On September 3, 2025, NDEWS Deputy Director, Dr. Joseph Palamar, presented along with Dr. Joshua DeBord of the Center for Forensic Science Research and Education (CFSRE) on the monitoring of drug trends in the US, during the Trends, Analysis, & Threats webinar, hosted by the Overdose Response Strategy (ORS) Program.
Current National Drug Early Warning System Surveillance Efforts and Findings Presentation Summary
| Novel Mixtures Causiing shifts in the Drug Landscape | What to Know |
|---|---|
| Medetomidine spread | Medetomidine, a veterinary sedative 200–300x stronger than xylazine, is appearing in fentanyl mixes; naloxone ineffective, withdrawal risk reported. Most prevalent in regions that previously saw xylazine; recent confirmations include Seattle, San Diego, and Florida biospecimens; |
| Local anesthetics (“-caines”) | Sustained rise in lidocaine/procaine/tetracaine mixed with fentanyl; multi-‘-caine’ combinations increasingly documented. Atypical clinical presentations reported (numbness/tingling, arrhythmias, gray/blue skin). |
| BTMPS | Emerged June 2024 (Portland & Philadelphia) then spread quickly nationwide; pattern suggests centralized sourcing; mechanism and risk profile under study |
| Colored Ketamine Concoctions | Tusi, or “pink powders,” usually contain ketamine mixed with drugs like MDMA or meth; NDEWS Reddit monitoring indicates concerns about possible fentanyl adulteration; staying on top of these changing variations (colors & drug mixtures) remains important |
| Fentanyl adulterated with ketamine | Fentanyl being adulterated with ketamine (not the reverse) is now being systematically detected in colored powders in Alberta, highlighting the need for close monitoring |
| NYC Night Club Saliva Testing | Testing of over 1,700 nightclub attendees revealed synthetic cathinones (e.g., CMC, MMC), with most exposures appearing unintentional. |
| Reddit Monitoring: 7-OH | 7-OH, a potent opioid-like compound found in some kratom products, is now being sold in drinks and gummies; concerns include withdrawal and overdose risks, NDEWS featured in FDA report on 7-OH |
In addition to the topics above, Dr. Palamar covered the NDEWS Networks (formal and informal), detection of trends through quantify drug discussions on Reddit by the NDEWS Web Monitoring team, Rapid Street Reporting (RSR), real-time EMS encounter data via biospatial.io, and our Weekly Briefing. To view the slides from all presenters, click here.
The full webinar summary can be viewed here: Webinar Summary. You can also view the September 2025 ORS TAT Webinar Recording, after you submit your registration information, you will be prompted for a password, which is ORS-TRAIN25
The next Trends, Analysis, & Threats Webinar is scheduled for Wednesday, November 5 from 2:00pm – 3:00pm ET
To learn more about the ORS program and their bi-monthly webinar series, click the flyer below:
