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`medication_intake_events.idempotency_key` carried a GLOBAL unique from 0001_init. The value is client-supplied, so two people running the same client can mint the same key — and on a global unique the second one is simply refused by the constraint. Their dose is not written and nothing tells them so. The bulk drain made it worse: its replay probe read the key with no user scope, resolved the first user's row, and reported the second user's entry as a duplicate carrying a stranger's row id. Migration 0273 replaces the global unique with `(user_id, idempotency_key)`, the grain every other client-supplied identity on the table already uses. Both unscoped reads in the bulk drain now key on the composite; the other four reads were already narrowed by user. On existing data this is a relaxation, so nothing needs reconciling: the old constraint is strictly stronger than the new one, and no pair of rows can violate an index the previous one already forbade. The migration still carries a reconciliation step for a database whose global index was dropped by hand at some point. It never deletes or rewrites a dose — it clears the dedup HINT on the later row of a colliding pair and keeps every intake event, timestamp, attribution and inventory stamp intact. The new index is created before the old one is dropped, so a failure aborts with the old protection still in place. A structural guard freezes the read side: no `medicationIntakeEvent` query may filter on the key without narrowing by `userId`.