National Drug Early Warning System (NDEWS) Weekly Briefing


Alert from NDEWS Web Monitoring team: Increases in Reddit discussions of tiletamine, April 2020–March 2021

According to the NDEWS Web Monitoring Team, led by Dr. Elan Barenholtz and PhD candidate Paul Morris at the Machine Perception and Cognitive Robotics (MPCR) Lab at Florida Atlantic University, online Reddit discussions of the dissociative anesthetic drug tiletamine have increased in 2020 and 2021.

Tiletamine is used in veterinary medicine in the combination product Telazol (tiletamine/zolazepam) and has previously been associated with at least one fatality. It was first recognized as a potentially relevant drug keyword through algorithmic monitoring of ~80 drug-oriented subreddits. The drug has been mentioned sporadically on Reddit since 2015 as a dissociative related to ketamine, but an upward trend in mentions and unique commenters began in April 2020 and has persisted through March 2021.

Have you heard anything about tiletamine? Let us know here.


New NCHS Data Brief: Urban–rural differences in drug overdose death rates, 1999–2019

A National Center for Health Statistics (NCHS) Data Brief published this week examined urban-rural differences in drug overdose death rates by sex, age, and type of drugs. Using the most recent mortality data from the National Vital Statistics System, the authors found that from 2016 through 2019, age-adjusted drug overdose death rates were higher overall in urban counties than rural counties. In 2019, rates of overdose deaths were higher in rural counties than urban counties for five states: California, Connecticut, North Carolina, Vermont, and Virginia. Urban-rural differences in overdose death trends were also found to vary by type of opioid and stimulant over time. Read the full report here.

New psychoactive substances in several European populations assessed by wastewater-based epidemiology

A new Europe-wide study published in Water Research assessed the suitability of monitoring the use of NPS through wastewater-based epidemiology. Using high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS), investigators monitored levels of select NPS and classic illegal drugs in wastewater samples collected in 2016 and 2017 from 22 cities in 14 European countries. The most frequently detected NPS was methcathinone (found in over 65% of cities), followed by mephedrone (found in over 25% of cities). Results demonstrate the comparatively lower use of NPS than classic drugs in Europe, as well as the value of wastewater-based studies for monitoring spatial and temporal changes in NPS use. Read the full article here.

Reported cases of adverse reactions to delta-8-THC products in West Virginia

The West Virginia Poison Center distributed an alert last week regarding several cases of adverse reactions to delta-8-THC products. In March 2021, two reported cases involved adults who mistook the delta-8-THC product for a product like CBD. Cases reported in neighboring states have also involved children requiring treatment after exposure. According to the alert, practitioners should watch for patients with "marijuana-like symptoms who do not report a marijuana exposure," and these individuals should be asked about their use of CBD or delta-8-THC products.


Retail alcohol and tobacco sales during COVID-19

A recently published article in the Annals of Internal Medicine examined how national household retail sales of alcohol and tobacco have changed during the COVID-19 pandemic. Data from the Nielsen National Consumer Panel, a longitudinal household cohort that collects information on retail and e-commerce purchases, were analyzed for the period of April 1 to June 30, 2020 and compared with April-to-June sales data from 2017 to 2019. Investigators found that total weighted sales in 2020 increased 34% for alcohol and 13% for tobacco compared with the same period in 2019. These purchases increased in all geographic and almost all demographic groups. Read the full study here.

A free mailed naloxone program in Philadelphia amidst the COVID-19 pandemic

In a new study published in the International Journal of Drug Policy, investigators examined barriers to naloxone access during the COVID-19 pandemic through data collected from participants who requested and received naloxone as part of a free mail-in program in Philadelphia. Results showed that the top three reported barriers to naloxone access were COVID quarantine restrictions (25%), lack of knowledge regarding access (13%), and cost (11%). The authors found that participants with personal proximity to overdose (62%) heard about the program more often through online web searches and less often through word of mouth. Read the full article here.


Federal Register: Notice of proposed placement of four specific fentanyl-related substances in Schedule I

The DEA proposed the placement of four fentanyl-related substances in Schedule I of the Controlled Substances Act due to their high potential for misuse and psychological and/or physical dependence. These substances include fentanyl carbamate, ortho-fluoroacryl fentanyl, ortho-fluoro isobutyryl fentanyl, and para-fluoro furanyl fentanyl. The temporary order is due to expire on May 6, 2021. Proceedings on the four substances to establish regulatory controls and sanctions for Schedule I controlled substances are underway. Read more from the Federal Register here.

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