National Drug Early Warning System (NDEWS) Weekly Briefing


2021 Q4 Report: Methamphetamine-related 911 EMS responses per 10k population, October 2021 – December 2021

In Quarter 4 (Q4) 2021, 24,803 methamphetamine-related 911 responses were recorded by for NDEWS Sentinel Sites. Of those 911 responses, a majority of persons were white (51%), and male (68%). Within our Sentinel Site Network, Colorado had the highest rate of responses with 6.17 responses per 10k residents (3,512 total responses), followed by Kentucky with 3.13 per 10k residents (1,400 total responses) and California with 2.70 responses per 10k (10,681 total responses). Click the image above or view the full report here.

Alert from the NDEWS Web Monitoring Team: Online mentions of flubrotizolam

What was found? A second trend of discussion for the drug Flubrotizolam has emerged on Reddit in 2022, following the drug's first trend in Summer 2021.

To what does Flubrotizolam refer? Flubrotizolam is a designer benzodiazepine-derivative drug with sedative effects.

How is it being discussed? Word cloud analysis reveals Flubrotizolam is frequently co-mentioned with benzodiazepine-derivative drugs. The drug is commonly referred to by the slang term "Fanax", referring to its marketing as an imitation of Xanax in the bar pill shape. "Fanax" can refer to Flubrotizolam, Flubromazolam, or a number of similar drugs.

Drug Terms: Flubrotizolam, Fanax.

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

New Substances Survey

Is flubrotizolam (fanax) being used in your area?

Tell NDEWS what you have heard about flubrotizolam use in your area. Click here.


Characteristics of fatal ‘novel’ synthetic opioid toxicity in Australia 

A study published in Drug and Alcohol Dependence reviewed all reported fatal poisonings related to novel synthetic opioids (NSOs) in Australia from 20002021 using the National Coronial Information System. Thirty-one cases were identified, of which 96.8% were due to unintentional drug toxicity. The mean age of decedents was 31.9 years and 87.1% were male. Ten NSOs were identified, and fentanyl analogs were present in 67.2% cases, most commonly furanylfentanyl. Read the full study here.


HIV outbreak during the COVID-19 pandemic among persons who inject drugs – Kanawha County, West Virginia, 2019–2021

This week's MMWR includes a Notes from the Field report regarding an HIV outbreak investigation in Kanawah County, West Virginia. Researchers conducted qualitative interviews with persons who inject drugs (PWID) and community partners and abstracted medical records for health care encounters beginning one year before HIV diagnosis through June 18, 2021. As of October, 27, 2021, 85 people met the HIV outbreak case definition. Data from interviews and medical records showed that the most frequently injected drugs were methamphetamines and heroin, with the majority of patients (88%) engaging in polysubstance use. According to the report, a common reason reported by PWID for reusing or sharing syringes was due to challenges in accessing sterile syringes after syringe services programs closures. Read the full report here

National Center for Health Statistics: Drug overdose deaths in the United States, 1999 – 2020

The Centers for Disease Control and Prevention published a recent National Center for Health Statistics Data Brief on drug overdose deaths in the United States from 19992020. The data from the National Vital Statistics System showed that the age-adjusted rate of drug overdose deaths increased 31% from 2019 to 2020. Among adults aged 35 to 44, drug overdose deaths increased 33% from 2019 to 2020. Rates also increased from 2019 to 2020 for all race and Hispanic-origin groups. The rate of drug overdose deaths involving synthetic opioids other than methadone (such as fentanyl) increased 56%, from 11 per 100,000 standard population in 2019 to 17.8 in 2020. Read the full report here.

Acceleration of opioid-related EMS runs in the spring of 2020: The National Emergency Medical Services Information System data for 2018-2020 

In a study published in Drug and Alcohol Dependence, a temporal analysis was conducted from 20182020 using data from the National Emergency Medical Services Information System (NEMSIS). Results showed that in 2020, opioid-related runs increased in JanuaryJune, with a pronounced acceleration in March. In both 2018 and 2019, opioid-related runs increased in JanuaryAugust without the spring acceleration. The authors concluded that, the acceleration of opioid-related EMS runs during the stay-at-home period of 2020 suggests that EMS data may serve as an early warning system for local health jurisdictions to deploy harm reduction/prevention resources. Read the full report here.

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