This Week’s Focus: NDEWS Early Warning in Action — Insights from the NDEWS Early Warning Network including Sentinel Sites Report and Rapid Street Reporting data
This week, the NDEWS Weekly Briefing focuses on our Sentinel Site Director (SSD) report and our newest Rapid Street Reporting (RSR) findings from our weekend visit to St. Louis, along with an NDEWS Web Monitoring Report on Etodezitramide HCL.
NDEWS RSR (Rapid Street Reporting) is a venue-intercept study conducted across our national Sentinel Sites, where interviewers travel to sites on weekends. People are interviewed with an anonymous survey about their use of substances in the past 12 months, including the recency and effects of use. The seven-minute interview covers common drugs as well as new psychoactive substances (NPS). With close to 8,000 participants surveyed to date, RSR complements traditional surveillance by capturing emerging trends.
We report for the first time in our NDEWS Web Monitoring Report an increasing trend in the discussion of Etodezitramide HC on Reddit. Over the past two weeks there has been significant engagement on posts made about the substance in monitored substance use subreddits.
Additionally, we highlight work from our NDEWS team and our Early Warning Network. One article, in Addiction, shows an increase in deaths when both fentanyl and stimulants were involved. And check the CFSRE report showing that carfentanil was the most frequently identified opioid in their drug material and tox reports.
As always, we welcome your input.
NDEWS ORIGINAL CONTENT
Rapid Street Report: Substance use in St. Louis in the past 12 months, September 19 to 21, 2025
The Rapid Street Reporting (RSR) team visited St.Louis from September 19th to 21st, 2025 and surveyed 284 individuals. After alcohol and marijuana for recreational use, the next most commonly reported substances used in the past 12 months were medical marijuana (11.3%), delta-8 (9.2%), psilocybin (8.5%), delta-10 (8.1%) and ecstasy/MDMA/molly (4.2%).
Observations from NDEWS St. Louis Site Director: Heidi Israel, PhD, FNP, LCSW, CCRC
“Traditional resources monitor many of the drugs that people think about when discussing abuse (cocaine, methamphetamine, fentanyl, heroin). The RSR [also] successfully targets Molly, mushrooms, various combinations of synthetics and powders, and high-grade marijuana along with alcohol.”
Click here to read the full report.
Click here to read more about NDEWS Rapid Street Reporting.
Sentinel Site Director Report, August 2025: What trends are being observed concerning synthetic cathinones or “bath salts” in the local drug supply?
Our Sentinel Site Directors were asked recently about synthetic cathinones in the drug supply. This question was prompted by the July 2025 issue of the European Union Drugs Agency’s (EUDA) monthly newsletter that highlighted three reports focusing on synthetic cathinones:
➡️ N-ethylnorpentedrone (NEP);
➡️ 2-methylmethcathinone (2-MMC);
➡️ 4-bromomethcathinone (4-BMC).
“Bath salts” have been increasing in prevalence in the EU and UK. Now, in the US, there have been increased reports of recreational use of and unintentional exposure to MMCs (methylmethcathinones), including 4-MMC (4-methylmethcathinone, mephedrone), 3-MMC (3-methylmethcathinone; metaphedrone), and 2-MMC (2-methylmethcathinone, ortomephedrone/ortho-mephedrone). Detection of synthetic cathinones has begun in New York City, and they are expected to start appearing in other cities. Synthetic cathinones are on our NDEWS’ radar and we will continue to monitor them. Let us know what you are hearing in your area.
NDEWS Web Monitoring Report: Etodezitramide HCL
Why are we reporting on this? Individual experience reports for Etodezitramide HCL have emerged in online communities within the past two weeks. The compound has recently appeared for sale from suppliers in China, and the web monitoring team was able to find three vendors beginning to list this substance in the past week. Despite limited discussion volume, posts about Etodezitramide HCL have generated significant engagement in monitored substance use subreddits.
What is Etodezitramide HCL? Etodezitramide HCL is a synthetic opioid analog of bezitramide with the chemical name 1-(1-(4-oxo-3,3-diphenylhexyl)piperidin-4-yl)-1,3-dihydro-2H-benzo[d]imidazol-2-one. Reddit users report that this compound is structurally related to brorphine and is purported to be significantly more potent than morphine, with claims of potency up to 20 times stronger than methadone. Reddit users report that the substance acts as an opioid receptor agonist, producing analgesic and euphoric effects typical of potent opioids.
Public Health Impacts: Reddit discussants express significant concern about the lack of contemporary safety data for Etodezitramide HCL, noting that while the compound was previously available (the last online mentions before the current trend were in 2020), current batches represent a return after a four-year absence with unknown purity or composition issues. Commenters report uncertainty about appropriate dosing. Some Reddit users mention concerns about the compound’s reported high potency suggesting potential for rapid tolerance development and dangerous overdose risk. Some discussion mentions previous experiences with quality control issues with suppliers from China, with some commenters questioning whether current synthesis methods produce the same compound that was available in 2020.
How is it being discussed? Reddit users report renewed availability of Etodezitramide HCL from suppliers in China after an absence from the research chemical market (the last online mentions before the current trend were in 2020). Discussants actively seek information about the compound’s current quality and effects, with some expressing skepticism about whether available samples represent the same material that was previously circulating. Some commenters mention planning to experiment with Etodezitramide HCL, often in the context of seeking alternatives following the market disappearance of nitazene compounds. The compound is discussed by Reddit users seeking potent opioid research chemicals, with particular interest from those with existing opioid tolerance. Discussions include references to the compound’s previous availability and comparisons to other bezitramide analogs like brorphine.
Drug Terms: Etodezitramide HCL, Etodesitramide
RECENT PUBLICATIONS
Journal of Psychoactive Drugs
The Epidemiology of recreational use and availability of DOC and DOI in the United States
A recently published research article in the Journal of Psychoactive Drugs, led by NDEWS Co-Director Joseph Palamar and co-authored by NDEWS and NIDA T32 alum Nicole Fitzgerald, presents a comprehensive review of DOC (2,5-dimethoxy-4-chloroamphetamine) and DOI (2,5-dimethoxy-4-iodoamphetamine). The review of these two substances covers the US Drug Enforcement Agency’s proposal to place DOC and DOI into Schedule I of the Controlled Substances Act. Additionally, the article discusses the trends of availability, recreational use, associated harms, and public health implications of both substances.
Addiction
Refining cause of death attribution among opioid, opioid-stimulant and stimulant acute toxicity deaths
A recently published research report in Addiction featuring NDEWS Sentinel Site Director Phillip Coffin reviewed 4,475 acute toxicity deaths in San Francisco from 2013 to 2023. The research focused on deaths involving fentanyl, stimulants (methamphetamine or cocaine), and other opioids. The findings revealed that 45% of deaths involved fentanyl and stimulant combinations, 24% involved stimulants only, and 12% involved fentanyl only. The authors suggest that deaths involving fentanyl and stimulants should be considered in the context of opioid overdose prevention, while stimulant-only deaths may require a focus on chronic medical conditions.
Quest Diagnostics
Quest Diagnostics: More workers testing positive for fentanyl
A recently published report by Quest Diagnostics identified that employees in the general US workforce are testing positive for fentanyl in random drug tests at a far higher rate than those in pre-employment testing. According to the 2025 Quest Diagnostics Drug Testing Index™, more an 8 million drug tests were analyzed and revealed that in 2024 the US workforce positivity for fentanyl was 707% higher in random tests, compared to pre-employment tests.
Center for Forensic Science Research & Education
NPS Trends Reports: Q3 2025
The Center for Forensic Science Research & Education (CFSRE), prepared by NDEWS SAG members Drs. Krotuslski and Logan et al., publishes quarterly trend reports using advanced GC-MS and LC-QTOF-MS techniques to detect over 1,200 substances, with a focus on novel psychoactive substances (NPS). In Q3 2025, carfentanil was the most frequently identified opioid, accounting for 180 total detections—171 in drug materials and 9 in toxicology cases. This quarter’s detections are more than four times the amount detected in the previous quarter.
Join the UF T32 Training Program in Substance Abuse and Public Health as a Pre or Postdoc! Work with the NDEWS Team!
Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!
What We Offer:
– Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
– Mentorship from leading UF faculty in epidemiology, public health, psychology, medicine, and more
– Hands-on research with landmark and important NIH-funded projects and access to rich data
– Career development support, including grant writing, publishing, and professional networking
– A collaborative, inclusive research community committed to reducing the burden of substance use
Eligibility:
– US citizens or permanent residents
– Interested in a PhD in Epidemiology, or early-stage postdoctoral fellows
– Demonstrated interest in substance use, addiction, or public health research
Location: Gainesville, Florida — a dynamic hub for scientific innovation with high quality of life and low cost of living.
UPCOMING WEBINARS & EVENTS
2025 American College of Medical Toxicology Psychedelics Seminar
📅 Dates: Friday, October 17, 2025
🕑 Time: 10:00 am – 5:00 pm ET
📍 Location: Online
ABOUT NDEWS
The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.
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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:
• NDEWS Hotspot Alerts using substance-related EMS data
• NDEWS Rapid Street Reporting (RSR) survey data reports
• NDEWS Web Monitoring Team Reddit Alerts
• NDEWS Sentinel Site Reports
• Previous issues of the NDEWS Weekly Briefings
The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.