National Drug Early Warning System (NDEWS) Weekly Briefing


Alert from the NDEWS Web Monitoring team: Recent growth in online mentions of metonitazene

What was found? A trend in discussion surrounding the drug Metonitazene peaked in Fall 2020, with a more recent trend of consistent mentions in 2021. The Fall 2020 discussion trend preceded an outbreak of the drug in toxicology reports and its temporary classification as a Schedule I controlled substance.
To what does Metonitazene refer? Metonitazene is an analgesic and derivative of etonitazene. (See below for two stories involving etonitazene.)
How is it being discussed? Commenters mention the drug's use as a potent opioid.
Drug Terms: Metonitazene

Methodological Note: Data was collected and analyzed by 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. Metrics 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.



NPS Discovery Public Alerts: Etodesnitazene — new synthetic opioid identified during forensic death investigations in the US and Canada and protonitazene increasing in prevalence across the US and Canada.

NPS Discovery published two public alerts about new synthetic opioids etodesnitazene and protonitazene. Etodesnitazene was identified during forensic death investigations in the US and Canada, and protonitazene is increasing in prevalence as "nitazenes" gain traction across the US and Canada. This story compliments our original contribution above. Read the full report here.


Drug Enforcement Administration Toxicology Testing Program Quarter 3 Report

The Drug Enforcement Administration's Toxicology Testing Program released their Quarter 3 Report this week. This publication presents the results of cases analyzed and completed by the Clinical Toxicology and Environmental Biomonitoring laboratory at the University of California at San Francisco from July 1, 2021 through September 20, 2021. Read the full report here.

Focus on prevention: The public is more supportive of "overdose prevention sites" than they are of "safe injection facilities"

In a study published last week in Criminology & Public Policy, a national survey examined Americans' national and local-level support for facilities that provide a safer space for individuals to use drugs under the supervision of medical professionals. Support for these facilities at both the national and local levels was dramatically higher when they were called "overdose prevention sites", rather than "safe injection sites". Framing the effects of these facilities using either a crime control or a public health frame did not significantly change support levels compared to not providing any information. Read the full study here.

Trends in and characteristics of drug overdose deaths involving illicitly manufactured fentanyls, US 2019 — 2020

A study published in this week's MMWR examined trends in drug overdose deaths involving illicitly manufactured fentanyl in the US from 2019 to 2020. The report showed that during 2019 to 2020, illicitly manufactured fentanyl-involved (IMF) overdose deaths increased sharply in midwestern, southern, and western jurisdictions. During 2020, approximately 40% of IMF- involved deaths also involved stimulants, and 56% of decedents had no pulse when first responders arrived. Injection drug use was reported in 25% of deaths, and non-injection routes of drug use in 27% of deaths. Read the full report here.


Percentage of adolescents reporting drug use decreased significantly in 2021 as the COVID-19 pandemic endured

The National Institute on Drug Abuse published their Monitoring the Future survey in a news release yesterday. The survey found a significant decrease in substance use in 2021. These findings represent the largest one-year decrease in overall illicit drug use reported since the survey began in 1975. Nora Volkow, M.D., NIDA director, said "we have never seen such dramatic decreases in drug use among teens in just a one-year period. These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents", "moving forward, it will be crucial to identify the pivotal elements of this past year that contributed to decreased drug use - whether related to drug availability, family involvement, differences in peer pressure, or other factors - and harness them to inform future prevention efforts." Read the full news release here.


Florida Poison Control: 40 hospitalized for severe bleeding after taking 'spice' in Hillsborough County

Florida Poison Control has issued a warning after patients in Hillsborough County began uncontrollably bleeding after they used the drug, aka "spice." Patients presented with significant clinical effects like blood in their urine, spontaneous bleeding from their nose, and easy bruising. Read the full article here.

SAMHSA announces unprecedented $30 million harm reduction grant funding opportunity to help address the nation's substance use and overdose epidemic

In a press release published last week, SAMHSA announced they are now accepting applications for their first-ever SAMHSA Harm Reduction grant program. This funding authorized by the American Rescue Plan, will help increase access to a range of community harm reduction services and support harm reduction service providers as they work to prevent overdose deaths and reduce health risks associated with drug use. Read the full press release here.

E-cigarettes may be independently linked to erectile dysfunction, new research finds

A study published in the American Journal of Preventative Medicine, reported on data from Wave 4 (2020) of the Population Assessment of Tobacco and Health study. Males 20 years of age or older who reported erectile dysfunction were included; the percentage of erectile dysfunction varied from 20.7% to 10.2%. The estimated prevalence of current ENDS (Electronic Nicotine Delivery Devices) use within the full and restricted samples was 4.8% and 5.6%, with 2.1% and 2.5%, respectively, reporting daily use. The authors note that the use of ENDS seemed to be associated with erectile dysfunction, independent of age, cardiovascular disease, and other risk factors. Read the full study here.

Schedules of controlled substances: Temporary placement of butonitazene, etodesnitazene, metodesnitazene, metonitazene, N-pyrrolidino etonitazene, and protonitazene in Schedule I

Last week, the Drug Enforcement Administration issued a notice of intent to publish a temporary order to schedule seven synthetic benzimidazole-opioid substances. Read the full announcement here.

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