National Drug Early Warning System (NDEWS) Weekly Briefing


Substance use in the past 12 months, Denver, CO

The National Drug Early Warning System (NDEWS) Rapid Street Reporting (RSR) team visited Denver, CO on October 21–23, 2022. The RSR team conducted surveys (N=215) in public spaces, including parks, nightlife, town squares, malls, sidewalks, stadiums, grocery stores, and transportation stations. Read the report here. Read more about the RSR project here.

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

Context: This alert follows NDEWS Briefing Issue 33 (April 2021), which identified an increase in online mentions of Desmetramadol in 2020/2021.

What was found? Subreddit mention counts for Desmetramadol have continued to rise steadily from 2020 through 2022. Total mention and unique commenter mention counts reached their highest peak in November 2022.

What is Desmetramadol? Desmetramadol is an opioid drug and the active metabolite of Tramadol. Since 2020, it has frequently been discussed online as a research chemical.

How is Desmetramadol being discussed? Desmetramadol is most commonly referred to on Reddit as ODSMT and O-DSMT. Desmetramadol is mentioned in drug Subreddits that discuss both opioids and benzodiazepines.

Drug Terms: Desmetramadol, O-DSMT, ODSMT, DSMT.


Validation of a lateral flow chromatographic immunoassay for the detection of fentanyl in drug samples

A recently published study in Drug and Alcohol Dependence examined the validity of a commonly used fentanyl test strip (FTS) assay in detecting fentanyl and its related analogs. The FTS assay detected fentanyl at 200 ng/ml in water, and 13 additional fentanyl analogs, but failed to detect carfentanil and furanyl fentanyl at or below 1000 ng/ml. Overall sensitivity and specificity for detecting fentanyls were 98.5% and 89.2%, respectively. The authors noted that FTS is a valid drug checking tool, but rapid immunoassays and other drug checking instruments that can detect a wider range of fentanyl analogs should be prioritized. Read the report here. 

Drug checking services as a surveillance tool for clinical laboratories: Examining trends in the unregulated fentanyl supply

In a study recently published in Clinical Biochemistry, investigators sought to determine whether information collected through Toronto's Drug Checking Services (DCS) and cross-provincial urine drug testing (UDT) data can be used as a surveillance tool for clinical laboratories. Similar trends were observed between the percent co-positivity of fentanyl with etizolam, flualprazolam, flubromazolam, carfentanil, and acetylfentanyl in both Ontario UDT and Toronto's DCS drugs/used paraphernalia. Regional differences were noted in co-positivity of etizolam and fentanyl analogs between Ontario and British Columbia. Read the report here.

Comparing projected fatal overdose outcomes and costs of strategies to expand community-based distribution of naloxone in Rhode Island

A recently published article in JAMA Network Open described a spatial microsimulation model developed to compare various strategies to increase naloxone distribution through community-based programs in Rhode Island. The strategy focusing on the distribution of naloxone according to geographic need to people who inject drugs resulted in the best outcomes at the lowest cost, and the authors suggest that future efforts should be prioritized for people at highest risk for overdose and redirected towards areas with the greatest need. Read the article here.

Massive intoxication due to cocaine adulterated with carfentanil

A recently published study aimed to identify the cause of a "massive intoxication" which led to 98 hospitalizations and 24 deaths in Buenos Aires in February of 2022. All of those treated reported using cocaine obtained from the same dealer. Analysis of the seized powder samples showed the powder was 51.6% pure cocaine, cut with sorbitol, and small amounts of other drugs, including carfentanil. Carfentanil was confirmed by MRM analysis and in an amount of approximately 30 μg/100 mg of pure cocaine. Read the report here.


FDA announces preliminary assessment that certain naloxone products have the potential to be safe and effective for over-the-counter use

The FDA has announced they are taking steps towards providing naloxone for over-the-counter use. The FDA published a notice earlier this week that low-dosage nasal, autoinjector, and subcutaneous naloxone drug products may be approvable for nonprescription use. This preliminary assessment is intended to aid in the development and approval of nonprescription naloxone products; however ,it is not a final determination. To make a final determination, the FDA will need product-specific data, including packaging and labeling. Read the release here.

US takes down European websites blamed for selling fentanyl

VICE World News recently published an article reporting on the targeting of British- and Dutch-owned websites accused of supplying fentanyl to US consumers. The websites were said to have sold fentanyl analogs, LSD analogs, and other illegal drugs, with site users paying through bank transfers or virtual currency. Read the article here.

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