National Drug Early Warning System (NDEWS) Weekly Briefing


Notes from the Field: Overdose deaths involving eutylone (psychoactive bath salts) — US, 2020 

This week's MMWR, in collaboration with CDC scientist and NDEWS Co-Investigator Dr. Bruce Goldberger, describes overdose deaths involving  eutylone. During 2020, 343 eutylone-involved deaths were reported by 22 of the 44 State Unintentional Drug Overdose Reporting System jurisdictions. Of those deaths, 259 were concentrated in two southern states: Florida and Maryland. Eutylone-involved deaths commonly co-involved illicitly manufactured fentanyl, and cocaine or methamphetamine. One in 10 eutylone-involved deaths in this report had evidence of current or past MDMA use but no toxicology findings of MDMA. The authors note risk for unintentional eutylone exposure might be mitigated by 1) increasing knowledge about synthetic cathinones, including eutylone, among persons using MDMA and other drugs with eutylone, 2) supporting rapid dissemination of results from enhanced toxicology testing of illicit drug products, including those sold as MDMA, and 3) broadly increasing availability and access to harm reduction strategies. Read the full report here.

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

What was found? An online discussion trend for fluorexetamine beginning in Summer/Fall 2022 has grown from dozens to hundreds of mentions per month in Summer 2022.

What is Fluorexetamine? Fluorexetamine is a dissociative NPS of the arylcyclohexylamine family.

How is Fluorexetamine being discussed? Fluorexetamine is abbreviated as FXE on Reddit. Recent FXE mentions discuss the drug's growing popularity as an alternative to ketamine. FXE is frequently co-mentioned with ketamine.

Drug Terms: Fluorexetamine, FXE.


Development and validation of machine models using natural language processing to classify substances involved in overdose deaths

A study recently published in JAMA Network Open compared different natural language processing and machine learning algorithms to identify substances related to overdose deaths in medical examiner data. The machine learning models showed perfect or near perfect performance in classifying deaths related to any opioids, heroin, fentanyl, prescription opioids, methamphetamine, cocaine, and alcohol. Classification of benzodiazepines was suboptimal. The authors note these algorithms can be integrated into workflows to decrease lag time in reporting overdose surveillance data. Read the full study here.

Geographic trends in opioid overdoses in the US from 1999 to 2020

A study published in JAMA Network Open examined trends in opioid-involved overdose death (OODs) rates in urban and rural US counties during the four waves proposed by NDEWS Scientific Advisory Group member Dr. Daniel Ciccarone. Wave 1 was prompted by doctors overprescribing opioid pain killers, wave 2 involved heroin, wave 3 involved illicit synthetic opioids, and wave 4 was complicated by the addition of stimulants and the COVID-19 pandemic. Counties of every urbanicity type experienced statistically significant heterogeneous annual OOD rate growth. Differences in OOD rates by urbanicity were largest at the start and end of the study period. In waves 1 and 4, OOD rates were higher in the most urban counties, but acceleration rates were higher in the most rural counties. Restrictions on synthetic and semisynthetic opioids are associated with increased heroin use, which contributed to wave 2. Read the full study here.

Legal responses to novel psychoactive substances implemented by 10 European countries: an analysis from legal epidemiology

A study published in Emerging Trends in Drugs, Addictions, and Health assessed the effectiveness of novel psychoactive substance (NPS) legal measures in preventing NPS use, as well as NPS-related intoxications and deaths. A comparative analysis of legal instruments adopted at national level as a response to NPS by 10 European countries between 2008 and 2019 was conducted. Results showed that implemented measures particularly individual listing – may be relatively effective in preventing NPS use, in the short term. However, purity and potency of substances may have indirect negative impact on users’ health. The authors also note that an increase in NPS-related poisoning episodes and deaths has been observed in most of the countries that have introduced control measures, regardless of the regulatory model applied. Read the full study here.

Synthetic cannabinoid poisonings and access to the legal cannabis market: findings from US national poison center data 2016–2019

A study published in Clinical Toxicology investigated trends in synthetic cannabinoid exposures reported to US poison control centers and their association with status of state cannabis legalization. A total of 7,600 synthetic cannabinoid exposures were reported during the study period which declined over time. Most reported exposures required medical attention, and 61 deaths were documented. Adoption of permissive cannabis law was associated with significant reductions in reported synthetic cannabinoid exposures. Read the full study here.


It's about to get easier to access affordable naloxone

The newly created nonprofit Remedy Alliance is expected to distribute mass amounts of naloxone to small community groups across the US. Researchers have found that there is no state with enough naloxone to meet demand. With their online website, Remedy Alliance has become a resource for harm reduction organizations nationwide to purchase naloxone. Formerly a buyer's network club, they distributed 1.3 million doses of naloxone in a year. Now, in the form of a nonprofit, they project a total of 1.8 million to 2 million doses in the next 12 months. Read the full article here.

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