National Drug Early Warning System (NDEWS) Weekly Briefing


Ambulance calls for substance-related issues before and after COVID-19

A retrospective analysis was recently conducted that examined 911 ambulance calls before and after the start of COVID-19 in Massachusetts. The average number of daily ambulance calls decreased by 20% after the statewide declaration of emergency. Similarly, calls for substance-related reasons decreased by 16%. However, despite an initial decrease, calls related to substance use began increasing by 0.7 calls per day, while calls for other reasons did not change. Refusal of transport for substance-related calls increased from 5% before COVID-19 to 7.5%. According to the authors, these results suggest that "COVID-19 is disproportionately affecting individuals with substance use disorder." Read the full article here.

Refusals after prehospital administration of naloxone during the COVID-19 pandemic

This recent retrospective cohort study investigated refusals of transport after naloxone administration in an emergency medical services (EMS) system. Prior to COVID-19, 15% of patients who received naloxone via emergency medical services refused transport. This percentage increased to 36% during COVID-19. Among those who did not receive naloxone, 30% were not transported prior to COVID-19, which increased to 41% during the pandemic. This EMS system experienced more than a two-fold increase in the rate of refusal after non-fatal opioid overdose following the COVID-19 outbreak. Read the full article here.


NPS Discovery identifies synthetic opioid AP-238

NPS Discovery announced the first identification of the novel synthetic opioid AP-238 this week in a sample from a postmortem case from Indiana (n=1) collected in August 2020. According to the recently published monograph, AP-238 is from the "cinnamylpiperazine sub-class," a class of opioids which are "structurally distinct from fentanyl and its analogs" but that have similarly been linked to adverse events and death. AP-238, the fourth analog in this series reported by NPS Discovery, is structurally similar to AP-237 (bucinnazine), which is an opioid used clinically outside of the US. Read the full report here.

NDEWS previously reported on AP-238 in Issue 5 of the Weekly Briefing after the NDEWS Web Monitoring Team discovered a spike in mentions of the substance through algorithmic monitoring of communities dedicated to drug discussion on the social media platform Reddit. Mentions of "AP-238" in the past 18 months across ~70 drug-oriented subreddit communities were quantified and aggregated by month to obtain a relative metric of discussion over time. This graph has been updated (see above) to reflect that discussion surrounding AP-238 has declined in the past six weeks after peaking in early fall months. 


Changes in delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in cannabis over time: systematic review and meta-analysis 

While cannabis products with high THC concentrations have been shown to have an increased risk of addiction and mental health disorders, CBD is also believed to moderate the effects of THC. A new study published in Addiction set out to systematically review the changes to THC and CBD concentrations over time. Using a multinational sample, the authors found that in herbal cannabis, THC concentration increased 0.29% yearly between 1970 and 2017. Cannabis resin THC concentration was found to have increased 0.57% a year between 1975 and 2017. There was no evidence of CBD concentration changing over time. Read the full article here. 


Montreal public health sounds alarm about counterfeit opioid pill after fatal overdose 

According to CBC, a Montreal resident has died after consuming a counterfeit pill sold as a 30 mg oxycodone tablet. Montreal public health officials say that the tablet, which had an "A/215" inscription, actually contained the synthetic opioid isotonitazene, which has a higher potency and risk for toxicity than fentanyl. Read the public advisory from DRSP here, which contains guidance for street drug users, clinicians, and care providers.

Isotonitazene was first identified in the US by NPS Discovery in November 2019, which prompted a public health alert. In quarter three of 2020, isotonitazene was the second-most commonly identified synthetic opioid in the US after brorphine.


NDEWS is currently recruiting for the following positions: 

•   NIDA T32 Postdoctoral Fellow (available immediately)

•   NIDA T32 Predoctoral Fellow (application due December 1)

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