National Drug Early Warning System (NDEWS) Weekly Briefing


Alert from NDEWS Web Monitoring Team: Increase in online discussions of 3-fluorodeschloroketamine (3F-DCK)

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 recent trend in online discussions of the drug 3-fluorodeschloroketamine (3F-DCK, FXM) has emerged on Reddit. 3F-DCK is a dissociative drug and an analog of 2-fluorodeschloroketamine (2-FDCK). Mentions of 3F-DCK on drug subreddits first appeared in August 2021, and the trend in monthly first-time mentions by unique commenters has increased in September. This recent online trend may signal emerging real-world interest in 3F-DCK and other dissociative drugs.

Methodological note: Data are based on word counts derived from algorithmic monitoring of ~80 drug-oriented Subreddits. No personally identifiable or post-specific information is incorporated in this monitoring process. For more methodological details, see our recent publication.

Have you heard of 3F-DCK in your area? Let us know here.

NDEWS Alert: Above-threshold rates of substance-related 911 calls for Sentinel Site counties, 9/3/21–9/9/21

Counties in several NDEWS Sentinel Sites saw above-threshold rates of 911 calls involving opioid overdoses, alcohol-related incidents, and methamphetamine-related incidents over the last week, based on real-time 911 dispatch data from biospatial, inc. States with counties that had observed 911 calls with unexpected increases for the week included Florida for opioid overdose-related calls, Illinois, Colorado, New York, and Florida for alcohol-related calls, and Florida and Georgia for methamphetamine-related calls.

NDEWS Alerts involve a dynamic notification system that calculates a score to quantify the degree to which observed counts of 911 calls deviate from the expected range of values. These alerts are provided by the anomalous alert system from biospatial. More information and past alerts can be found here.


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

A new report was released last week from the ToxIC Fentalog Study Group, a partnership between the American College of Medical Toxicology (ACMT) and the Center for Forensic Science Research and Education (CFSRE) which was established to assess the role and prevalence of synthetic opioids and other drugs involved in suspected overdose events in the US. Residual biological samples from patients presented to emergency departments experiencing a suspected opioid overdose were obtained for testing. In the third quarter of 2021, NPS were detected from all five major subclasses, with fentanyl remaining the most commonly detected opioid nationally. Geographical differences were seen for opioids and combined drug use, with findings highlighted for several cities. Read the full report here.

UNODC: Counterfeit Xanax contains NPS flualprazolam and flubromazolam

The United Nations Office on Drugs and Crime (UNDOC) advises that several drug-testing agencies in Austria, Switzerland, the United Kingdom, and New Zealand have reported on seizures of counterfeit Xanax containing the NPS benzodiazepines flualprazolam or flubromazolam in 2020 and 2021. Flualprazolam and flubromazolam are triazolo-benzodiazepines, similar to alprazolam, with high potency and capacity to produce central nervous system depression. Flubromazolam was reported to the UNODC Early Warning Advisory on NPS for the first time in 2015, while flualprazolam was reported for the first time in 2017. Read the full announcement here.


Transition from injecting opioids to smoking fentanyl found in San Francisco, California

A new study published in Drug and Alcohol Dependence assessed changes in opioid injection frequency and smoking fentanyl in a cohort of people in San Francisco who inject drugs. Between 2018 and 2020, researchers found a shift from injecting tar heroin to smoking fentanyl. Qualitative interviews with participants showed that their motivation for switching from injecting tar heroin to smoking fentanyl was related to their difficulties finding easily accessible veins. Read the full study here

Mobile telemedicine for buprenorphine treatment in rural populations with opioid use disorder

In a recent article published in JAMA Network Open, researchers evaluated the use of a telemedicine mobile treatment unit to improve access to medications for opioid use disorder for individuals living in a rural area. From February 2019 to June 2020, patients received buprenorphine prescriptions after an initial teleconsultation and virtual follow-ups with study physicians via the modified recreational vehicle, which was equipped with medical, videoconferencing, and data collection devices. Results showed that, comparable to office-based telemedicine programs, 59% of patients who were treated in the mobile telemedicine treatment unit remained in treatment at 90 days, and longer retention was associated with reduced opioid use. Read the full study here.

Toxicological and pharmacologic sex differences in unintentional or undetermined opioid overdose deaths

In a study recently published in Drug and Alcohol Dependence, researchers retrospectively reviewed accidental or undetermined opioid-involved overdose deaths in Rhode Island from 2016 to 2019 to examine sex differences in toxicological and pharmacologic results. Of the 766 identified cases, 74% involved men. Results showed that, compared to men, women were more likely to have higher benzodiazepine, antipsychotic, and antidepressant exposure, whereas men were more likely to have alcohol and fentanyl exposure. Records showed that women were also more likely to have been prescribed a benzodiazepine or opioid in the 30 days prior to death. Read the full study here.


Opioid-related deaths before and after COVID-19 stay-at-home orders in Los Angeles County

A retrospective cohort study used data from the Los Angeles (LA) County Medical Examiner-Coroner to compare the number of opioid-related deaths in 2019 and 2020 in order to examine the impact of COVID-19 stay-at-home orders. Researchers found an "alarming rise" in opioid-related deaths in LA County following the onset of COVID-19 and related policies in 2020, which occurred most often among Non-Hispanic Caucasian individuals. Read the full study here.


Biden-Harris administration provides recommendations to Congress on reducing illicit fentanyl-related substances

The Biden-Harris administration has published their recommendations to Congress on reducing illicit fentanyl-related substances, which were the leading cause of overdose deaths in 2020. The proposal, which was developed in partnership with the Office of National Drug Control Policy, the Department of Health and Human Services, and the Department of Justice, includes a recommendation to permanently place identified illicit fentanyl-related substances into Schedule I of the Controlled Substances Act. Read the full press release here.

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