National Drug Early Warning System (NDEWS) Weekly Briefing


Seeking information on Dipyanone

According to the NDEWS Web Monitoring Team, led by Dr. Elan Barenholtz and PhD candidate Paul Morris of the Machine Perception and Cognitive Robotics (MPCR) Lab at Florida Atlantic University, a new opioid research chemical, Dipyanone, has emerged in online discussion on Reddit. Comments and vendor listings claim similarity to Z, which is an opioid and Schedule I controlled substance. Algorithmic monitoring of ~80 drug-oriented subreddits has revealed an upward trend of Dipyanone discussions through March and early April 2021. Comments refer to its availability from online marketplaces. Have you heard anything about Dipyanone? Let us know here.



A review of levamisole—a toxic adulterant in illegal drug preparations. 

A recent study published in Therapeutic Drug Monitoring reviewed the role of levamisole as a toxic adulterant. Levamisole is an antiparasitic drug used in veterinary applications and has been found in up to 79% of the street supply of cocaine. Levamisole is not currently in routine drug testing panels. NDEWS Scientific Advisory Group Member Barry Logan and team conclude that the medical and forensic community should be aware of the potential effects and the prevalence of the drug in the illegal drug market. Read the full review here.


How many naloxone prescriptions are filled following emergency department encounters for opioid use disorder, overdose, or withdrawal?

The American Journal of Emergency Medicine published an article this week examining naloxone prescriptions using insurance claims data. Investigators found that of the claims for 21,700 opioid-related emergency department (ED) visits, only 1.1% of those patients filled a prescription for naloxone within thirty days. The authors concluded that clinical and policy interventions should expand distribution of naloxone in the ED setting. Read the full study here.

New NCHS Data Brief shows co-involvement of opioids with drug overdoses and cocaine and psychostimulants.

The CDC’s National Center for Health Statistics published a new Data Brief this week concerning overdose deaths and concurrent involvement with opioids. Researchers found that in 2019, 76% of overdose deaths involving cocaine also involved an opioid, and 54% of overdose deaths involving psychostimulants also involved an opioid. Read the full Data Brief here.



From NPS Discovery: 2021 Quarter 1 Trend Reports for synthetic cannabinoids, NPS stimulants and hallucinogens, NPS opioids, and NPS benzodiazepines

NPS Discovery released its 2021 Q1 Trend Reports yesterday. An increasing number of emergency room admissions, death investigations, and intoxication events have been involved synthetic cannabinoids, NPS stimulants, hallucinogens, and opioids in Q1 of 2021. The top NPS identified by class were etizolam (benzodiazepines), metonitazene (opioids), eutylone (stimulants and hallucinogens), and MDMB-4en-PINACA (synthetic cannabinoids). Read the full trend reports here.

Report on opioid overdoses from the Toxicology Investigators Consortium (ToxIC) Fentalog Study Group 

NPS Discovery and collaborators published a new report on opioid overdoses across the United States this week. A partnership between the American College of Medical Toxicology (ACMT) and the Center for Forensic Science Research and Education (CFSRE) was established to comprehensively assess the role and prevalence of synthetic opioids and other drugs. The study was comprised of four different regions (Bethlehem, PA, New York, NY, Portland, OR, and St. Louis, MO). Although geographical differences were noted in terms of opioids and NPS, fentanyl was the most common opioid found. Combined opioid and stimulant use was also common throughout all regions. Read the study here.



New HIDTA Bulletin: Gel capsules containing a combination of fentanyl, cocaine, and xylazine combination tied to aggressive behavior 

The Washington/Baltimore High Intensity Drug Trafficking Area (HIDTA) released an alert this week for a new drug combination called “wipeout” surfacing in the Baltimore region. The Carroll County Heroin Coordinator and local law enforcement identified gel capsules containing a combination of fentanyl, cocaine, and xylazine. Two overdoses involving this drug combination resulted in “aggressive and erratic behavior.” Read more about HIDTA here.

Overdose deaths may have topped 90,000 in 2020, according to CDC estimates.

The Washington Post published an article this week with provisional data from the CDC on overdose deaths in 2020. Researchers estimate total overdose deaths in 2020 may have exceeded 90,000 — up from 70,630 in 2019. This increase would be the largest jump in two decades. The article also highlights differences between the previous US administration and the 11-page paper released last week by the Biden-Harris Administration. Notably, harm reduction is a new priority. Read the full article here.

Announcement from CDC and SAMHSA: Federal grantees may now use funds to purchase fentanyl test strips 

The CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) released an announcement this week that federal funding may now be used to purchase rapid fentanyl test strips (FTS). The announcement notes that approximately 88,000 drug overdose deaths occurred in the United States in the 12 months ending in August 2020, according to provisional data from CDC, and that overdose deaths have continued to accelerate during COVID-19. Read the announcement here.

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