Jim Hall is a retired epidemiologist who worked for 35 years at Nova Southeastern University in Davie, Florida, and since 1982 has served as director of the Up Front Drug Information Center in Miami. From 1984 to 2014, he served as the Florida representative to the NIDA Community Epidemiology Work Group (CEWG), the predecessor to NDEWS. Through Nova Southeastern University, Hall more recently served as a consultant with the United Way of Broward County’s Commission on Behavioral Health and Drug Prevention, formerly the Commission on Substance Abuse, which was one of the earliest drug-free community programs that is part of the Community Anti-Drug Coalitions of America (CADCA).
The following was edited for length and clarity.
Q: Can you tell us about the early days of CEWG?
A: It began in the mid-1970s as the Heroin Correspondence Group, with a handful of maybe 7 to 10 epidemiologists or Department of Health officials from 12 different locales across the country who reported on heroin trends. Then, over the years as more drugs came into view, we did general overall substance use disorder-oriented surveillance. It was based on metropolitan areas and then grew into regions. I joined in 1984 as the Miami representative, and we grew into the Southeast Florida Region — Palm Beach, Broward, and Miami-Dade. The group met semi-annually for a week and grew to about 20 reporting areas. Each gave a 20-minute oral presentation and prepared a 20-page document, which became the historical records in the proceedings of the CEWG.
We met in different cities each time, where the host city presented data from their report. It became like a fraternity of epidemiologists and others. It was also like a semi-annual homecoming when we got together, and we worked carefully through non-CEWG reporting periods throughout the years, sharing information and looking at specific topics. We were among the first to report crack cocaine in the early 1980s. We were often the first to report many trends.
Q: How did CEWG morph into the NDEWS project?
A: From my perspective, NIDA in 2014 decided that it wanted to make CEWG more research-oriented than it had been. CEWG sites prepared semiannual reports on each of the 20 metropolitan areas, plus overall summaries of the data. The Drug Abuse Warning Network (DAWN) at SAMHSA was expanded; DEA seizure data for the local regions in metropolitan areas of the CEWG were also used to determine trends in our communities. NDEWS began at the University of Maryland and in 2020 was awarded to the University of Florida. Many of the same CEWG sites are Sentinel Network Sites.
Q: How do you see the value of NDEWS to the field?
A: Well, I think it was ahead of the game as we moved through the 21st century seeing the rapidly changing dimensions. They are featured weekly in our weekly briefings with the latest, newest synthetic drugs. Generally speaking, we previously knew about 12 drugs … but now we’re looking at really hundreds of possible different substances. So one of the key roles is the early warning feature of NDEWS, which was always an informal part of CEWG. However, quick turnaround is important, while also keeping up with the tools of online networks and webinars so that it’s easier to disseminate the information.
In the 1990s, when I was co-chair of a Surveillance Epidemiology Committee for NIDA, I was asked to define surveillance epidemiology and we got it down to simply: information for action. I see that as the key role today of NDEWS. What is the information needed by people who are conducting programs? NDEWS doesn’t conduct prevention programs or provide treatment services or harm reduction, but we inform all those domains of emerging issues. Not always big trends, not always everywhere, and sometimes they disappear almost as quickly as they come onto the scene, where they’re replaced by another substance — particularly with synthetic cannabinoids and synthetic cathinones, which change almost weekly or, at least, monthly. Certainly, the Weekly Briefing is a key tool in reaching a large audience both nationally and internationally. NDEWS’ work is recognized in international networks in Europe, the Organization of American States, and even the United Nations, so we’re part of an important think-global and act-local network.
Q: How do you see the value of the work being done in the field to NDEWS?
A: One thing is the more rapid reporting of emerging trends. We don’t have to wait a year or two to get it. Instead, we wait a week or two. And with the changing natures we’ve just discussed, I think that’s a real advantage of NDEWS. And NDEWS is also expanding its outreach, which is well beyond what was the capability of the individual CEWG members in their own sentinel sites, by incorporating such things as the Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), The State and National Overdose Web (SNOW), and other national trends or national data sets that can be quickly implemented and broadcast.
Once again, it’s the early identification of new and emerging substances but also patterns that we’ve seen of combinations that have become an increasing issue, particularly in the last five years in the University of Florida’s time with NDEWS. Rather than a single drug used today, it’s certain patterns of combinations of substances, and those get more and more complicated with each of the new synthetics that are introduced as well as the veterinary pharmacopeia that has shifted into the illicit drug use market, from Xylazine and others.
Q: How do you use the data published in the briefing?
A: The United Way of Broward County’s Commission on Behavioral Health and Drug Prevention’s Surveillance Committee meets monthly where it does a 20-minute summary of the previous month’s weekly briefings from NDEWS. Our Co-chair Dr. Teri Stockham, who is a forensic toxicologist, prepares that summary, which alerts the Department of Health that is working particularly on the opioid crisis. It also alerts the crime lab, which is looking at new novel psychoactive substances.
The report also alerts the Broward Sheriff’s Office, which has multiple portable mass spectrometers that they use on-site to immediately identify substances, ensuring they have the latest substances available for identification. We’ve had great cooperation from them, and they follow very carefully what we report are the latest drugs to be aware of, like dimethylpentylone just a year or so ago — they were quick to get that into their radar. And of course, what’s sold as conventional drugs often is something else, particularly with cocaine being sold as, you know, whether it’s synthetic cathinone or now the tusi, or pink cocaine, or whatever the dealer has and wants to call it whatever the buyer wants.
We also link with other community organizations. Part of the process of making that summary is also taking it out of the academic field and into the applied information. Once again, information for action as might be relevant to the members of the committee.