National Drug Early Warning System (NDEWS) Weekly Briefing

ORIGINAL NDEWS CONTRIBUTIONS

The National Drug Early Warning System (NDEWS) reports the NDEWS Sentinel Sites with 911 calls above the threshold for selected events for the week of 8/26 to 9/2, 2021. For this week, we are reporting on opioid-involved overdoses and alcohol-related incidents; no methamphetamine alerts were triggered for this period. States with counties that had observed 911 calls that deviated from the expected range of values for the week included New York, Florida, Maine, and California for opioid overdose-related calls, and Illinois, California, and Florida for alcohol-related calls.

NDEWS Alerts is a dynamic notification system based on the degree to which 911 calls recorded in each county deviates from the expected range of values within a 87-day window, provided by biospacial, inc.

NDEWS also reports the top ten states with coverage in the biospatial, inc. platform for 911 alcohol-related calls for the month of August 2021 (New Mexico, Rhode Island, Colorado, Georgia, Montana, Wyoming, Alaska, Michigan, Maine, and Mississippi). Nearly a quarter (21%) of alcohol-related 911 calls were among 50- to 59-year-olds; 42% were among persons identified as white. New Mexico ranked first in August for alcohol-related 911 calls per 10k population (21.9), while Georgia had the highest count of alcohol-related calls (15,598).

RECENTLY PUBLISHED

Illicit benzodiazepines detected in patients evaluated in emergency departments for suspected opioid overdose in four states, October 6, 2020–March 9, 2021

In last week's issue of the Centers for Disease Control and Prevention (CDC)'s Morbidity and Mortality Weekly Report, a study from the Toxicology Investigators Consortium (ToxIC) Fentalog Study Group analyzed 141 biologic samples from adult patients evaluated in an emergency department in four states (Missouri, New York, Oregon, and Pennsylvania) following a suspected opioid overdose. Between October 6, 2020 and March 9, 2021, the presence of illicit benzodiazepines was identified in 21 (15%) patients, including most frequently clonazolam, etizolam, and flubromazolam. Read the full report here.

Results from a mobile drug checking program using three technologies in Chicago, IL, USA

A recent study published in Drug and Alcohol Dependence examined the feasibility of community-based drug checking services using three technologies. In 2019, a harm reduction program in Chicago, IL established a drug checking pilot in collaboration with state and city public health officials, which included five mobile outreach and one fixed location. Between March 2019 and August 2020, participants who visited and engaged in the drug checking services volunteered 422 total drug samples, the majority of which were sold as heroin (67%). Fentanyl detection in opioid samples ranged from 13% to 58% depending on the technology used, suggesting that multiple drug technologies may enhance the ability to identify fentanyl in local drug markets. Read the full study here.

NEW PSYCHOACTIVE SUBSTANCES (NPS)

NFLIS announcement of an emerging synthetic opioid: 2-naphthyl U-47700

A recent announcement from the DEA's National Forensic Laboratory Information System (NFLIS), in partnership with the Real-Time Communication Synth-Opioids Network (Synth-Opioids), details the first appearance of 2-naphthyl U-47700. Participants in the Synth-Opioids Network from the Ohio Bureau of Criminal Investigation shared information on the synthetic opioid's appearance in several case samples from Ohio in May 2021. The samples also contained tramadol, fentanyl, and heroin. Read the full announcement here.

New systematic naming for synthetic cannabinoid "MDA-19" and its related analogs: BZO-HEXOXIZID, 5F-BZO-POXIZID, and BZO-POXIZID

Scientists from Cayman Chemical and NPS Discovery have established a new and more relevant naming system for addressing the newly emergent "MDA-19" synthetic cannabinoids. Rather than applying naming conventions that use the initials of a researcher or organization and may be misleading, the authors developed a new naming convention for this emerging "OXIZID" generation of synthetic cannabinoids. "OXIZID" represents the core/liner region of the synthetic cannabinoid structure. Read the full report here.

Prevalence and concentrations of new designer stimulants, synthetic opioids, benzodiazepines, and hallucinogens in postmortem hair samples: a 13-year retrospective study

A recently published study reanalyzed over 1,200 postmortem hair samples collected in Germany from 2008 to 2020 to characterize the prevalence and concentration ranges of new psychoactive substances (NPS) using a validated liquid chromatography–tandem mass spectrometry method. NPS were detected in 32% of cases, many which tested positive for more than one NPS in the same time period. The most frequently detected classes of NPS were cathinones (47%), amphetamines (24%), and piperazines (11%). Read the full study here.

IN THE NEWS

FDA denies marketing applications for about 55,000 flavored e-cigarette products for failing to provide evidence that they appropriately protect public health

Electronic nicotine delivery systems (ENDS) products received the first marketing denial order from the US Food and Drug Administration (FDA). The FDA determined that the applications for about 55,000 flavored ENDS products from three applicants did not have sufficient supporting evidence for their benefit to adult smokers to overcome their impact on potential or actual youth use. Although the FDA has issued other negative actions for some applications, this is the first set of marketing denial orders for applications that have reached the substantive scientific review portion of premarket review. Read the news release here.

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