National Drug Early Warning System (NDEWS) Weekly Briefing


Substance use in the past 12 months: Gainesville, Florida April 9, 2022

The National Drug Early Warning System's (NDEWS) Rapid Street Reporting (RSR) team conducted rapid venue-intercept surveys in Gainesville, FL, on April 9th, 2022. Florida is one of the NDEWS Sentinel Sites with state-wide coverage, and Gainesville is home to the University of Florida and the NDEWS Coordinating Center. The RSR team conducted surveys in parks, nightlife areas (bars/clubs), malls (shopping areas), outdoor markets, grocery stores, and a housing shelter. Notable differences between the Gainesville, FL site visit and the Tampa, FL site visit include the following: Gainesville respondents reported use of DMT, poppers/nitrites, synthetic marijuana, Modafinil, and 1P-LSD, while Tampa respondents did not. Conversely, Tampa respondents reported NPS benzodiazepine use while Gainesville respondents did not.
View the report here.

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

Context: This alert follows warnings for nitazenes published by the Canadian Community Epidemiology Network on Drug Use (CCENDU) in March 2022 and the Ohio Bureau of Criminal Investigation (BCI) in April 2022. These warnings were reported on in our NDEWS Weekly Briefing, issues 77 and 82.

What was found? Mention trends for different nitazene NPS show evolution of the drug trend on Reddit since 2019. Trends for mentions of the general drug class "nitazenes" are compared against ten frequently mentioned nitazene drugs. Metonitazene was the most frequently discussed nitazene on Reddit from Fall 2020 to Fall 2021. Metonitazene was also most prevalent in the Ohio BCI's April 2022 report on nitazene prevalence in Ohio laboratory tests.

What are nitazenes? Nitazenes are benzimidazole opioids. First discovered in the 1950s, a group of nitazene NPS have been sold online in recent years. CCENDU warns that nitazenes are often used unintentionally due to being incorrectly marketed.

How are nitazenes being discussed? Early interest in etonitazene and isotonitazene in late 2019 was replaced by a second wave of substances in 2020-2021. During this 2nd period, metonitazene reached new levels of interest, while substances like butonitazene and etodesnitazene experienced only brief trends before falling to obscurity. In a third, Fall 2021 discussion pattern, the metonitazene trend is declining and discussion of "nitazenes" as a drug class has grown. This may be influenced by feedback from news reporting in 2021.

Drug Terms: Nitazenes, isotonitazene, metonitazene, etonitazene, butonitazene, protonitazene, clonitazene, flunitazene, isotodesnitazene, metodesnitazene, etodesnitazene.


NPS Discovery: Announcement of newly identified novel psychoactive substance CH-PIATA in the US

Last week, NPS Discovery announced the identification of a novel psychoactive substance, CH-PIATA. The new substance is classified as a synthetic cannabinoid, and the “ATA” represents the linker region of the synthetic cannabinoid structure. Prior generations of synthetic cannabinoids have been reported to cause psychoactive effects similar to delta-9 THC. The authors note after a synthetic cannabinoid class-wide ban implemented by China in July 2021, an emergence of new synthetic cannabinoid subclasses has seemingly replaced those among the recreation drug supply nationally and internationally. Read the full report here.


Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin

A study published in Drug and Alcohol Dependence examined whether a hypothetical reduced efficacy of naloxone in reversing fentanyl is a major contributor to the rising overdose mortality. The authors estimated that, absent naloxone, the annual overdose death rate would be 1.0% for heroin and 4.1% for fentanyl. With naloxone reaching 80% of those at risk, the overdose death rate was 0.7% and 3.6% for heroin and fentanyl, respectively, representing reductions of 26.4% and 12.0%. The authors note heightened risk for overdose and subsequent death, alongside the time sensitive need for naloxone administration, fully account for increased mortality when fentanyl replaces heroin. Read the study here.

CDC’s new nonfatal overdose data visualization dashboard

Last week, the CDC announced the release of a new overdose data visualization dashboard. This dashboard will display current nonfatal overdose data from the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) system, which captures electronic health record information in syndromic surveillance data systems. Data can be used to compare monthly and annual trends in nonfatal drug overdose-related emergency department visits by drug type (i.e., all drugs, all opioids, heroin, and all stimulants), state, sex, and age group. View the dashboard here.


FDA issues warning letters to companies illegally selling CBD and delta-8 THC products

Earlier this week, the FDA issued warning letters to five companies for selling products labeled as containing delta-8 THC in ways that violate the Federal Food, Drug, and Cosmetic Act. This is the first time the FDA has issued warning letters for products containing delta-8 THC. In addition to the violations related to products containing delta-8 THC, several warning letters outlined violations related to marketing CBD products claiming to treat medical conditions in humans and animals, promoting CBD products as dietary supplements, and adding CBD to human and animal foods. View the bulletin here.

FDA proposes rules prohibiting menthol cigarettes and flavored cigars to prevent youth initiation, and significantly reduce tobacco-related disease and death

Last week, the FDA announced proposed product standards to prohibit menthol as a characterizing flavor in cigarettes and prohibit all characterizing flavors (other than tobacco) in cigars. The proposed rules aim to reduce disease and death from combusted tobacco product use, and advance health equity by reducing tobacco-related health disparities. If finalized and implemented, FDA enforcement will only address manufacturers, distributors, wholesalers, importers and retailers who manufacture, distribute, or sell such products within the US that are not in compliance with applicable requirements. These proposed regulations do not include a prohibition on individual consumer possession or use. Beginning May 4, 2022, the public can provide comments on these proposed rules. View the bulletin here

Protonitazene kills 3 people in Upstate South Carolina

A coroner in Oconee County, SC issued a warning last week for the western Carolinas and northeastern Georgia after protonitazene was found in the region in February. The synthetic opioid was partially responsible for three deaths in the region between February 12 and 14. Read the article here.

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