National Drug Early Warning System (NDEWS) Weekly Briefing


Emergency department-administered high-dose buprenorphine may enhance opioid use disorder treatment outcomes

The National Institute on Drug Abuse (NIDA) issued a press release this week regarding initiating high-dose buprenorphine (12mg or more) in emergency departments. Buprenorphine is an opioid partial agonist and used in medication assisted treatment for opioid use disorder. Read the full release here.

The recommendation is based on a new study published in JAMA Network Open this week examined 579 cases of high-dose buprenorphine use and documented no episodes of respiratory depression. Results also showed that the practice of administering high doses in the emergency department improves engagement in continued treatment and is cost-effective. Read the full study here

CDC provisional drug overdose rates

The Centers for Disease Control and Prevention (CDC) reported that more than 93,000 people died of a drug overdose in the US in 2020, representing a record number and a nearly 30% increase from 2019. Ten states are predicted to have at least a 40% rise in drug overdose deaths: Vermont, Kentucky, South Carolina, West Virginia, Louisiana, California, Tennessee, Nebraska, Arkansas, and Virginia. Read the report here.

Biden picks former West Virginia health official as nation’s drug czar

President Biden nominated Dr. Rahul Gupta to be the Director of the Office of National Drug Control Policy (ONDCP). Gupta previously served as West Virginia’s health commissioner and worked to combat the state’s opioid epidemic in 2018. Read The Washington Post article on the nomination here.


NPS Discovery 2021 Q2 trend reports

NPS Discovery released their most recent trend reports this week​, which provide updated information regarding NPS prevalence and positivity based on analysis of forensic casework samples. ​In Q2 of 2021, etizolam was the most frequently identified benzodiazepine, flurofentanyl was the most ​frequently identified synthetic opioid, eutylone was the most frequently identified stimulant, and MDMB-4en-PINACA was the most ​frequently identified synthetic cannabinoid. The organization issued a public health alert for ​synthetic opioid N-Pyrrolidino etonitazene ​in June 2021. Read all the trend reports here.

Seizures of new psychoactive substances in Italy during the COVID-19 pandemic

A new study published in Forensic Science International examined seizure data in Italy. NPS were identified in 92.6% of the samples. The most prevalent compounds were synthetic cathinones, with 3-MMC representing nearly a fifth (18.6%) of the total cases. Other prevalent NPS were 5F-MDMB-PICA, 2-FDCK, 1cp-LSD and 1P-LSD. Read the full study here.

The rise and fall of isotonitazene and brorphine

A new review published in the Journal of Analytical Toxicology summarized the key events in the emergence, rise, and subsequent decline of two non-fentanyl opioids - isotonitazene and brorphine. By evaluating these characteristics, public health officials can better adapt to a post-fentanyl synthetic market. Read the review here.

Strategic decision-making by a forensic toxicology laboratory in response to an emerging NPS

Another study in the Journal of Analytical Toxicology this week examined how The Centre of Forensic Sciences Detection in Ontario was able to interpret and monitor carfentanil in death investigations from July 2017 to June 2018. Multi-target liquid chromatography–tandem mass spectrometry (LC–MS-MS) quantitative methods were adapted for carfentanil and 156 death cases were classified as either mixed drug toxicity or carfentanil overdose. Read the full study here.


Use of medication for treatment of opioid use disorder among US Medicaid enrollees in 11 states, 2014-2018

A new study in JAMA used data from over 1 million Medicaid enrollees in 11 states to examine the prevalence of medication treatment for opioid use disorder (MOUD). Researchers found that MOUD increased from 47.8% of individuals with OUD in 2014 to 57.1% in 2018. Read the full study here.

Treatment outcomes among Black adults receiving medication for opioid use disorder

A paper was published in The Journal of Racial and Ethnic Health Disparities this week examining opioid use disorder (OUD) treatment for Black adults. Researchers found that when provided access to medication for OUD treatment with buprenorphine, Black adults with OUD demonstrated positive outcomes. Read the full study here.

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