National Drug Early Warning System (NDEWS) Weekly Briefing



Changes in outpatient buprenorphine dispensing during the COVID-19 pandemic

NDEWS Sentinel Site Director Dr. Jessica Cance published a study in JAMA last month evaluating the Drug Enforcement Administration (DEA) temporarily relaxing measures regarding prescribing regulations for outpatient buprenorphine. After COVID-19 was declared a national emergency, the DEA began permitting prescribing buprenorphine to new patients via telephone or telemedicine and to existing patients by any method (including email) and encouraging use of electronic prescriptions.

This study determined if changes in federal regulations corresponded with changes in outpatient buprenorphine dispensing in Texas. In the 90 days after the national emergency declaration, the number of patients filling prescriptions for buprenorphine increased and the mean days’ supply per prescription increased. Buprenorphine for treatment of opioid use disorder (OUD) reduces the likelihood of opioid overdose and can be prescribed in office-based outpatient settings.

Racial/ethnic disparities in unintentional fatal and nonfatal emergency medical services-attended opioid overdoses during the COVID-19 pandemic in Philadelphia

Another study published in JAMA found that the absolute number of overdose deaths was higher among Black individuals than among White individuals. The study finds that OUD treatment, harm reduction, and overdose prevention efforts should be immediately targeted to Black and other communities at highest risk during the COVID-19 pandemic. Researchers determined COVID-19 has exacerbated preexisting stressors in Black communities, possibly contributing to increased substance use. Read the full study here.



NPS Discovery announces new identification of synthetic cannabinoid 4F-ABINACA in the United States

NPS Discovery issued an alert regarding the first identification of 4F-ABINACA in the US this week. 4F-ABINACA is classified as a synthetic cannabinoid, compountds which tend to have psychoactive effects similar to delta-9-tetrahydrocannabinol (THC). Read the full alert here.

Metonitazene begins proliferation as newest synthetic opioid among latest cycle of non-fentanyl related drugs

Metonitazene, an NPS opioid with effects like fentanyl, is the latest synthetic opioid to emerge in the illicit drug market as a possible replacement for the recently scheduled isotonitazene and brorphine. NPS Discovery published an alert after eight confirmed forensic cases. According to the authors, while the toxicity of metonitazene has not been extensively examined, “recent association with drug user death leads professionals to believe that this new synthetic opioid retains the potential to cause widespread harm and is of public health concern.” Read the full release here.



Consumer discernment of fentanyl in illegal opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina (submitted by Dr. Jane Maxwell)

One of the more interesting aspects in tracking the patterns of drug use is the variation in changes that we see in the way in which drugs are consumed, routes of administration, new patterns of use, and new names or terms for the drug as it changes over time and population. Zibbell et al. in the 2021 January International Journal of Drug Policy reported that persons recruited from a North Carolina syringe services program were consistent in reporting the physical characteristic of the test strips prior to adding water, psychological effects compared to heroin, the strength of the rush, time to withdrawal, and unusual sensations. The authors reported persons who inject drugs are becoming more proficient in identifying and recognizing fentanyl through the test strips in combination with sensory strategies of the users could be an emerging approach to risk reduction.

A transnational perspective on the evolution of the synthetic cannabinoid receptor agonists market: Comparing prison and general populations

A study published in Drug Testing and Analysis examined the synthetic cannabinoid market in prison populations. The study used toxicology-based and/or seized sample-based prevalence data relating to synthetic cannabinoids in prisons from four geographical regions: one in Germany, two in the UK (distinct datasets from Scotland and Wales), and one in the US. The study found that while there were regional differences, synthetic cannabinoid prevalence in prisons closely aligned with the synthetic cannabinoids detected in the local market, demonstrating that NPS monitoring programs in prisons can act as early warning systems for the wider populations in those jurisdictions. Read the full study here.

Carfentanil on the darknet: Potential scam or alarming public health threat?

Another study published in the International Journal of Drug Policy identified 63 carfentanil vendors operating on 19 darknet marketplaces. The study concludes that the availability of highly potent drugs such as carfentanil on the darknet requires the urgent development of novel scientific methods and tools able to monitor and to predict such new threats. Read the full study here.


Kratom: What science is discovering about the risks and benefits of a controversial herb

University of Florida wrote an article for The Conversation about recent kratom research. McCurdy and his team study why kratom use in Asia is “safe” vs “harmful” kratom use in the US over the last decade. They hypothesize that addiction to kratom is the result of the quantity and inferior quality of the product ingested. Kratom in Asia is prepared traditionally from freshly harvested leaves, whereas kratom in the US is from dried leaf material, which changes chemical composition as it dries and ages. Read the full article here.


HIDTA team evaluating surge of encrypted social media applications

An unclassified informational release from the Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) shared with NDEWS showed surges in use of encrypted social media applications. Following the news that WhatsApp will be sharing data with Facebook on February 8, 2021, the social media applications Telegram and Signal have been growing in users. According to RMHIDTA, law enforcement will likely have difficulty with search warrants for Telegram as the platform is “decentralized and requires several court orders across different jurisdictions.” NDEWS will continue to update our readers on this story. Find the RMHIDTA website here.


NDEWS is currently recruiting for a NIDA T32 Postdoctoral Fellow, available immediately. Visit this link to apply.

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