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6…are discordant with what would be expected from opioids only." And critically: "Naloxone reverses opioid toxicity but has no effect on the sedating properties of xylazine, which may persist."The Fentanyl Crisis Research Synthesis: Sharpest Evidence for a Long-Form Hamilton/Ontario Essay2 Xylazine wound mechanism — the surgical/clinical literatureDrugs & public health"Many overdoses go unreported due to the prevalence of the overdose-reversal drug naloxone, meaning the real number is likely higher."The Fentanyl Crisis Research Synthesis: Sharpest Evidence for a Long-Form Hamilton/Ontario Essay4 The mortality-undercount argument — STRONGEST evidence and named sourcesDrugs & public health…23, 2025) describe how the combination of (a) sedative adulterants resistant to naloxone, (b) xylazine wounds, (c) methamphetamine co-use displacing cocaine, and (d) housing precarity has created a clinical picture distinct from the heroin era.The Fentanyl Crisis Research Synthesis: Sharpest Evidence for a Long-Form Hamilton/Ontario Essay5 The "four-cause synthesis" — academic articulationDrugs & public healthBC pioneered a take-home naloxone program (now over 400,000 kits annually) that has clearly saved lives.How We Got Here: A Field Guide to the Fentanyl Crisis in Canada and on Hamilton's StreetsPolicy decisions that shaped the curveDrugs & public health…ted clinical phenomenon that fentanyl overdoses often require multiple doses of naloxone to reverse, with reversal sometimes followed by re-overdose ("re-narcotization") as fentanyl redistributes out of fat into blood.How We Got Here: A Field Guide to the Fentanyl Crisis in Canada and on Hamilton's StreetsWhy fentanyl is so much more potentDrugs & public healthBromazolam, like all benzodiazepines, does not respond to naloxone — naloxone reverses the opioid component, restoring breathing, but the user remains profoundly sedated for hours.How We Got Here: A Field Guide to the Fentanyl Crisis in Canada and on Hamilton's StreetsThe current adulteration crisis: benzodope and tranqDrugs & public health