can have negative consequences. Misunderstanding opioid overdose can lead to trauma and false attributions of symptoms. The primary cause of opioid overdose is hypoxia, lack of oxygenation. In supervised consumption sites, bagging someone and assisting ventilation is often sufficient without naloxone. Too much naloxone administered to someone with physical dependence on opioids can induce withdrawal.
Proper Naloxone Administration and Factors Affecting Overdose Response
Administering too much naloxone to someone overdosing on opioids with physical dependence and tolerance can send them into precipitated withdrawal. Give the minimum amount of naloxone required to stabilize breathing, even if the person doesn't wake up. If someone has a known or suspected physical tolerance to opioids, it is important to give them enough naloxone for their breathing to stabilize. Naloxone may take two to three minutes to start working. Wait between doses and consider symptoms and administration method before concluding that an overdose was naloxone resistant. Other factors like xylazine, diphenhydramine, or benzos in the drug supply can affect sedation levels after naloxone administration. EMS cannot confirm which factor is causing resistance without further information. If someone might be overdosing on opioids, check their breathing and consciousness level. Give naloxone if available or perform rescue breaths via CPR barrier if trained. Start CPR if there is no pulse. Fentanyl involvement in overdose deaths is not a myth but quantifying its exact role is complex due to multiple substances involved and limited screening resources in some regions.
Determining Cause of Death and Challenges in Fentanyl Testing
Teasing apart the specifics of deaths related to substances can be difficult due to multiple factors involved. Overdosing on fentanyl can lead to hypoxia and cell death in vital organs. Autopsy reports and substance analysis can provide a clearer picture of the cause of death. Determining the cause of death becomes more complicated when multiple substances are involved. Cocaine use can increase the risk of cardiac events, which may overshadow opioid overdose as the cause of death. Having eyewitness accounts, substance analysis, and autopsy reports can provide a comprehensive understanding of what happened. DanceSafe does not test patrons at events but provides them with testing strips for personal use. Testing for fentanyl requires precision and there is a high degree of user error with strip testing. False positives can occur with fentanyl test strips, requiring further verification through lab analysis. Fentanyl distribution in substances is uneven, so thorough mixing is necessary for accurate testing results. Trace amounts of fentanyl contaminating ketamine or MDMA have been reported in very few cases around the country.
Challenges in Testing Fentanyl and Addressing Drug Distribution
Uncertainty regarding the prevalence of fentanyl in substances like ketamine, as every attempt to gather information has been inconclusive. The likelihood of fentanyl contaminating cocaine is higher than other commonly used substances. Factors such as cross-contamination risk and specific drug combinations can complicate testing for fentanyl. DanceSafe aims to educate consumers about drug testing, but it's challenging to reach all drug users in various settings. Efforts are being made to address the supply side of drug distribution and support harm reduction among sellers. Regional issues exist, such as the presence of xylazine in Philadelphia's opioid supply, which enters at the street level. Addressing poverty and implementing systemic changes like universal basic income and healthcare could help alleviate drug-related problems. Current harm reduction measures are band-aid solutions that stem from a lack of broader systemic changes.
Consent Culture and Resources for Drug Users
DXM found in pills can create a hypothermic crisis for some people. Implementing harmful structures was faster than undoing them. Appeal to individuals in friend groups to be point persons and establish captains throughout different regions. Provide resources and knowledge to others based on recent findings. Encourage drug providers to do the right thing and buy testing kits. Hold substance suppliers accountable by demanding proof of testing. We Love Consent program focuses on creating a consent culture in the community. 'Healing is Power' campaign addresses consent and power dynamics in the music industry. Campaign provides specific actions and behaviors for bystander intervention and support for survivors of sexual assault. Mandatory consent training included in new training program.
Recommended Resources and Reporting Guidelines
Consent is important even in simple actions like tickling, as it can cause trauma if someone doesn't want it. DanceSafe offers free online courses and materials on their website, with some items available for purchase. Recommended resources include psychonautwiki.org for drug information, effectindex.com for detailed drug experience descriptions, drugsdata.org for advanced drug checking results, and street safe dot supply for University of North Carolina's drug checking program. Always communicate the limitations of what you know and share only what you witnessed or did when reporting on something. EMS workers should avoid spreading misinformation by sharing observations instead of speculation. Confirmatory information about drugs can only come from proper testing.
Understanding Naloxone and Its Use in Opioid Overdose
Narcan works by lifting opioids out of receptors and reversing respiratory depression effects. Naloxone is an opioid antagonist that specifically targets receptors. It is not a stimulant and only works for opioid overdose.
Chapters
- Psychedelics Education Center Launching Navigating Psychedelics Course
- Drug Testing at Festivals and DanceSafe's Efforts
- Challenges and Limitations of Drug Checking Results at Festivals
- Understanding Opioid Overdose and Naloxone Administration
- Proper Naloxone Administration and Factors Affecting Overdose Response
- Determining Cause of Death and Challenges in Fentanyl Testing
- Challenges in Testing Fentanyl and Addressing Drug Distribution
- Consent Culture and Resources for Drug Users
- Recommended Resources and Reporting Guidelines
- Understanding Naloxone and Its Use in Opioid Overdose
Drug Testing at Festivals and DanceSafe's Efforts
07:02 - 13:54
- Rachel Clark from DanceSafe discusses drug testing at festivals and busts some fentanyl myths
- Provides important information on identifying and treating overdoses
- Drug testing services at festivals are highly utilized and popular
- DanceSafe is working on implementing better systems to track and record drug checking results at festivals
Challenges and Limitations of Drug Checking Results at Festivals
13:36 - 20:01
- Drug checking results at festivals are sporadic and limited
- Efforts underway to create a centralized database of drug checking results
- Drug trends at festivals vary by region and event genre
- Reagent tests have limitations and should be used to identify red flags rather than confirm substances
- DanceSafe volunteers provide more detailed information based on their understanding of different substances on the market
- Most commonly tested substances at festivals include MDMA, MDA, ketamine, cocaine, and LSD
- Limitations in testing other substances like GHB, shrooms, weed, and counterfeit benzos
- About 20% of reagent tests do not react as expected on average
- Cases reveal substances sold as drugs that are actually Epsom salts or muscle relaxants
- Counterfeit Xanax often contains other benzodiazepines
- Non-prescription oxies likely to contain fentanyl
- GHB may actually be GBL or 14B with different dosing requirements and risks when mixed with alcohol
- Synthetic cathinones appearing on the market without confirmatory testing available in the field
Understanding Opioid Overdose and Naloxone Administration
19:33 - 26:30
- Transdermal absorption of fentanyl unlikely to cause overdose
- Opioid overdose symptoms include slow breathing, reduced consciousness, and pinpoint pupils
- Primary cause of opioid overdose is hypoxia, lack of oxygenation
- Conflating harm reduction with fentanyl test strips and naloxone can lead to misattributions and unnecessary panic
- Administering naloxone when not indicated can have negative consequences
- Misunderstanding opioid overdose can lead to trauma and false attributions of symptoms
- In supervised consumption sites, bagging someone and assisting ventilation often sufficient without naloxone
- Too much naloxone administered to someone with physical dependence on opioids can induce withdrawal
Proper Naloxone Administration and Factors Affecting Overdose Response
26:08 - 32:59
- Administering too much naloxone to someone overdosing on opioids with physical dependence and tolerance can send them into precipitated withdrawal
- Give the minimum amount of naloxone required to stabilize breathing, even if the person doesn't wake up
- If someone has a known or suspected physical tolerance to opioids, give them enough naloxone for their breathing to stabilize
- Naloxone may take two to three minutes to start working
- Wait between doses and consider symptoms and administration method before concluding that an overdose was naloxone resistant
- Other factors like xylazine, diphenhydramine, or benzos in the drug supply can affect sedation levels after naloxone administration
- EMS cannot confirm which factor is causing resistance without further information
- If someone might be overdosing on opioids, check their breathing and consciousness level. Give naloxone if available or perform rescue breaths via CPR barrier if trained. Start CPR if there is no pulse
- Fentanyl involvement in overdose deaths is not a myth but quantifying its exact role is complex due to multiple substances involved and limited screening resources in some regions
Determining Cause of Death and Challenges in Fentanyl Testing
32:41 - 39:37
- Teasing apart the specifics of deaths related to substances can be difficult due to multiple factors involved
- Overdosing on fentanyl can lead to hypoxia and cell death in vital organs
- Autopsy reports and substance analysis can provide a clearer picture of the cause of death
- Determining the cause of death becomes more complicated when multiple substances are involved
- Cocaine use can increase the risk of cardiac events, which may overshadow opioid overdose as the cause of death
- Having eyewitness accounts, substance analysis, and autopsy reports can provide a comprehensive understanding of what happened
- DanceSafe does not test patrons at events but provides them with testing strips for personal use
- Testing for fentanyl requires precision and there is a high degree of user error with strip testing
- False positives can occur with fentanyl test strips, requiring further verification through lab analysis
- Fentanyl distribution in substances is uneven, so thorough mixing is necessary for accurate testing results
- Trace amounts of fentanyl contaminating ketamine or MDMA reported in very few cases around the country
Challenges in Testing Fentanyl and Addressing Drug Distribution
39:13 - 46:24
- Uncertainty regarding the prevalence of fentanyl in substances like ketamine
- Likelihood of fentanyl contaminating cocaine higher than other commonly used substances
- Factors such as cross-contamination risk and specific drug combinations can complicate testing for fentanyl
- DanceSafe aims to educate consumers about drug testing but challenging to reach all drug users in various settings
- Efforts being made to address the supply side of drug distribution and support harm reduction among sellers
- Regional issues exist, such as the presence of xylazine in Philadelphia's opioid supply
- Addressing poverty and implementing systemic changes like universal basic income and healthcare could help alleviate drug-related problems
- Current harm reduction measures are band-aid solutions that stem from a lack of broader systemic changes
Consent Culture and Resources for Drug Users
45:55 - 52:40
- DXM found in pills can create a hypothermic crisis for some people
- Implementing harmful structures was faster than undoing them
- Appeal to individuals in friend groups to be point persons and establish captains throughout different regions
- Provide resources and knowledge to others based on recent findings
- Encourage drug providers to do the right thing and buy testing kits
- Hold substance suppliers accountable by demanding proof of testing
- We Love Consent program focuses on creating a consent culture in the community
- 'Healing is Power' campaign addresses consent and power dynamics in the music industry
- Campaign provides specific actions and behaviors for bystander intervention and support for survivors of sexual assault
- Mandatory consent training included in new training program
Recommended Resources and Reporting Guidelines
52:21 - 59:30
- Consent is important even in simple actions like tickling, as it can cause trauma if someone doesn't want it
- DanceSafe offers free online courses and materials on their website, with some items available for purchase
- Recommended resources include psychonautwiki.org for drug information, effectindex.com for detailed drug experience descriptions, drugsdata.org for advanced drug checking results, and street safe dot supply for University of North Carolina's drug checking program
- Always communicate the limitations of what you know and share only what you witnessed or did when reporting on something
- EMS workers should avoid spreading misinformation by sharing observations instead of speculation
- Confirmatory information about drugs can only come from proper testing
Understanding Naloxone and Its Use in Opioid Overdose
59:04 - 1:03:13
- Narcan works by lifting opioids out of receptors and reversing respiratory depression effects
- Naloxone is an opioid antagonist that specifically targets receptors
- It is not a stimulant and only works for opioid overdose