Firstly the availability of fentanyl test strips, but these are not available in many countries. Then increasingly educate users not to consume alone and preferably someone to carry naloxone spray.

Best

May I recommend some sources?

https://www.forum-substitutionspraxis.de/substanzen/opioide/fentanyl

https://www.forum-substitutionspraxis.de/schadensminderung/verschiedenes/how-should-harm-reduction-be-included-in-care-continua-for-patients-with-opioid-use-disorder?highlight=WyJhbWEiXQ==

https://www.forum-substitutionspraxis.de/newpolitik/international/usa-overdose-epidemic-physicians-actions-to-help-end-the-nations-drug-related-overdose-and-death-epidemic-and-what-still-needs-to-be-done

https://www.forum-substitutionspraxis.de/newpolitik/national/synthetic-opioids-in-germany-are-we-prepared-proposals-for-a-national-council

https://so-prep-project.eu/publications/

Kind regards!

Hans-Guenter Meyer-Thompson

Hamburg/Germany

Forum Substitutionspraxis

editor

From locally developed info for people using drugs, key borrowed bits with thanks to Harm Reduction Coalition,

Use slow and use less. Take a test dose – a small amount or part of a pill. A little goes a long way (compared to heroin) and overdoses can occur quickly, sometimes even before finishing injecting. Relax the tourniquet completely after finding the vein, this allows you to inject less if it tastes stronger than usual. Injecting carries the highest risk for overdose, so shifting to snorting (least risky usually) or smoking may help but you can still easily overdose.

· If using pills with heroin, be aware the pills may have opioids in them as well Be careful when switching from one type of pill to another since what is in them, their strengths and dosage may vary. Even splitting one pill can have one person ending up with all the drug. · If you buy tablets that are of poor quality or crumble easily, this may be an indicator that they have been illicitly produced. Be aware that even if a tablet looks authentic, it may be fake and it can be difficult to distinguish between genuine and counterfeit medication. Any medicine obtained without a prescription should be treated with caution.

· If you get a different supplier test the drugs again! Space out your doses. Take time between doses because synthetic opioids can act fast and are different for everyone, depending on dose and tolerance. If you take gabapentin or pregabalin with new pills, the way they work might cause a rapid overdose so check it out first by using a test dose.

· Always carry naloxone. Carry two packs!! Be familiar with the signs of an overdose and be prepared to respond with naloxone. Know CPR and rescue breathing techniques!

· Practice extra caution when using alone. We’re safer together but it’s not always possible to be with a friend you trust. Try to have someone you know check on you regularly if you have to use alone. If in a shared house/flat/hostel leave the door unlocked or slightly ajar whenever possible (think about what might happen with any valuables if you were unconscious!).

· In a group? Stagger your use. Develop an overdose plan! Make sure someone is always alert and that at least one person has naloxone on them.

.Test strips (and most drug testing systems) show if a drug is present, but not its strength. Due to very small size but very high potency of active ingredient of drug, dividing drugs in a dry form may not produce an even division, even if weight is same. Division in soluble form is only guarantee that everyone has same dose. This recommendation has other consequences if not using sterile equipment.

· Listen to your body. Overall health impacts overdose risk. Hydrate, eat, and rest as much as possible. Use less at first if you’ve been sick, lost weight, or have been feeling under the weather or weak — this can affect tolerance.

Assume overdose risk no matter what drug you’re using, and consistently practice as much harm reduction as possible. Because there is no safe access to known drugs it makes evidence-based strategies such as safety planning more vital than ever.

Controversial thought. Perhaps need to educate illicit pill cooks about better ways of ensuring equal distribution of active drug amongst a batch of pills.