National Drug Early Warning System (NDEWS) Weekly Briefing


Analysis of drug test results before and after the U.S. declaration of a national emergency concerning the COVID-19 outbreak

A study published in JAMA examined prevalence in urine drug test results from patients diagnosed with or at risk for substance use disorder. Drug tests were ordered by health care practitioners between November 2019 and July 2020, and the authors compared results before and after the declaration of a national emergency on March 13, 2020.

Compared with the period before COVID-19, the percentage of specimens testing positive during COVID-19 increased from 3.6% to 4.8% for cocaine, from 3.8% to 7.3% for fentanyl, from 1.3% to 2.1% for heroin, and from 5.9% to 8.2% for methamphetamine. This study demonstrated that urine drug test positivity in a population diagnosed with or at risk for substance use disorders increased significantly during COVID-19. Read the full article here.

The opioid epidemic within the COVID-19 pandemic: Drug testing in 2020

A recent study examined changes in clinical drug testing patterns and results at a national clinical laboratory, comparing data obtained before and during the pandemic. Testing for prescription and illegal drugs declined during the pandemic, with weekly test volumes falling by about 70%.

During the pandemic, among those tested, positivity increased by 35% for non-prescribed fentanyl and 44% for heroin. Positivity for non-prescribed fentanyl increased among those testing positive for other drugs. Positivity increased by 89% for specimens positive for amphetamine, 48% for benzodiazepines, 34% for cocaine, and 39% for opiates. These findings suggest possible increases in dangerous drug combinations during COVID-19. Read the full study here.

NDEWS COVID-19 study progress as of 11/20/2020 

NDEWS is conducting ongoing interviews with three key informant groups––funeral directors, emergency responders, and syringe exchange programs––across all 18 sentinel sites to understand the national and regional impact of COVID-19 on drug use, drug-related mortality, and health services. To date, NDEWS has completed 42 baseline interviews with key informants (see table above) across 11 sentinel sites.

Stay tuned: Findings will be rapidly disseminated to the scientific community and public. Read more about the supplement here.


Brorphine: Investigation and quantitation of a new potent synthetic opioid in forensic toxicology casework using liquid chromatography-mass spectrometry

Brorphine, a NPS opioid with effects similar to fentanyl, is the latest synthetic opioid to emerge in the illicit drug market as a possible replacement for the recently scheduled isotonitazene. Researchers with NMS Labs and the Center for Forensic Science Research and Education (CFSRE), including NDEWS Scientific Advisory Group member Dr. Barry Logan, recently published a paper in Journal of Forensic Sciences based on a series of deaths associated with brorphine, the majority of which originated in the Midwestern states. In the 20 confirmed forensic cases, brorphine was commonly found in combination with fentanyl and flualprazolamFor more information, read the full paper here and the press release here. 

NPS Discovery announces new identification of synthetic cannabinoid ADB-BINACA in the U.S.

NPS Discovery recently announced the first identification of the novel synthetic cannabinoid ADB-BINACA from tests performed on a sample of seized material. According to the new drug monograph, ADB-BINACA is structurally similar to MDMB-BINACA. The sample appeared to be a "hand-rolled cigarette containing plant-like material." Synthetic cannabinoids have previously been linked to adverse events, including deaths. While ADB-PINACA and AB-PINACA are Schedule I substances in the U.S., ADB-BINACA and MDMB-BINACA are not explicitly scheduled. Download the monograph here.


Opioids, stimulants, and depressant drugs in fifteen Mexican cities: A wastewater-based epidemiological study

A study recently published in the International Journal of Drug Policy used wastewater-based epidemiology, an approach to screening metabolic residues of illicit drugs in urban wastewater, to monitor temporal and geographical drug patterns in 15 Mexican cities. Investigators collected 105 samples to identify concentrations of cocaine, methamphetamine, amphetamine, MDMA, cannabis, heroin, ketamine, and fentanyl and utilized back-calculation of drug quantities to estimate weekly patterns in substance use. Read the full paper here. 


'We are shipping to the U.S.': Inside China's online synthetic drug networks

NPR recently published an article with the Center for Advanced Defense Studies (C4ADS) on their research into online synthetic drug networks. For many years, fentanyl trafficking into the U.S. was mainly sourced by China until a national law banned the production and sale of the drug and its variations in May 2019. However, online vendors have utilized cultivated shipping practices to bypass China’s strict ban through complex layers of export methods and company entities, as well as selling the precursor ingredients under the guise of basic research chemicals that are not banned in China or the U.S.

While the DEA has reported a significant decrease in Chinese fentanyl imports, these online networks provide a broad and international reach for distributing synthetic opioids. Read the full article from NPR here, and the full report from C4ADS here. 


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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